Clinical manifestations of adrenal crisis

Adrenal crisis develops slowly and may not attract people's attention until many years later. Occasionally, it is a precursor to a disease because of stress reactions such as infection, trauma, and surgery. Once discovered, appropriate treatment is needed in normal times, and adjustments should be made to avoid worsening of the disease, and the clinical manifestations should be understood.

Symptoms and signs

1. The disease develops slowly and may not be noticed until many years later. In some cases, adrenal crisis is occasionally discovered clinically due to stress such as infection, trauma, and surgery. 2. Pigmentation of the skin and mucous membranes is mostly diffuse, and is most obvious in exposed parts, areas of frequent friction, bases of nails, scars, areola, external genitalia, around the anus, gums, oral mucosa, and conjunctiva. The reason for pigmentation is that when glucocorticoids decrease, the feedback inhibition on the secretion of melanocyte stimulating hormone (MSH) and adrenocorticotropic hormone (ACTH) is weakened. Some patients may have patchy areas of depigmentation. The MSH and ACTH levels of patients with secondary adrenocortical insufficiency are significantly reduced, so there is no pigmentation.

3. Fatigue: The degree of fatigue is parallel to the severity of the disease. In mild cases, the patient only has poor work tolerance, while in severe cases, the patient is bedridden. It is caused by electrolyte imbalance, dehydration, and protein and sugar metabolism disorders.

4. Gastrointestinal symptoms such as loss of appetite, nausea, vomiting, upper abdominal, right lower abdominal or unlocalized abdominal pain, sometimes diarrhea or constipation. Many people like high-sodium diets. Often accompanied by weight loss. Gastrointestinal symptoms are more common in patients with long-term and severe illness.

5. Cardiovascular symptoms: Due to sodium deficiency, dehydration and insufficient corticosteroids, patients often have hypotension (both systolic and diastolic blood pressure decrease) and orthostatic hypotension. The heart is smaller, the heart rate is slower, and the heart sounds are duller.

6. Symptoms of hypoglycemia: Due to the lack of insulin antagonists in the body and gastrointestinal dysfunction, the patient's blood sugar is often low, but because the disease progresses slowly, it is usually well tolerated and the symptoms are not obvious. Just hunger, sweating, headache, weakness and restlessness. In severe cases, tremors, blurred vision, diplopia, mental disorders, and even convulsions and coma may occur. This disease is particularly sensitive to insulin, and even a small injection can cause severe hypoglycemia.

7. Mental symptoms include lack of energy, apathy, memory loss, dizziness, and drowsiness. Some patients suffer from insomnia, irritability, and even delirium and mental disorders.

8. Patients with adrenal crisis have low resistance, and any stress load such as infection, trauma, surgery, anesthesia, etc. can induce acute adrenal insufficiency crisis.

9. Others are very sensitive to anesthetics and sedatives, and even a small dose can cause drowsiness or coma. Hypogonadism, such as impotence, menstrual disorders, etc.

10. Manifestations of primary diseases such as tuberculosis, various autoimmune diseases and various symptoms of glandular failure syndrome.