What Is Adrenal Exhaustion?

Refers to a series of clinical symptoms caused by insufficient or absent adrenocortical hormone secretion for various reasons, which can affect multiple systems. The main symptoms are adrenocortical hormone deficiency symptoms, such as dehydration, decreased blood pressure, orthostatic hypotension, prolapse, anorexia, vomiting, depression, lethargy and even coma. Patients are sometimes misdiagnosed as acute abdomen and undergo surgical treatment or delay diagnosis, eventually progressing to a total coma, or even death.

Basic Information

English name

adrenal crisis

Visiting department

Endocrinology

Common symptoms

Dehydration, decreased blood pressure, orthostatic hypotension, prostration, anorexia, vomiting, loss of energy, lethargy and even coma

Contagious

no

Causes of adrenal crisis

Chronic adrenal insufficiency (Addison disease), due to infection, trauma and surgery and other stress conditions, or stop taking hormones and induce acute hypoadrenal hypofunction. Large amount of adrenocortical hormone therapy for a long time. After adrenal surgery, due to adrenal hyperplasia that depends on the hypothalamic pituitary or extra-adrenal diseases (such as metastatic breast cancer), adrenalectomy is performed; or after adrenal adenoma removal, the remaining adrenal glands often shrink and the hypothalamus-pituitary- The function of the adrenal axis is inhibited due to the long-term secretion of a large amount of cortisol by the adenoma. The recovery of its function takes at least 9 months or more than 1 year. If the hormone is not supplemented or the hormone dose is not increased correspondingly under stress, Can cause acute adrenal insufficiency. Acute adrenal hemorrhage, severe sepsis is common, mainly meningococcal sepsis, which causes adrenal hemorrhage, which is related to diffuse intravascular coagulation. Adrenal hemorrhage may be complicated by sepsis and epidemic hemorrhagic fever caused by other bacteria. For patients with reduced adrenal cortical reserve function or congenital adrenal hyperplasia, use some drugs and foods that inhibit steroid hormone synthesis or promote its metabolism and clearance, such as rifampicin, mifepristone, sedatives, mitotan, ketoconone Azole, thyroxine, licorice, grapefruit juice, etc.

Adrenal crisis clinical manifestations

The clinical manifestations of adrenal crisis include symptoms caused by adrenocortical hormone deficiency, as well as the manifestations of diseases that trigger or cause acute adrenal insufficiency. Adrenocortical hormone deficiency is mostly mixed, that is, both glucocorticoid and natriuretic hormone deficiency.

Fever

More common, there can be high fever above 40 , sometimes the body temperature can be lower than normal.

2. Digestive system

Anorexia, nausea, and vomiting are often early symptoms. If they can be identified and treated in time, they often improve quickly. May also have abdominal pain, diarrhea and other symptoms.

3. Nervous system

Weakness, malaise, lack of desire, apathy, lethargy, and extreme weakness can also manifest as irritability, delirium, confusion, and even coma.

4. Circulatory system

The heart rate is fast, up to 160 beats / minute, the limbs are cold, the circulation collapses, the blood pressure drops, and it falls into shock.

5. Dehydration signs

Often exists to varying degrees.

6. Other

When secondary adrenal insufficiency occurs, the patient's renin-angiotensin-aldosterone system is relatively normal, low blood volume is rare, and usually it will rarely cause a crisis. Hypoglycemic coma is more common and may be accompanied by hyponatremia. Patients are often accompanied by other symptoms of anterior pituitary hormone deficiency. If the crisis is caused by pituitary stroke caused by pituitary tumors, patients may have severe headaches, visual field defects, and sharp decline in vision. Under the stress of infection, surgery and trauma, they may have hypotension and shock.

Adrenal crisis

Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

The possibility of adrenal crisis diagnosis should be considered in the following situations: (1) dehydration, hypotension, and shock that are difficult to explain with the current disease; (2) acute abdomen on the basis of fatigue, anorexia, and weight loss; (3) unexplained low Blood glucose, which may be the only abnormal manifestation of secondary adrenal failure; (4) unexplained high fever and hypothermia; (5) hyponatremia, hyperkalemia, and other biochemical abnormalities including azotemia , Hyperphosphatemia, hypochloremia, hypercalcemia and hypoproteinemia. Laboratory tests are mainly low plasma cortisol levels. In primary adrenal crisis, ACTH increases, renin-aldosterone levels decrease, and secondary ACTH decreases, and aldosterone secretion is normal; (6) ACTH stimulation test is the most diagnostic test to detect adrenal glands Responsiveness to exogenous ACTH.

Adrenal crisis treatment

When clinically suspected adrenal cortical crisis, blood samples should be collected for cortisol and ACTH treatment immediately. The fundamental goal of treatment is to maintain adequate glucocorticoids in the circulation and inadequate sodium and water supplementation. Treatment includes intravenous infusion of large doses of glucocorticoids, correction of hypovolemia and electrolyte disturbances, removal of incentives and systemic supportive care.

1. Intravenous infusion of 5% glucose salt solution, and intravenous bolus of hydrocortisone, followed by continuous infusion at a rate of 10 mg per hour; another method of administration is intravenous hydrocortisone, The first 24-hour total was 300-400 mg, and most patients were under control within 24 hours. As the crisis situation improves, the dose of hydrocortisone can be gradually reduced. If the patient is stable, he can eat, but can be taken orally instead. Those with stable disease gradually reduced to the maintenance amount after 4-7 days.

2. More than 50 mg of hydrocortisone per day can have a mineralocorticoid effect equivalent to 0.1 mg of hydrocortisone. Therefore, supplementation of mineralocorticoids in the acute phase is redundant, but with the improvement of the condition, the dose of glucocorticoids is gradually reduced to a maintenance amount, and mineralocorticoid treatment can be started as needed, and oral cortisol is required.

3. For patients with hypotension and hyponatremia, a large amount of isotonic fluid or 5% dextran should be added intravenously under continuous ECG monitoring. In the first 24 hours, 2000 ~ 3000ml glucose saline can be added. Dopamine and other drugs that constrict blood vessels can be used in severe cases , To assist in capacity expansion. At the same time, electrolytes need to be adjusted to prevent and correct hypoglycemia.

4. Adrenal crisis patients often have incentives such as infection and scoring, and those who have not eliminated the cause are difficult to control. During the course of the disease, they should actively control the infection and other incentives, while giving systemic supportive treatment to pass the critical stage.