chronic adrenal insufficiency
Introduction
Introduction to chronic adrenal insufficiency Chronic adrenal insufficiency is divided into primary and secondary types. The primary is also known as Addison's disease. It is caused by autoimmune, tuberculosis, fungal infections, tumors, leukemia, etc., which destroys the bilateral adrenal glands. Part of the adrenocortical hormone secretion is insufficient. Secondary refers to the hypothalamic secretion of CRF or pituitary secretion of ACTH deficiency. Chronic adrenal insufficiency is more common in adults, tuberculosis is more men than women, and idiopathic women are more likely to have more idiopathic immunity than men. The clinical manifestations are mainly weak and weak, skin mucosal pigmentation, weight loss, hypotension, loss of appetite, nausea, vomiting, water and electrolyte metabolism disorders and nervous system damage. basic knowledge The proportion of sickness: 0.0001% - 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: Adrenal crisis, nausea and vomiting, syncope, shock, coma
Cause
Causes of chronic adrenal insufficiency
Adrenal tuberculosis (35%):
Only bilateral adrenal tuberculosis, most of the adrenal gland tissue was destroyed, clinical symptoms, mostly associated with lung, bone or other areas of tuberculosis, accounted for about half of chronic adrenal insufficiency in the 1950s, and gradually decreased with the control of tuberculosis in recent years. .
Autoimmune disorder (30%):
Adrenal cortical atrophy caused by idiopathic autoimmune reaction is the most common cause. Anti-adrenal tissue antibodies can often be detected in serum, mainly invading bundled cells. Antigens are mainly in microsomes and mitochondria. There are other autoimmune disorders, such as multiple endocrine gland dysfunction syndrome (Schmidt syndrome), which may include, for example, adrenal insufficiency, hypothyroidism, hypoparathyroidism, gonadal failure, diabetes, hypopituitarism, Gastric wall cell antibody positive, pernicious anemia, hyperthyroidism, colon tumor, myasthenia gravis, solitary red blood cell aplasia.
Malignant tumor metastasis (15%):
Adrenal metastasis of malignant tumors, about 10% of patients with cancer metastasis have bilateral adrenal metastasis, more common with lung cancer and breast cancer, can also be seen after bilateral adrenalectomy, systemic fungal infection, adrenal amyloidosis.
Prevention
Chronic adrenal insufficiency prevention
1. The patient's immunity is extremely low, susceptible to respiratory infections, gastrointestinal disorders, and even adrenal cortical crisis, while the long-term application of hormone replacement therapy has more side effects, so it should actively cooperate with Chinese medicine treatment to achieve the best. Efficacy.
2. Pay attention to rest and avoid mental and physical overwork, but should be combined with exercise and physical exercise to enhance physical fitness and reduce complications.
3. Avoid colds, injuries, surgical irritation, vomiting, sweating or excessive hot and cold stimuli.
4. Diet should be rich in protein, vitamins and carbohydrates, poly-sodium salts, less potassium to maintain electrolyte balance.
Complication
Chronic adrenal insufficiency complications Complications adrenal crisis nausea and vomiting syncope shock coma
In stress (trauma, infection, etc.) or sudden interruption of hormone replacement therapy, adrenal crisis can be induced, nausea, vomiting, syncope, shock, coma can occur.
Symptom
Symptoms of chronic adrenal insufficiency Common symptoms Urine persistent sodium stun coma adrenal crisis abdominal pain fatigue drowsiness insomnia tremors weight loss convulsions
First, the slow onset may cause attention after many years. Occasionally, some cases, induced by adrenal gland crisis due to infection, trauma, surgery and other stress, were clinically discovered.
Second, pigmentation of the skin and mucous membrane pigmentation, mostly diffuse, to the exposed part, often rubbing parts and nails (toe) nails, scars, areola, external genitals, around the anus, gums, oral mucosa, conjunctiva is obvious, pigment The cause of depression is the decrease in feedback inhibition of melanocyte stimulating hormone (MSH) and adrenocorticotropic hormone (ACTH) secretion in the reduction of glucocorticoids. Some patients may have flaky pigmentation loss zone, secondary adrenal cortex. The levels of MSH and ACTH in patients with hypofunction were significantly reduced, so there was no pigmentation.
Third, the degree of fatigue is parallel with the severity of the disease. The lighter ones only have poor labor tolerance, and the heavy ones are bedridden, caused by electrolyte imbalance, dehydration, and disorder of protein and glucose metabolism.
