WordNet
- of critical importance and consequence; "an acute (or critical) lack of research funds"
- having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
- extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
- having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
- of an angle; less than 90 degrees
- a lack of competence; "pointed out the insufficiencies in my report"; "juvenile offenses often reflect an inadequacy in the parents" (同)inadequacy
- (pathology) inability of a bodily part or organ to function normally
- lack of an adequate quantity or number; "the inadequacy of unemployment benefits" (同)inadequacy, deficiency
- of or pertaining to the adrenal glands or their secretions
- near the kidneys
PrepTutorEJDIC
- (先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の
- 不十分な[点],不足;不適当,不向き
- 副腎(じん)の
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/05 10:12:06」(JST)
[Wiki en表示]
| Adrenal crisis |
| Classification and external resources |
| MedlinePlus |
000357 |
Adrenal crisis (also known as Addisonian crisis, Acute adrenal insufficiency) is a constellation of symptoms that indicate severe adrenal insufficiency caused by insufficient levels of cortisol.[1] This may be the result of either previously undiagnosed or untreated Addison's disease, a disease process suddenly affecting adrenal function (such as adrenal hemorrhage in Waterhouse-Friderichsen syndrome), suddenly stopping intake of glucocorticoids Glucocorticoid#Withdrawal, or an intercurrent problem (e.g. infection, trauma) in someone known to have Addison's disease. It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment.
Contents
- 1 Causes
- 2 Presentation
- 3 Diagnosis
- 4 Treatment
- 5 Prevention
- 6 Epidemiology
- 7 References
- 8 External links
Causes
It is caused due to deficiency of cortisol. Cortisol deficiency maybe due to Addison's disease or corticosteroid biosynthetic enzyme defects.
Presentation
Signs and Symptoms
Characteristic symptoms are:[2]
- Sudden penetrating pain in the legs, lower back or abdomen
- Confusion, psychosis, slurred speech
- Severe lethargy
- Convulsions
- Fever
- Hyperkalemia (elevated potassium level in the blood)
- Hypercalcemia (elevated calcium level in the blood): the etiology of hypercalcemia is a combination of increased calcium input into the extracellular space and reduced calcium removal by the kidney, this last caused by decreased glomerular filtration and increased tubular calcium reabsorption. Both renal factors are secondary to volume depletion and, in fact, improve rapidly during rehydration with saline infusion.[3]
- Hypoglycemia (reduced level of blood glucose)
- Hyponatremia (low sodium level in the blood)
- Hypotension (low blood pressure)
- Hypothyroid (low T4 level)
- Severe vomiting and diarrhea, resulting in dehydration
- Syncope (loss of consciousness and ability to stand)
Diagnosis
Various investigations aid the diagnosis.
- ACTH (cosyntropin) stimulation test
- Cortisol level (to assess the level of glucocorticoids)
- Fasting blood sugar
- Serum potassium (to assess the level of mineralocorticoids)
- Serum sodium
Treatment
Acute adrenal insufficiency is a medical emergency and needs to be treated with injectable hydrocortisone and fluid support.[1]
Prevention
Adrenal crisis is triggered by stress and hence people with adrenal insufficiency need to avoid stressful situations.
Epidemiology
Hahner et al investigated the frequency, causes and risk factors for adrenal crisis in patients with chronic adrenal insufficiency.[4] Annane et al's landmark 2002 study found a very high rate of relative adrenal insufficiency among the enrolled patients with septic shock.[5]
References
- ^ a b "Acute adrenal crisis (Addisonian crisis)". Endocrine Surgery Encyclopedia. UCLA Health System. Retrieved 14 August 2013.
- ^ "Addison's Disease". National Endocrine and Metabolic Diseases Information Service. Retrieved 14 August 2013.
- ^ http://link.springer.com/article/10.1007%2FBF02411297
- ^ Hahner, S.; Loeffler, M.; Bleicken, B.; Drechsler, C.; Milovanovic, D.; Fassnacht, M.; Ventz, M.; Quinkler, M.; Allolio, B. (2 December 2009). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". European Journal of Endocrinology 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.
