Werbel S S, Ober K P
Department of Internal Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Endocrinol Metab Clin North Am. 1993 Jun;22(2):303-28.
Acute adrenal insufficiency is a rare disorder associated with high morbidity and mortality if allowed to progress unrecognized. A constellation of nonspecific symptoms including weakness, easy fatigue, nausea, anorexia, and weight loss are typical features of adrenal insufficiency. The index of suspicion should be particularly high if the patient has hyperpigmentation; hyponatremia and/or hyperkalemia; a history of autoimmune disease (hypothyroidism, diabetes) or recent prior use of exogenous steroids or if the patient is on anticoagulant therapy. Any decline in clinical status (hypotension, fever, decreasing mental status), especially in the setting of an acute intercurrent illness, should be treated aggressively, even before laboratory confirmation of the diagnosis. Diagnostic testing is fairly straightforward and readily available. The development of purified synthetic corticosteroid preparations has provided a safe and effective means of replacement. Early awareness, recognition, and intervention remain significant steps in altering the course of acute adrenal insufficiency.
急性肾上腺功能不全是一种罕见的疾病，如果未被识别而任其发展，会导致高发病率和死亡率。包括虚弱、易疲劳、恶心、厌食和体重减轻在内的一系列非特异性症状是肾上腺功能不全的典型特征。如果患者有色素沉着、低钠血症和/或高钾血症、自身免疫性疾病史（甲状腺功能减退、糖尿病）或近期曾使用外源性类固醇，或者患者正在接受抗凝治疗，那么怀疑指数应该特别高。任何临床状态的下降（低血压、发热、精神状态下降），尤其是在急性并发疾病的情况下，即使在实验室确诊之前，也应积极治疗。诊断测试相当简单且容易获得。纯化合成皮质类固醇制剂的开发提供了一种安全有效的替代方法。早期的认识、识别和干预仍然是改变急性肾上腺功能不全病程的重要步骤。
