Acute insufficiency of the adrenal cortex

Acute insufficiency of the adrenal cortex is a catastrophic condition that threatens the life of the patient and develops As a result of the rapid or sudden sharp decline in the functional reserves of the adrenal cortex during stress.
The disease can develop at any age with the same frequency in both males and females. The syndrome of Oaterhaus — Friedereichsen develops predominantly in the newly born and parturient women.

Historical data. A detailed description of the disease caused by bilateral hemorrhage into the adrenal cortex was given by Waterhouse in 1911 and Friederichsen in 1918.

Etiology. The causes of acute malnutrition crust nadpochech nicknames can be primary and secondary chronic insufficiency nadpochech- nicknames, birth trauma, meningococcal sep ICU, causing extensive bleeding in the adrenal cortex, bilateral adrenalectomy, removing glyukosteromy against the background of other adrenal atrophy, stress conditions (infection, surgery and etc.) against the background of hypo- and hyperplastic processes in the thymus or long-term treatment with glucocorticoids, congenital aplasia or dysfunction to ry adrenal, acute necrosis of the adrenal glands. Sometimes acute insufficiency of the adrenal cortex can occur with the thrombosis of the adrenal vessels, exposure to toxic agents.
(alcohol, chloroform, etc.), conducting anticoagulant therapy, in particular in patients with myocardial infarction. Acute insufficiency of the adrenal cortex can also occur with large traumatic operations, when the compensatory abilities of the organism are at the limit. The cause of acute insufficiency of the adrenal cortex in cancer patients may be metastases in the adrenal glands.

Pathogenesis. The basis of the pathogenesis is a sharp shortage of corticosteroid hormones (gluco- and mineralocorticoids).

Pathological anatomy. An autopsy for Waterhauz — Friedereichsen syndrome in the cortex of both adrenal glands reveals extensive hemorrhages and hemorrhagic necrosis. In case of acute insufficiency of the adrenal cortex caused by other causes, hypoplasia, atrophy, caseous tuberculosis, adrenal venous thrombosis, and sometimes syphilitic gummas or cancer metastases are noted. Histological examination revealed the main pathological changes in the sheaf and reticular zones of the adrenal cortex.
Classification. Acute insufficiency of the adrenal cortex may be primary, due to the primary lesion of the adrenal glands, and secondary – hypothalamic-pituitary genesis.

Clinic. Symptoms of acute insufficiency of the adrenal cortex due to their apoplexy (Waterhouse syndrome — Friederich hay) are the same as in the addisonic crisis, but unlike the latter, they usually develop in a few hours and, less often, in 1-2 days.

Waterhausen-Friederichsen syndrome has a number of special features.

The disease occurs suddenly and is lightning fast. Death often occurs in the first day.
Patients have headache, shortness of breath, severe abdominal pain, vomiting, diarrhea, severe nervous excitement, convulsions, chills, high fever, cyanosis, extensive petechial drainage skin hemorrhages. A severe collapse with a sharp drop in blood pressure develops. Death occurs with the phenomena of collapse, pulmonary edema and dehydration.

The following variants of acute adrenal insufficiency are distinguished:

1) cardiovascular (collapse prevails with hypotension down to zero digits);

2) gastrointestinal (nausea, vomiting, anorexia, diarrhea, abdominal pain, simulating acute diseases of the abdominal cavity);

3) neuropsychiatric (irritability, delusions with visual hallucinations or asthenia, adynamia, depression). Acute adrenal insufficiency as a result of hemorrhage into the adrenal glands during treatment with anticoagulants is most often manifested by abdominal pains with the rapid development of collapse.

The characteristic symptoms of acute adrenal insufficiency during surgery are a sharp and rapid vascular collapse and signs of respiratory depression. If it is difficult to diagnose acute adrenal insufficiency, the definition in plasma of cortisol or fluorogenic corticosteroids is used. The level of cortisol in the blood is reduced. Fluorogenic corticosteroids are determined before and 30 and 60 minutes after a single intramuscular or intravenous injection of 0.25 mg of ACTH. An increase in corticosteroid levels of no less than 2 times in plasma indicates a normal function of the adrenal cortex.

Diagnosis and differential diagnosis. The diagnosis of acute insufficiency of the adrenal cortex is established on the basis of anamnesis and characteristic clinical symptoms (severe weakness, nausea, vomiting, anorexia, fever, decreased blood pressure, dehydration, acute cardiovascular insufficiency, abdominal disorders, etc.). ) and datav

laboratory investigations (severe hyponatremia, hypochloremia and hyperkalemia, severe hypoglycemia, a sharp decrease in urine excretion of 17-CU and 17-ACS, etc.). The basis for the diagnosis of Waterhouse – Friedeichsen syndrome is sudden onset, a septic condition (meningococcal sepsis), shortness of breath, cyanosis, high fever, severe collapse and hypotension, petechial skin hemorrhages in combination with other signs characteristic of acute insufficiency of the cortex above the kidney. Acute adrenal insufficiency in a number of cases is differentiated from food intoxication, acute diseases of the gastrointestinal tract, myocardial infarction, stroke.

In the pseudoperitoneal form of acute insufficiency of the adrenal cortex, unlike acute diseases of the abdominal organs, there are usually no symptoms of peritoneal irritation, there is a severe collapse, eosinophilia without neutrophilic leukocytosis, severe hypoglycemia.

Acute insufficiency of the adrenal cortex, in contrast to 0t myocardial infarction or stroke, is indicated, along with characteristic clinical and laboratory data, the lack of anamnesis of circulatory diseases, etc.
Forecast. With early diagnosis and timely treatment, the prognosis is usually favorable. Without treatment in the syndrome of Waters, House – Friderihsen death occurs within 1-2 days.

Prevention. The prevention of acute insufficiency of the adrenal cortex consists in the early diagnosis of this condition, as well as in the active detection and regular follow-up of patients suffering from Addison’s disease and long-term receiving corticosteroids for various chronic diseases.

It is necessary to timely use of corticosteroid drugs during stressful situations (surgery, infection, etc.) in patients with suspected hypofunction of the adrenal cortex, as well as increasing the dose of corticosteroid drugs 2 times compared with the maintenance dose during stress in patients with Addison’s disease and after bilateral adrenal ectomy.

Treatment. Acute insufficiency of the adrenal cortex is treated in the same way as an addisonic crisis. The treatment is carried out immediately in the hospital. To fight the infection, large doses of antibiotics are prescribed in combination with sulfa drugs.

local_offerevent_note January 22, 2019

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