Leshin M
Urol Clin North Am. 1982 Jun;9(2):229-35.
Acute adrenal insufficiency may present only with nonspecific symptoms and signs. Hyperpigmentation is not a feature of secondary adrenal insufficiency and is absent in patients with primary adrenal failure of recent or acute onset. Similarly, characteristic electrolyte disturbances may be obscured by concomitant vomiting and diarrhea as well as by parenteral electrolyte replacement. A high index of suspicion must therefore be maintained to make the diagnosis of acute adrenal insufficiency in patients without a recognized history of autoimmune adrenal insufficiency or of other diseases or therapeutic regimens known to result in pituitary-adrenal failure. Timely intervention with volume and glucocorticoid replacement rapidly reverses all symptoms and signs of adrenal insufficiency. Guidelines are presented for glucocorticoid replacement in the treatment of adrenal crisis as well as for the prevention of acute adrenal insufficiency in patients with known or suspected pituitary-adrenal disease. In addition, recommendations are given for the simultaneous diagnosis and treatment of adrenal insufficiency in patients without previously established disease.
急性肾上腺功能不全可能仅表现为非特异性症状和体征。色素沉着不是继发性肾上腺功能不全的特征，在近期或急性发作的原发性肾上腺功能衰竭患者中不存在。同样，特征性的电解质紊乱可能会被同时出现的呕吐、腹泻以及胃肠外电解质替代所掩盖。因此，对于没有自身免疫性肾上腺功能不全病史或其他已知会导致垂体 - 肾上腺功能衰竭的疾病或治疗方案病史的患者，必须保持高度的怀疑指数以诊断急性肾上腺功能不全。及时进行容量补充和糖皮质激素替代治疗可迅速逆转肾上腺功能不全的所有症状和体征。本文给出了糖皮质激素替代治疗肾上腺危象以及预防已知或疑似垂体 - 肾上腺疾病患者发生急性肾上腺功能不全的指南。此外，还给出了针对既往未确诊疾病患者肾上腺功能不全的同时诊断和治疗的建议。
