Addisonic crisis

Addisonic crisis develops more often gradually, less often – sharply (within a few hours). With the gradual development of an addisonic crisis, the symptoms of the disease increase over several days or even weeks. Gradually, general weakness increases, appetite decreases, pigmentation increases, rapid weight loss is noted, abdominal pain often occurs, and when simulating acute diseases of abdominal viscera. Nausea appears, often the smell of acetone from the mouth, uncontrollable vomiting, diarrhea, which increase dehydration.

The latter is expressed by a decrease in skin turgor and intraocular pressure> a sharp drop in blood pressure, blood clotting, etc. The phenomena of acute cardiovascular insufficiency are increasing. In the absence of infection, body temperature is lowered. Often there are clonic convictions and meningeal syndrome, sometimes blackout.

In the blood, hyperhemoglobinemia, leukocytosis, increased ESR, severe hyponatremia are detected. hypochloremia and hyperkalemia, often hypegzhetonemia, often pronounced hypoglycemia, increased levels of residual nitrogen and urea, caused by a sharp drop in glomerular filtration due to dehydration and collapse. Levels of aldosterone cortisol and 17-ocs! reduced in blood. Acetone often appears in the urine, proteinuria, leuco! Shturiya, microhematuria, cylindruria (new and granular hilarians) appear. The urinary excretion of 17-KS and 17-OX decreases sharply. Without timely treatment, the patient loses consciousness, there comes a coma (hypochloremic) and death.

Laboratory data. In the blood marked lymphocytosis, eosinophilia. In a number of cases, there is a secondary reason for the presence of an active tuberculous process increased. Often (with severe disease) there are hyponatremia, hypochloremia, hypercaemia. The content of ACTH in the blood is increased, and cortisol, fasting blood sugar is reduced. Excretion of 17-ACS with urine is reduced. Indicators of the glucose tolerance test after glucose loading are flat, with a pronounced hypoglycemic phase by the 3rd hour after exercise, hypoalbuminemia, hyperglobulinemia, and tendency to hypocholesterolemia are often noted. In case of idiopathic addison disease, an indirect immunofluorescent method reveals an increase in the antibody titer to the adrenal tissue. Excretion of urine with potassium is reduced, sodium and chloride – increased. Aldosterone, 17-cc and 17-oks in urine is reduced. With severe f disease, there is a decrease in basal metabolism.

Diagnostic tests. To diagnose the erased F ° rm of Addison’s disease, a test is carried out with AKTG (synacthene) and a water sample of Robinson – Power – Kepler (in the absence of edematous syndrome). The test with ACTH is carried out as follows: 25 IU of ACTH in isotonic sodium chloride solution are administered intravenously for 8 hours or 0.25 mg of the synthetic drug ACTH – synacthen. The level of 17-ACS in the blood determines before and 30 and 60 minutes after drug administration. In healthy people and patients with hypopituitarism after intravenous administration of ACTH, the content of 17-ACS in the blood and urine rises, and in patients with chronic insufficiency of the adrenal cortex remains reduced.

local_offerevent_note February 15, 2019

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