Adrenal insufficiency heart disease

Introduction to adrenal insufficiency heart disease Adrenal insufficiency is a group of clinical syndromes caused by autoimmune, tuberculosis and tumors that severely damage the adrenal cortex hormones caused by bilateral adrenal glands. Burnout, weakness, hyperpigmentation, weight loss and blood pressure drop are its main clinical manifestations. Some patients may have significant cardiovascular damage, called adrenal insufficiency. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: hypotension, syncope, heart failure

Adrenal insufficiency heart disease

(1) Causes of the disease

Adrenal insufficiency mainly has the following reasons:

1. Adrenal fiber cheese-like tuberculosis.

2. Both sides of the adrenal cortex atrophy associated with autoimmunity.

3. Other rare causes: adrenal metastatic tumors; leukemia infiltration, amyloidosis, hemochromatosis, etc.

(two) pathogenesis

Tuberculous Addison disease is often caused by the spread of tuberculosis in other parts of the body. The adrenal cortex and medulla are involved. The main pathology is tuberculous nodules, fibrous caseous necrosis, lymphocytes and macrophages under light microscope. Endothelial cell infiltration, adrenal calcification is a characteristic change of adrenal tuberculosis, idiopathic Edison disease caused by idiopathic adrenal atrophy, mainly due to autoimmune destruction, manifested as cortical fibrosis, cortical ball, bundle, net The three-band structure disappeared, and there were a large number of lymphocytes, plasma cells infiltrated, and the medulla was not changed. 50% of the patients had anti-adrenal antibodies in their serum. In recent years, the acquired immunodeficiency syndrome (AIDS) can also be Caused by this disease, manifested as necrotizing, adrenal inflammation with cytomegalovirus infection, visceral pathology, anterior pituitary basophils (ACTH secreting cells) proliferation, hyaline degeneration, heart shrinkage, brown atrophy of the myocardium, skin hair growth layer And the dermis and submucosal pigmentation increased.

Glucocorticoids have the effect of maintaining the normal response of blood vessels to circulating vasoconstrictors such as norepinephrine, and affecting the distribution and excretion of body fluids. Mineralocorticoids affect the extracellular fluid volume and electrolyte balance by storing sodium and potassium. Decreased cortisol and aldosterone can cause loss of water and sodium in the body, blood volume and cardiac output are decreased, blood pressure is significantly decreased, pulse pressure difference is reduced, and low blood pressure can reduce coronary blood volume, and myocardial blood supply is relatively insufficient. This can gradually cause the heart to shrink. In addition to hemodynamic changes, sugar and protein metabolism disorders also play an important role in the pathogenesis of heart disease caused by Edison disease. When glucocorticoids are insufficient, the gluconeogenesis ability is weakened. The original synthesis decreased, the myocardial energy reserve decreased, and the myocardial contraction dysfunction. In addition, when Edison was sick, the patient had electrolyte imbalance, which was characterized by high potassium and hyponatremia, although the content of potassium and sodium in the myocardium of the adrenal excised animals. The results of the experimental study are inconsistent, but the effect of electrolyte imbalance on cardiac function and myocardial contraction rhythm is not ignore.

Adrenal insufficiency heart disease prevention

1. The improvement of heart damage in this disease is based on the treatment of Edison's disease itself, so it is necessary to actively treat the primary disease.

2. To educate patients to understand the nature of the disease, to prepare for life-long use of hormone replacement therapy, before the use of glucocorticoid replacement therapy should be based on the patient's height, weight, gender, age and physical labor intensity to determine a suitable The basic amount, usually use this basic amount to supplement the physiological needs, in the case of complications should be appropriate according to the specific circumstances.

3. On the basis of the diagnosis of Edison's disease, we must be alert to the occurrence of heart damage, protect the heart function, and prevent complications.

Adrenal insufficiency heart disease complications Complications, hypotension, syncope, heart failure

There may be complications such as hypotension, syncope, and heart failure.

Adrenal insufficiency heart disease symptoms common symptoms traumatic heart weight increase nausea salt corticosteroid secretion too little weakness heart failure tired appetite hypotension hypertension low blood pressure

1. Systemic manifestations: due to insufficient secretion of aldosterone and/or cortisol, sodium is lost, resulting in extracellular fluid and effective blood volume reduction, decreased cardiac output, poor perfusion of surrounding tissues, loss of appetite, nausea, vomiting and energy intake Reduced, glucose metabolism disorders, fat mobilization and utilization are weakened, the body's ability to external stress is weakened, etc., resulting in significant fatigue and weakness. About 2/3 of the patients complained of fatigue, and there are still weight loss, abdominal pain, diarrhea, bloating, constipation. , lack of spirit, lack of cortisol, feedback inhibition of pituitary ACTH, black cell stimulating hormone (MSH), lipoprotein (LPH) (all from a common precursor POMC) Decreased, the secretion of hormones in this group increased, skin, mucous membrane pigmentation, facial, limb exposed parts, joint flexion, wrinkles and other common friction parts and gums, tongue, oral mucosa is more obvious, pigmentation is Edison's disease characteristics Sexual performance, the earliest, has diagnostic value.

