Excessive secretion of glucocorticoids
Introduction
Introduction Too little glucocorticoids are commonly seen in patients with secondary adrenal insufficiency. May be caused by secondary endocrine diseases, drug effects, genetic factors. The main symptoms in the early stage are weakness and weakness, and the degree of fatigue is proportional to the severity of the disease. Severe muscle spasms, especially in the legs; weight loss due to gastrointestinal dysfunction caused by cortisol deficiency; pigmentation in the skin and mucous membranes; cardiovascular symptoms such as dizziness, vertigo, erectile fainting, etc.; neurological symptoms such as Apathy, lethargy, and even mental disorders; reduced resistance to various stresses such as infections and trauma, and easy to induce adrenal crisis.
Cause
Cause
May have secondary adrenal insufficiency.
Examine
an examination
Related inspection
Blood test neurological immunoassay
Diagnosis: The clinical manifestations of chronic adrenal insufficiency are due to a lack of cortisol and aldosterone.
(1) Weakness and weakness: For the main symptoms in the early stage, the degree of fatigue is directly proportional to the severity of the illness. In severe cases, you can reach the inability to turn over or reach out. Severe muscle spasms can also be seen, especially in the legs. These muscle lesions may be associated with imbalances in sodium and potassium at the neuro-muscle endplates.
(B) weight loss: due to cortisol deficiency caused by gastrointestinal dysfunction such as loss of appetite, nausea and vomiting, abdominal distension and diarrhea, decreased fat storage and muscle consumption and other factors can lead to weight loss, progressively greater reduction of the adrenal cortex crisis may.
(3) Pigmentation: The feedback inhibition of pituitary ACTH, melanocyte stimulating hormone (MSH) and lipoprotein (LPH) is weakened after cortisol deficiency, which increases the secretion of these hormones, and ACTH and LPH contain respectively. With -MSH structure, skin, mucous membrane pigmentation, friction, palm print, areola, scars, etc. are particularly obvious. Pigmentation is one of the main criteria for the identification of primary and secondary adrenal insufficiency. A sudden increase in pigment may indicate a worsening of the condition.
(4) Cardiovascular symptoms: As the hypotensive response to catecholamines is weakened, blood pressure is lowered, and orthostatic hypotension is most common. X-ray shows that the heart shadow is reduced, the electrocardiogram shows low voltage, and the PR and QT intervals are prolonged. Patients often have dizziness, vertigo, and erectile fainting.
(5) Hypoglycemia: The patient's sensitivity to internal and exogenous insulin is increased, and hypoglycemia is prone to occur in cases of hunger, gastrointestinal dysfunction, infection, and the like.
(6) Neurological symptoms such as apathy, lethargy and even mental disorders.
(7) The resistance to various stresses such as infection and trauma is reduced, and the adrenal crisis is easily induced. It is extremely sensitive to anesthetics, sleeping sedatives and hypoglycemic drugs, and a small amount can cause coma.
(8) Sexual dysfunction: Both male and female patients may have sexual dysfunction. Female adrenal glands and androgen are related to maintenance hair and sexual desire. Therefore, female hair, pubic hair is sparse or shedding, menstrual disorders or amenorrhea, and loss of libido. If it is an autoimmune cause, there may be premature ovarian and testicular failure.
diagnosis
Determination of hypothalamic-pituitary-adrenal axis integrity can be administered intravenously via tecocopeptide 5~250g. After 30 minutes, plasma cortisol should be >20g/dl (>552nmol/L), and pituitary mass or pituitary atrophy strongly suggest secondary adrenal insufficiency.
Diagnosis
Differential diagnosis
Adrenal cortical hormone deficiency: A rare endocrine disease caused by insufficient secretion of adrenocortical hormone due to the adrenal gland itself. Adrenocortical hormones are a general term for hormones secreted by the adrenal cortex and belong to the steroidal compound. Can be divided into three categories: 1 mineralocorticoids (mineralocorticoids), secreted by the globular band, there are aldosterone (desostercortone, desoxycortone, desoxycorticosterone). 2 glucocorticoids, synthesized and secreted by the fascicle, hydrocortisone and cortisone, etc., whose secretion and production are regulated by corticotropin (ACTH). 3 sex hormones, secreted by the reticular band, usually referred to as adrenocortical hormone, excluding the latter. Clinically used corticosteroids are glucocorticoids.
The secretion of mineralocorticoid is too small: mineralocorticoid mainly acts on sodium, potassium, chloride and water metabolism, so it is called mineralocorticoid. Among these hormones are aldosterone and deoxycorticosterone, among which aldosterone is the strongest. Mineralocorticoids have the effect of preserving sodium and potassium, promoting the reabsorption of sodium by the renal tubules and the effect of potassium release, thereby maintaining the proper concentration of sodium and potassium in the plasma. When the adrenal cortex hyperfunction (such as Cushing's syndrome), 11-deoxycorticosterone secretion, due to retention of sodium and water in the body beyond the limits of edema, increased blood volume, elevated blood pressure, high blood sugar, hypokalemia Wait. Conversely, if the adrenal cortical function is insufficient, the metabolism of sugar and minerals is disordered, causing a bronze disease, or "Addison's disease", which shows muscle weakness, decreased blood pressure, skin pigmentation and hypoglycemia, blood. Symptoms such as decreased sodium and increased potassium, while blood loses water and concentrates, and are life-threatening in severe cases.
Corticosteroid dependence: Glucocorticoid dermatitis refers to dermatitis caused by long-term topical glucocorticoids, which is characterized by dependence on hormones. This is a side effect caused by inappropriate topical glucocorticoids. The glucocorticoid-dependent dermatitis is characterized by skin flushing, papules, skin atrophy, telangiectasia, acne-like and rosacea-like rash, with burning sensation, pain, itching. Dry, tight feeling, after the topical glucocorticoids are stopped, the skin disease recurs and there is a rebound phenomenon. The disease is extremely common, and more than 500 cases have been reported in various parts of China.
