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Treatment of adrenalovy crisis

Adrenalovy, or addisonicheskiya, crisis is an extreme complication of an illness of Addison. The state develops against the hardest defeat and dysfunction of bark of adrenal glands. Usually doctors find it difficult to answer, whether the person from consequences of this illness will be able to recover.

Clinical picture of an illness of Addison

Fully to understand as well as why there is an adrenalovy crisis, it is necessary to know with what everything begins. The so-called bronze illness becomes the prime cause of adrenalovy crisis – quite so still call a condition of chronic insufficiency of bark of adrenal glands.

Addison's illness affects both adrenal glands that leads to a partial or full stop of development of hormones these vitals. Speak about a disease when more than 85 - 87% of fabric of bark of adrenal glands suffered.

Autoimmune failure in an organism when own immune system takes up arms against an organism is the most common cause of development of an illness of Addison. The second actual factor which causes a bronze illness, call tuberculosis of adrenal glands. Among other "responsible" for this disease experts note:

  • operation on removal of adrenal glands;
  • dysfunction of adrenal glands after long treatment by hormonal preparations;
  • the diseases caused by microorganisms mushrooms, for example, histoplasmosis;
  • formation of a tumor in adrenal glands;
  • system benign illness – sarkoidoz kidneys;
  • hemorrhage in bark of adrenal glands;
  • syphilis;
  • AIDS.

The first sign of development of an illness of Addison is increase in blood of concentration of hormones – adrenokortikotropny and alpha melanotsitostimuliruyushchego. It affects at once appearance of skin and mucous membranes of the patient – they darken (because of this symptom an illness call bronze).

There is also a secondary form of an illness of Addison which does not cause darkening of integuments, and is caused by small activity of a hypophysis of a brain.

Symptoms of a disease have some extent in time. So, change of skin color and mucous can outstrip manifestation of other symptoms of a bronze illness for months, and even years. Sometimes on epidermis there are marks of vitiligo which results from autoimmune destruction of melanotsit. These cages are responsible for a natural color of skin.

Eventually in process of development of an illness of Addison in the person there are also other its symptoms. Let's list the main:

  • muscular dystrophy, sharp loss of weight against lack of appetite, increased fatigue;
  • lowering of arterial pressure and, as a result, dizziness and high sensitivity to low ambient temperature;
  • gastrointestinal tract dysfunction in the form of nausea, vomiting and an incidental diarrhea;
  • rather often frustration of mentality – psychoses and psikhopatiya meet;
  • irresistible need for salty food. General sharpening of perception of all sense organs;
  • adrenalovy crises which recognize as the heaviest exacerbation of a bronze illness.

Reasons of adrenalovy crisis

Latent factors which, undoubtedly, influence development of this life-threatening state, systematic emotional and physical stresses are. Quickly to react to an emotional overstrain and, respectively, to correct (to raise a dose of replaceable hormones), it is very heavy therefore most often the weakened organism does not cope with such overloads.

As the main indisputable reason of adrenalovy crisis it is possible to consider sudden and prompt reduction in blood of concentration of hormones which are developed by bark of adrenal glands, and also a sharp exit from a working condition of the bark. Most often there is it under following conditions:

  • outpouring of blood in bark of both adrenal glands;
  • the person having Addison's illness stops accepting the replacing hormonal preparations;
  • big loss of blood;
  • complication of a burn disease;
  • sepsis which becomes the reason of dying off of bark of adrenal glands;
  • surgical intervention in bark of adrenal glands or their trauma;
  • removal of adrenal glands and lack of full replaceable support of an organism against this loss;
  • diseases as a result of which nadpochechnikovy arteries and veins suffer (for example, an embolism or thrombosis);
  • sharply proceeding infectious diseases.

Each of the listed above reasons, as well as set of some of them, can become the reason of sharp deficiency in an organism of hormones, responsibility for which production lies on bark of adrenal glands. The state involves unfavourable and hard reversible consequences. So, there is dehydration (dehydration) of an organism, together with liquid from fabrics of bodies and systems potassium disappears, activity and endurance of all muscular system of an organism decreases, thus the cardiac muscle especially suffers. As a result of violation of a carbohydrate exchange the renal failure develops. It leads to that the patient can immediately fell into a coma.

As adrenalovy crisis is shown

The state can develop within several days or several hours that depends on severity of an illness of Addison and a factor because of which there were suitable conditions for complication development. Clinical picture following:

  1. Sharp lowering of arterial pressure is noted.
  2. There is a cardiac arrhythmia.
  3. The patient feels that heart works "not as usually".
  4. Excessive sweating begins.
  5. In a stomach there are well notable sharp pains.
  6. There is a nausea, vomiting and a diarrhea open.
  7. The patient has very cold brushes and feet, thus he is tormented by a fever.
  8. The daily dose of urine is sharply reduced.
  9. Extreme weakness: the patient is not held by feet.
  10. There is a dizziness and violation of consciousness (a hallucination, speech violations, loss of consciousness).
  11. Coma. notes that the family of the person who has Addison's illness, have to be acquainted with the list of symptoms of this dangerous complication. In the presence of at least some of them, the victim it is necessary to hospitalize and correct urgently his state in the conditions of reanimation.

As diagnose adrenalovy crisis

Ascertaining of an extreme form of an illness of Addison assumes urgent carrying out blood test which as a result of research will show the accelerated SOE, aggressive leykotsitoz and sharp increase in number of red blood little bodies. Level of glucose will be lower than norm. Level of electrolytes (potassium, chlorine, sodium) falls, and at urine there are a protein, blood and acetone.

Hormonal blood test of the patient indicates decrease in concentration of corticosteroids which are developed by bark of adrenal glands. By means of an electrocardiogram diagnose violation of conductivity of a cardiac muscle.

Treatment of adrenalinic crisis

The patient is given help in conditions of office of intensive therapy. The condition of the patient is corrected first of all by means of corticosteroids, all dosages are selected only individually. The accompanying methods of treatment are antishock therapy, drop introduction of solution of glucose and solutions of electrolytes.

Except this program of treatment it is possible to allocate also other actions which indirectly promote improvement of health of the patient who is in a condition of adrenalovy crisis:

  1. Stabilization of arterial pressure and body temperature. By results of correction of pressure judge stabilization of a condition of the patient. Improvement, as a rule, comes in 4–6 hours after intensive treatment.
  2. Prevention and adequate treatment of diseases of an infectious origin.
  3. Timely and competent correction of doses of hormonal replacement therapy if the surgery is necessary to the patient.
  4. Intravenous administration of solution of sodium of chloride of 0,9% and hydrocortisone with the purpose to eliminate organism dehydration.

The forecast after the postponed adrenalovy crisis it is impossible to call good - rather, satisfactory.

After the postponed complication and in living conditions with Addison's illness bark of adrenal glands it is irreversible it is damaged because of what the person will need to be on the supporting hormonal and replaceable treatment. Competent experts appoint a therapy course so that most fully to compensate those functions which cannot carry out the patient's adrenal glands any more. The person for life remains on the account at the doctor of the endocrinologist who will watch his current state and in case of need to correct doses of hormonal preparations.

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