- ^ Annane, D. (20 August 2002). "Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock". JAMA: the Journal of the American Medical Association 288 (7): 862–871. doi:10.1001/jama.288.7.862. PMID 12186604.
External links
- Acute adrenal crisis on PubmedHealth
- Adrenal Crisis on Patient.co.uk
- Katherine White (28 July 2004). "What to do in an emergency -Addisonian crisis". Addison's Disease Self Help Group (ADSHG).
- Addisonian crisis on rightdiagnosis.com
|
Endocrine pathology: endocrine diseases (E00–E35, 240–259)
|
|
Pancreas/
glucose
metabolism |
| Hypofunction |
- types:
- type 1
- type 2
- MODY 1 2 3 4 5 6
- complications
- coma
- angiopathy
- ketoacidosis
- nephropathy
- neuropathy
- retinopathy
- cardiomyopathy
- insulin receptor (Rabson–Mendenhall syndrome)
- Insulin resistance
|
|
| Hyperfunction |
- Hypoglycemia
- beta cell (Hyperinsulinism)
- G cell (Zollinger–Ellison syndrome)
|
|
|
Hypothalamic/
pituitary axes |
| Hypothalamus |
- gonadotropin
- Kallmann syndrome
- Adiposogenital dystrophy
- CRH (Tertiary adrenal insufficiency)
- vasopressin (Neurogenic diabetes insipidus)
- general (Hypothalamic hamartoma)
|
|
| Pituitary |
| Hyperpituitarism |
- anterior
- Acromegaly
- Hyperprolactinaemia
- Pituitary ACTH hypersecretion
- posterior (SIADH)
- general (Nelson's syndrome)
|
|
| Hypopituitarism |
- anterior
- Kallmann syndrome
- Growth hormone deficiency
- ACTH deficiency/Secondary adrenal insufficiency
- GnRH insensitivity
- FSH insensitivity
- LH/hCG insensitivity
- posterior (Neurogenic diabetes insipidus)
- general
- Empty sella syndrome
- Pituitary apoplexy
- Sheehan's syndrome
- Lymphocytic hypophysitis
|
|
|
| Thyroid |
| Hypothyroidism |
- Iodine deficiency
- Cretinism
- Congenital hypothyroidism
- Myxedema
- Euthyroid sick syndrome
|
|
| Hyperthyroidism |
- Hyperthyroxinemia
- Thyroid hormone resistance
- Familial dysalbuminemic hyperthyroxinemia
- Hashitoxicosis
- Thyrotoxicosis factitia
- Graves' disease
|
|
| Thyroiditis |
- Acute infectious
- Subacute
- De Quervain's
- Subacute lymphocytic
- Autoimmune/chronic
- Hashimoto's
- Postpartum
- Riedel's
|
|
| Goitre |
- Endemic goitre
- Toxic nodular goitre
- Toxic multinodular goiter
|
|
|
| Parathyroid |
| Hypoparathyroidism |
- Hypoparathyroidism
- Pseudohypoparathyroidism
- Pseudopseudohypoparathyroidism
|
|
| Hyperparathyroidism |
- Primary
- Secondary
- Tertiary
- Osteitis fibrosa cystica
|
|
|
| Adrenal |
| Hyperfunction |
- aldosterone: Hyperaldosteronism/Primary aldosteronism
- Conn syndrome
- Bartter syndrome
- Glucocorticoid remediable aldosteronism
- AME
- Liddle's syndrome
- 17α CAH
- cortisol: Cushing's syndrome (Pseudo-Cushing's syndrome)
- sex hormones: 21α CAH
- 11β CAH
|
|
Hypofunction/
Adrenal insufficiency
(Addison's, WF) |
- aldosterone: Hypoaldosteronism
|
|
|
| Gonads |
- ovarian: Polycystic ovary syndrome
- Premature ovarian failure
- testicular: enzymatic
- 5α-reductase deficiency
- 17β-hydroxysteroid dehydrogenase deficiency
- aromatase excess syndrome)
- Androgen receptor (Androgen insensitivity syndrome
- general: Hypogonadism (Delayed puberty)
- Hypergonadism
- Hypoandrogenism
- Hypoestrogenism
- Hyperandrogenism
- Hyperestrogenism
|
|
|
| Height |
- Dwarfism/Short stature
- Midget
- Laron syndrome
- Psychosocial
- Ateliosis
- Gigantism
|
|
| Multiple |
- Autoimmune polyendocrine syndrome multiple
- Carcinoid syndrome
- Multiple endocrine neoplasia
- Progeria
- Werner syndrome
- Acrogeria
- Metageria
- Woodhouse-Sakati syndrome
|
|
|
|
|
noco (d)/cong/tumr, sysi/epon
|
proc, drug (A10/H1/H2/H3/H5)
|
|
|
|
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Severe Hyponatremia Due to Valproic Acid Toxicity.
