Difficulties in diagnosis of addisonian crisis in primary adrenal insufficiency
Autor: | V N Oslopov, E. N. Khasanov, M A Makarov, J. V. Oslopova |
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Rok vydání: | 2016 |
Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.diagnostic_test Hyperkalemia Adrenal cortex business.industry 030106 microbiology General Medicine medicine.disease Culdocentesis Hypoplasia Surgery Primary Adrenal Insufficiency 03 medical and health sciences medicine.anatomical_structure Prednisone Congenital adrenal hypoplasia medicine Adrenal insufficiency medicine.symptom business medicine.drug |
Zdroj: | Kazan medical journal. 97:797-800 |
ISSN: | 2587-9359 0368-4814 |
Popis: | The observation of a rare case of Addisonian crisis, which developed in 28-year old patient with asymptomatic hypocorticoidism in a stressful situation and was fatal, is described. In patient with left-sided interrupted tubal pregnancy after recovery from anesthesia after a successful laparoscopic tubectomy, shock blood pressure lowering happened, an acute left ventricular heart failure occurred. Addisonian crisis developed under stress conditions (pregnancy, rupture of the fallopian tube, culdocentesis, anesthesia, performed surgery) amid the previously undiagnosed primary adrenal insufficiency due to congenital hypoplasia of the adrenal cortex. During the autopsy there was found hypoplasia of fasciculate and reticular zones of adrenal cortex, which formed only about 40%, while normally form 85% of the adrenal cortex. Under stress (in the presence of normal adrenal glands) fasciculate zone must significantly increase in size (and account for more than 75%), while in patient who was under the severe stress they accounted for only 10-20% of the adrenal cortex. Adrenal insufficiency was not recognized. The patient has no hyperpigmentation and hyperkalemia, which confirms the conclusion of primary adrenal insufficiency. Therapeutic measures were reduced to the administration of low-dose prednisone, sympathomimetic drugs and liquid. Due to the possible existence of forms of the adrenal insufficiency with mild manifestations, there should be an awareness in terms of possible hypocorticoidism in case of development of hemodynamic instability in response to stress, despite intensive infusion therapy and administration of adrenergic drugs. In such cases, it is necessary to administer, perhaps ex juvantibus, high doses of glucocorticoids, which at the correct diagnosis match «as the key to the lock», and at the same time are safe for use. In the treatment of shock of various etiologies, there is a need for wider use of glucocorticoid therapy using high doses of hormones. |
Databáze: | OpenAIRE |
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