Crisis adrenal

　　1La insuficiencia adrenal cortical crónica (enfermedad de Addison) se desencadena debido a situaciones de estrés como infecciones, traumas y cirugías, o por la interrupción del tratamiento hormonal, lo que provoca una disminución aguda de la función de la corteza suprarrenal.

　　2, long-term and large amounts of adrenal cortical hormone treatment suppress the hypothalamus-Pituitary-Adrenal axis function1years, its function is still low, especially poor responsiveness to stress. Oyama studied the function of the adrenal axis treated with steroids for a long time, even if the drug is stopped14Cases before and after anesthesia induction30min and after surgery1h measured blood cortisol levels, respectively107±18μg/L (10。7±1。8μg/dl),108±15μg/L (10。8±1。5μg/dl) and148±25μg/L (14。8±2。5μg/dl). While the control group10Cases in this3The blood cortisol levels at different times were108±14μg/L (10。8±1。4μg/dl),175±16μg/L (17。5±1。6μg/dl) and263±18μg/L (26。3±1。8μg/dl). Therefore, patients receiving long-term corticosteroid therapy will also develop acute adrenal cortical insufficiency if they do not supplement or increase the dose of hormones in time when exposed to stress.

　　3, adrenal resection is performed due to adrenal cortical hyperplasia dependent on the hypothalamus and pituitary or adrenal diseases outside the adrenal glands (such as metastatic breast cancer) after adrenal surgery; or after resection of adrenal adenoma, the remaining adrenal glands often atrophy, the hypothalamus-Pituitary-The function of the adrenal axis, due to the long-term secretion of large amounts of cortisol by the adenoma, is suppressed. The recovery of its function requires at least9months or1years, if hormones are not supplemented or the dose of hormones is not increased correspondingly under stress conditions, it can also cause acute adrenal cortical insufficiency.

　　4, common acute adrenal hemorrhage is severe sepsis, mainly meningococcal sepsis, causing adrenal hemorrhage, related to disseminated intravascular coagulation. Sepsis caused by other bacteria, epidemic hemorrhagic fever, etc. can also lead to adrenal hemorrhage.

　　5, congenital adrenal cortical hyperplasia to date is known to have defects in nine enzymes, with21hydroxylase,11β-hydroxylase,17α-hydroxylase,18hydroxylase,18oxidase, Δ5-3β-hydroxysteroid dehydrogenase,22carbon chain enzyme,17β-hydroxysteroid dehydrogenase and17,20 cleavage enzyme. Most enzymes are essential for cortisol synthesis. Among them, Δ5-3β-hydroxysteroid dehydrogenase,22Carbon chain enzyme with18Hydroxylase and18Defects in oxidases can also affect the synthesis of mineralocorticoids.

　　Adrenal crisis should be treated immediately once it occurs to avoid life-threatening multiple organ dysfunction. Patients with adrenal crisis have metabolic disorders in the body, including glucose metabolism disorders, leading to increased lactic acid production. When it exceeds the compensatory capacity of the liver, it can directly cause severe metabolic acidosis. At the same time, brain edema can occur due to metabolic disorders in brain tissue, even triggering cerebral hernia. Therefore, for patients with consciousness disorders, the occurrence of this disease should be vigilant.

　　The clinical manifestations of adrenal crisis include symptoms caused by adrenal cortical hormone deficiency, as well as diseases that trigger or cause acute adrenal cortical insufficiency. Adrenal cortical hormone deficiency is mostly mixed, that is, both glucocorticoids and mineralocorticoids are deficient.

　　1Fever is common, and the fever can reach4Above 0°C, the body temperature may sometimes be lower than normal.

　　2Gastrointestinal symptoms such as anorexia, nausea, vomiting, etc. are often early symptoms. If identified and treated in time, they often improve quickly, and symptoms such as abdominal pain and diarrhea may also occur.

　　3Neurological weakness, fatigue, lack of desire, apathy, drowsiness, extreme weakness, can also manifest as irritability, delirium, confusion of consciousness, and even coma.

　　4、Circulatory system heart rate rapid, can reach160 times/min, the extremities were cold, circulatory collapse, blood pressure dropped, into shock, due to the fact that this disease has a lack of both glucose皮质激素 and sodium-retaining hormones, it is easier and faster to appear peripheral circulatory failure than Sheehan crisis, most patients with changes in consciousness and blood pressure drop at the same time; a few patients have changes in consciousness before, followed by blood pressure drop, we observed that changes in consciousness and blood pressure occurred earliest after the cause occurred4h,1/3and2/3patients were in24,48h.

　　5、Dehydration signs are present to varying degrees.

　　Patients with chronic adrenal cortical insufficiency should be educated to persist in taking hormones and not to interrupt arbitrarily. When encountering stressful situations, it is necessary to increase the dose under the guidance of a physician. In case of minor stress such as upper respiratory tract infection, tooth extraction, etc., increase the hormone dose to twice the amount until the disease is cured, usually4～5days to see control. In case of major stress, such as surgery, myocardial infarction, severe trauma, and infection, hydrocortisone should be given up to200～300mg/d. Hormone dosage should be increased several hours before surgery. When the patient goes out for treatment, it is necessary to carry an adequate amount of hormones for use.