Fourth, gastrointestinal symptoms such as loss of appetite, nausea, vomiting, upper abdomen, right lower abdomen or no localized abdominal pain, sometimes diarrhea or constipation, more than high sodium diet, often accompanied by weight loss, gastrointestinal symptoms more common in the course of the disease, serious illness By.
V. Cardiovascular symptoms Due to lack of sodium, dehydration and insufficient corticosteroids, patients have low blood pressure (boost systolic and diastolic blood pressure) and orthostatic hypotension, small heart, slow heart rate, and low heart sound.
6. Hypoglycemia performance Due to the lack of insulin antagonists and gastrointestinal disorders in the body, the patient's blood sugar is often low, but due to the slow development of the disease, more tolerable, the symptoms are not obvious, only hunger, sweating, headache, weakness, Uneasy, severe tremors, blurred vision, diplopia, mental disorders, even convulsions, coma, the disease is particularly sensitive to insulin, even if injected with a small dose can cause severe hypoglycemia.
Seven, mental symptoms, lack of energy, expression indifferent, memory loss, dizziness, lethargy, some patients have insomnia, irritability, and even paralysis and mental disorders.
Eight, adrenal crisis patients with low resistance, any stress load such as infection, trauma, surgery, anesthesia, etc. can induce acute adrenal insufficiency crisis.
Nine, other sensitive to narcotics, sedatives, small doses can cause dizziness or coma, hypogonadism, such as impotence, menstrual disorders.
Ten, the primary disease manifestations such as tuberculosis, various autoimmune diseases and various symptoms of glandular failure syndrome.
Examine
Examination of chronic adrenal insufficiency
First, the general examination 1 blood image examination has mild positive cell anorectal anemia, lymphocytes and eosinophils are high. 2 blood biochemical examination, some patients with low serum sodium, high serum potassium, low blood sugar, about 1/3 of cases below the normal range, glucose tolerance test showed a low flat curve or reactive hypoglycemia. 3 ECG low voltage and T wave low or inverted, Q ~ T time can be extended. 4X line inspection, visible heart shadow reduction, vertical position.
Second, special inspection
(1) The discharge of urinary 17-hydroxycorticosteroid (17OHCS) and 17-ketone corticosteroid (17KS) was lower than normal, and the degree of reduction was parallel with the function of the adrenal cortex.
(2) The determination of plasma cortisol was significantly reduced, and the circadian rhythm disappeared.
(III) ACTH Excitation Test This test is to check the functional reserve of the adrenal cortex, and to identify patients with mild chronic adrenal insufficiency and to identify primary chronic adrenal insufficiency and secondary chronic adrenal insufficiency.
Third, the plasma ACTH basic value determination of primary adrenal insufficiency significantly increased, more than 55pmol / L (250pg / ml), often between 88 ~ 440pmol / L (400-200pg / ml) (normal value 1.1 ~11pmol/L, ie 5~50pg/ml) and secondary adrenal insufficiency, the plasma ACTH concentration is extremely low.
Fourth, the cause of tuberculosis in the adrenal gland X-ray film may be seen in the adrenal calcification may also have other tissues and organs of tuberculosis, in the serum of patients with autoimmune adrenal cortex may be detected in the serum of adrenal cortex, Patients often have other autoimmune diseases and endocrine gland dysfunction, metastatic adrenal cancer patients, may find primary cancer.
Diagnosis
Diagnosis and diagnosis of chronic adrenal insufficiency
First, secondary chronic adrenal insufficiency, five pigmentation, and skin color becomes lighter, even pale, water and salt metabolism disorder is light, blood sugar fluctuations, hypoglycemia tends to be obvious; both polygland dysfunction; plasma ACTH is significantly reduced.
Second, the cause of Riel's disease is unknown, may be related to exposure, cosmetics, autonomic dysfunction and nutritional deficiencies, facial pigmentation, occurs in the exposed parts of the forehead, ankle, neck, etc., with mild telangiectasia and The hair follicles are keratinized, the skin lesions have powdery scales, and the adrenal cortex functions normally.
Third, other diseases 17-KS about one-third from male testes, and cirrhosis, malnutrition, renal insufficiency and chronic wasting disease patients also reduced urine output, while obesity or urine output increased High, it should eliminate the above diseases or influencing factors, chronic liver disease, hemochromatosis, acanthosis nigricans and chronic lead, mercury, arsenic poisoning, etc., can also cause hyperpigmentation, but does not have the characteristics of this disease, plus supplemented by the relevant detection can be identified .
