Adrenal crisis

Introduction Refers to a series of clinical symptoms caused by insufficient or absent secretion of adrenocortical hormone by various reasons, which can affect multiple systems. Mainly manifested by symptoms caused by adrenocortical hormone deficiency, such as dehydration, decreased blood pressure, orthostatic hypotension, collapse, anorexia, vomiting, lack of energy, lethargy and even coma. Clinical manifestations of adrenal crisis include symptoms caused by adrenocortical hormone deficiency, as well as disease manifestations that cause or cause acute adrenal insufficiency. Adrenal cortical hormone deficiency is mostly mixed, that is, both glucocorticoids and sodium strontium hormones are lacking.

Cause

(a) chronic adrenal insufficiency (Addison disease)

Acute reduction of adrenal function is induced by stress, infection, trauma, and surgery, or by stopping hormones.

(B) long-term massive adrenocortical hormone therapy

Inhibition of the hypothalamic-pituitary-adrenal axis function, even after one year of withdrawal, its function is still in a low state, especially the response to stress is poor.

(three) after adrenal surgery

Adrenalectomy due to adrenal hyperplasia or extra-adrenal gland hyperplasia (such as metastatic breast cancer) depending on the hypothalamic pituitary; or adrenal gland atrophy after adrenal adenoma removal, hypothalamic-pituitary-adrenal axis function, Because adenoma is secreted by long-term secretion of a large amount of cortisol, its function recovery requires at least 9 months or more. If the hormone is not supplemented or does not increase the hormone dose under stress, it can also cause acute adrenal cortex. Function is reduced.

(D) acute adrenal hemorrhage

Common is severe sepsis, mainly meningococcal sepsis, causing adrenal hemorrhage, and is associated with disseminated intravascular coagulation. Other bacteria-induced sepsis, epidemic hemorrhagic fever, etc. may also be complicated by adrenal hemorrhage.

(5) Congenital adrenal hyperplasia

There are nine enzyme defects known to date, including 21 hydroxylase, 11 hydroxylase, 17 hydroxylase, 18 hydroxylase, 18 oxidase, 5-3 hydroxysteroid dehydrogenase, 22 carbon chain enzyme, 17 Hydroxysteroid dehydrogenase and 17,20 lyase. Most enzymes are required for cortisol synthesis. Defects such as 5-3 hydroxysteroid dehydrogenase, 22 carbon chain enzyme, 18 hydroxylase and 18 oxidase can also affect the synthesis of sputum hormones.

an examination

Related inspection

Adrenal MRI examination of adrenal CT

The total number of white blood cells is increased, caused by blood concentration and infection. Neutral multinucleated cells. Increased hemoglobin and blood concentration. Hyperkalemia, hyponatremia, hypoglycemia, mild increase in blood urea nitrogen, mild acidosis and a decrease in total blood cortisol.

Differential diagnosis

Need to be identified with the following symptoms:

Adrenal intoxication: Adrenalin and noradrenalin are commonly used first aid drugs, and excessive amounts can cause poisoning. A small number of patients are highly sensitive to adrenaline, although adverse effects can also occur with therapeutic doses. Children with pre-excessive hyperthyroidism and cardiovascular disease are also sensitive to adrenaline and are prone to poisoning.

Adrenal metastasis: Adrenal metastasis is common in adrenal metastases. Adrenal metastasis is the fourth most common site for tumor metastatic tumors, mostly from lung cancer, breast cancer, stomach cancer, liver cancer and pancreatic cancer. Therefore, in patients with the above primary malignant tumors, adrenal masses are also found, and adrenal metastases should be considered first.

Adrenal cortical hormone deficiency: Adrenal cortical hormone deficiency is one of the clinical manifestations of primary chronic adrenal insufficiency. Due to severe destruction of the adrenal gland, the secretion of corticosteroids including cortisol and aldosterone is affected, the former is more serious, can cause systemic dysfunction of the system.

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