　　Total white blood cell count increased, blood concentration and infection caused, neutrophils increased, hemoglobin increased, blood concentration. Hyperkalemia, hyponatremia, hypoglycemia, mild increase in blood urea nitrogen, mild acidosis, and a decrease in the total amount of blood cortisol. Once an adrenal crisis occurs, treatment should be immediate to avoid organ dysfunction threatening life.

　　1、Adrenal crisis what kind of food is good for the body

　　Eat more vegetables and soy products, eat low-salt, high-vitamin, light and fresh foods.

　　2、Adrenal crisis is best not to eat what kind of food

　　Fish, shrimp, seafood, rooster, carp, and beef.

　　（The above information is for reference only, please consult a doctor for details）

　　1、Supplement sugar皮质激素：If there is loss of consciousness and shock, hydrocortisone sodium succinate ester should be injected immediately100mg dissolved in a small amount of fluid by intravenous injection, this is a water-soluble preparation, with rapid absorption, able to enter the body quickly, and produce immediate and transient improvement in circulatory failure. Subsequently, hydrocortisone (this preparation has low solubility in water, soluble in50％ethanol solution100mg/20ml, when used, it is necessary to use isotonic saline or5％glucose500ml dilution）100～400mg dissolved in500～2000ml of fluid for intravenous infusion.

　　2、Supplement salt皮质激素：After using hydrocortisone sodium succinate ester or hydrocortisone, systolic blood pressure cannot return to13。3），or if there is hyponatremia, it can be simultaneously injected intramuscularly with醋酸去氧皮质酮（DOCA）10kPa（1～3mg, daily1～2Also, it can be changed to oral administration when the condition improves and food can be taken9α-fluorohydrocortisone 0.05～0.2mg/mg

　　3d. Los pacientes con deficiencia grave de función de la corteza suprarrenal o con extirpación bilateral de las suprarrenales necesitan tomar una dosis de mantenimiento a largo plazo. Durante el uso de hormonas corticosuprarrenales, se debe prestar atención a los efectos secundarios de la sobredosis de medicamentos que retienen sodio y agua, como hinchazón, hipertensión y hipernatremia.、纠正脱水和电解质紊乱：10％，se estima que la suplementación de líquidos es aproximadamente el 100% del peso corporal normal. En el caso de una crisis grave de suprarrenal, la deshidratación rara vez excede el volumen total de líquidos del cuerpo.6％ aproximadamente, como el peso70kg, se debe suplementar con aproximadamente4000ml. La cantidad de líquido para rehidratar debe determinarse según la gravedad de la deshidratación, la edad y la condición del corazón del individuo. La composición del líquido, al principio se debe proporcionar5％ solución salina de glucosa1000ml, después de ajustar según sea necesario, se puede suplementar sodio.150～250mmol/L. Debido a que los pacientes con deficiencia de función de la corteza suprarrenal tienen una capacidad reducida para excretar la carga de agua renal, por lo tanto, la cantidad total y la velocidad de la infusión de líquidos deben controlarse, no deben ser excesivos ni demasiado rápidos, para evitar la inducción de edema pulmonar. Si hay hiperkalemia antes del tratamiento, generalmente puede reducirse a la normalidad después de corregir la deshidratación y el shock, aumentar la orina, suplementar hormonas glucocorticoides y glucosa.3L líquido, se puede suplementar potasio según sea necesario.20～40mmol, para suplementar la deficiencia de potasio total. Esta enfermedad puede tener acidosis, pero generalmente no se convierte en un problema grave, no se necesita suplementar medicamentos alcalinos, cuando la capacidad de unión del dióxido de carbono en sangre es inferior a22Vol％ (ácido bórico en sangre <10mmol/L) cuando se puede suplementar con una cantidad adecuada de bicarbonato de sodio.

　　4、预防和治疗低血糖：Aunque esta enfermedad solo falta cortisol y no se acompaña de una disminución simultánea de la hormona del crecimiento, por lo tanto, la aparición de hipoglucemia no es tan común como la crisis de Sheehan, pero también debe prestar atención, se debe proporcionar una cantidad suficiente de glucosa durante el tratamiento. Si el paciente ya está en la etapa terminal en el hogar o en las unidades de atención médica primaria, y falta los medicamentos efectivos mencionados anteriormente, se puede inyectar inmediatamente por vía intravenosa.50％ glucosa60～100ml, ayuda a prolongar la vida, tiempo de emergencia, para que sea posible tomar medidas de tratamiento efectivo.

　　5、处理诱因：En caso de infección concomitante, se debe seleccionar antibióticos efectivos y en la cantidad adecuada, y se debe expandir y drenar la infección de la incisión. Durante el período de rescate, se debe tratar activamente otras causas desencadenantes.

　　En el período de peligro de la enfermedad, se debe establecer una atención especial y fortalecer la atención. Los pacientes con deficiencia de función de la corteza suprarrenal son particularmente sensibles a la morfina y otros medicamentos barbitúricos, y deben abstenerse de estos medicamentos antes de comenzar el tratamiento efectivo de la crisis.