2. Cardiovascular manifestations: lack of corticosteroids leads to lack of sodium, loss of water, decreased blood output, reduced sensitivity of vascular smooth muscle to catecholamines, prone to hypotension and cardiac shrinkage, weakened myocardial contractility, mild labor can cause Obvious breathing difficulties, chest tightness, palpitations, but rarely typical symptoms of heart failure, significant hypotension is a prominent feature of the disease, is an important basis for diagnosis, the average blood pressure is 8.0kPa (60mmHg), systolic blood pressure is very small More than 14.7kPa (110mmHg), diastolic blood pressure is often lower than 9.3kPa (70mmHg), the original high blood pressure, blood pressure can be reduced to normal, when the patient changes position or wake up in the morning, prone to upright hypotension, conscious dizziness , palpitations, blurred vision, and even syncope, under concurrent stress, surgery, trauma and other stress conditions, patients with extreme weakness, increased gastrointestinal symptoms, further decline in blood pressure caused by peripheral circulatory failure, shock (or adrenal crisis), can be endangered life.

Examination of adrenal insufficiency heart disease

1. Blood biochemistry: low sodium, low chloride blood, hyperkalemia and nitrogen retention, fasting blood glucose is lower than normal, glucose tolerance is a low flat curve.

2. Adrenal cortical function test: 24h urinary 17-OHCS, 17-KS discharge was significantly reduced, 24h urinary free cortisol was lower than normal, plasma cortisol was lower than normal level, circadian rhythm changes could disappear, ACTH stimulation test not only The adrenal cortex reserve function can be detected, and the primary and secondary cases can be identified.

3. Serological examination: plasma cortisol is decreased in patients with primary adrenal insufficiency, plasma ACTH is significantly increased, plasma cortisol is decreased in patients with secondary adrenal insufficiency, and plasma ACTH is also decreased.

4. Electrocardiogram: visible low-voltage bradycardia, PR interval, QT interval prolonged, T wave low or inverted, a few of the visible hyperkalemia ECG changes to T wave high tip, symmetrical, such as tent-like.

5. Chest X-ray: The shape of the heart is reduced, tuberculosis may be found in the lungs, and bilateral adrenal calcification is 10%.

Diagnosis and diagnosis of adrenal insufficiency heart disease

diagnosis

For those who have fatigue, loss of appetite, weight loss, blood pressure, skin pigmentation, deeper adrenal insufficiency should be considered. The main laboratory diagnosis basis for this disease is:

1. Basal blood, urinary cortisol, and urine 17-hydroxycorticosteroids are low.

2. ACTH stimulation test: the most diagnostic value for detecting adrenal cortical reserve function, and can identify primary and secondary adrenal insufficiency. The commonly used method is intravenous infusion of ACTH 25mg for 8h, observing urine 17-hydroxyl Corticosteroid changes, normal people on the first day of stimulation increased 1 to 2 times compared with the control day, 1.5 to 2.5 times on the second day, the patient's urine 17-hydroxycorticosteroids did not change significantly.

3. Plasma-based ACTH measurement: patients with primary adrenal insufficiency significantly increased, more than 250pg / ml, often between 400 ~ 2000pg / ml (normal people less than 80pg / ml), and secondary adrenal function In patients with hypoxemia, ACTH concentrations are also reduced in the case of a decrease in plasma cortisol.

Differential diagnosis

Cardiac changes due to other causes should be excluded from the diagnosis and differentiated from orthostatic hypotension, drugs or idiopathic hypotension, chronic constrictive pericardial lesions, and other chronic wasting diseases.

1. Chronic liver disease: patients often have systemic pigmentation, accompanied by fatigue, nausea, vomiting, abdominal distension, diarrhea and other digestive symptoms, similar to chronic adrenal insufficiency, but liver function abnormalities in patients with liver disease, abdominal B-ultrasound can be The size and shape of the liver and spleen, in addition, the portal vein can be seen in the portal vein, and the spleen vein is widened, which is helpful for identification.

2. Malignant tumors: patients with malignant tumors may also have 17-hydroxyl and 17-ketones in urine, but the ACTH stimulation test shows blood, urinary corticosteroids increase significantly, combined with the consumption characteristics of malignant tumors and related biochemical and pathological evidence, it is easy to identify .

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