- Gupta E1, Kunjal R1, Cury JD2.
- Journal of clinical medicine research.J Clin Med Res.2015 Sep;7(9):717-9. doi: 10.14740/jocmr2219w. Epub 2015 Jul 24.
- Hyponatremia is a very commonly encountered clinical entity with potentially dangerous effects and for which many precipitating factors have been identified. We present a case of valproic acid (VPA) overdose causing profound hyponatremia, with one of the lowest serum sodium levels ever documented in
- PMID 26251688
- Relative adrenal insufficiency in severe acute variceal and non-variceal bleeding: influence on outcomes.
- Graupera I1,2, Pavel O1,2, Hernandez-Gea V1, Ardevol A1, Webb S3,4, Urgell E5, Colomo A1, Llaó J1, Concepción M1, Villanueva C1,2.
- Liver international : official journal of the International Association for the Study of the Liver.Liver Int.2015 Aug;35(8):1964-73. doi: 10.1111/liv.12788. Epub 2015 Feb 10.
- BACKGROUND & AIMS: Relative adrenal insufficiency (RAI) is common in critical illness and in cirrhosis, and is related with worse outcomes. The prevalence of RAI may be different in variceal and non-variceal bleeding and whether it may influence outcomes in these settings is unclear. This study
- PMID 25644679
Related Links
- If you have Addison disease, learn to recognize signs of potential stress that may cause an acute adrenal crisis. If you have been instructed by your doctor, be prepared to give yourself an emergency shot of ...
- 1. Endocrinol Metab Clin North Am. 2006 Dec;35(4):767-75, ix. Acute adrenal insufficiency. Bouillon R(1). Author information: (1)Clinic and Laboratory of Endocrinology, University Hospital Gasthuisberg ...
★リンクテーブル★
[★]
- 英
- adrenal crisis
- 同
- 急性副腎不全？？？、副腎急性発症 副腎発症、急性副腎皮質不全、急性副腎皮質機能低下症 acute adrenal insufficiency、アジソンクリーゼ Addison crisis、 Addison-Krise
- 関
- アジソン病
概念
- アジソン病で未治療の患者や、治療中でも感染や外傷、外科手術などのストレス時に、コルチゾールの必要量が増加したにもかかわらず、補充が不十分の場合に発症する、急性の副腎不全。
[★]
- 関
- dearth、deficient、deficit、dysfunction、failing、failure、hypofunction、imperfecta、in short、inadequate、incompetence、insufficient、insufficiently、lack、low、malfunction、paucity、poorly、regurgitation、scanty、scarce、scarcity、short、shortage、shortness、stun
[★]
- (疾患)急性の、急性型の、急性的な。(形状が)鋭い、鋭角の。(感覚、才知などが)鋭い。明敏な、鋭い眼識のある。
- 関
- acutely、quick、sharp
[★]
- 関
- adrenal gland、suprarenal