[Diagnostic points
(A) Clinical manifestations
1, hyperpigmentation: It is one of the early symptoms of primary chronic hyperalgesia, and is seen in almost all cases.
Hypotension: Patients feel dizzy, dizzy, and have lower blood pressure, sometimes below 10.7/6.67kpa (80/50mmHg), and may faint due to postural hypotension.
3, gastrointestinal symptoms: The first to appear is loss of appetite, followed by nausea, vomiting and constipation, constipation is less common.
4. Hypoglycemia: Patients’ fasting blood sugar is often lower than normal, and glucose tolerance test shows a low flat curve. Hypoglycemic reaction is more likely to occur during infection, starvation or trauma, or when insulin is injected for some reasons.
5. Weakness: It only appears at the beginning when exertion, and can be relieved after rest. Later on, it gradually worsens, and even when resting, it feels weak and cannot insist on work. About 2/3 of the patients seek medical attention with the main complaint of weakness.
6.Neuropsychiatric symptoms: About 70% of the patients can have them, such as mental depression, indifference, memory loss and drowsiness in mild cases; insomnia, irritability, even delirium, convulsions and coma in severe cases.
7, other symptoms: patients often have chronic water loss phenomenon, obvious wasting, weight loss of more than 10-20 pounds, women menstrual disorders or premature amenorrhea, men more impotence.
8, adrenal crisis: when the patient is complicated by infection, trauma, surgery, childbirth, overexertion, heavy sweating or interruption of cortisol treatment can induce a crisis, manifested as high fever, nausea, vomiting, diarrhea, dehydration, irritability, in severe cases, blood pressure drops, pulse weakness, peripheral circulation failure, leading to shock and coma. In some cases, hypoglycemia is the main manifestation.
(II) Laboratory tests
1. Electrolyte disorders
(1) Low blood sodium, low blood chloride, high blood potassium
(2) Hypoglycemia, hypercalcemia
(3) Blood sodium to potassium ratio <30:1
2.Glucose tolerance curve is low flat curve
3.Adrenal cortical function test
(1) Decrease in 24-hour urinary 17-hydroxy and 17-ketone
(2) Decrease in blood cortisol and 24-hour urine free cortisol
(3) Significant increase in ACTH in primary cases and significant decrease or lack of ACTH in secondary cases
Treatment measures
(i) Diet: Eat rich carbohydrates, proteins and vitamins, salt intake should be more than normal, 10-15g per day.
(ii) Corticosteroid replacement therapy: It is the basic treatment for this disease, and the purpose is to supplement the daily physiological dose of adrenocorticosteroids, generally glucocorticoids are the mainstay, some patients need to be supplemented with salt corticosteroids, once this disease is diagnosed, the hormones should be taken for a long time and maintained for life.
1.Glucocorticoids
(1) Corticosteroids: commonly used cortisone acetate, most patients take 12.5-37.5mg of oral tablet daily, generally not more than 37.5mg
(2) Cortisol (hydrocortisone): 10-30mg daily
(3) Prednisone and prednisolone: 5-7.5mg daily
The above glucocorticoids can be given orally once in the morning for small doses, and in two doses for moderate doses and above, with 2/3 of the dose given at 8:00 a.m. and 1/3 of the dose given at 4:00 p.m. This is closer to the circadian rhythm of cortisol secretion in normal people. This is closer to the circadian rhythm of cortisol secretion in normal people. It is preferable to give the drug after meals to avoid gastrointestinal irritation.
2. Salt corticosteroids (not required for secondary hyperalgesia)
(1) 9a-fluorohydrocortisone: synthetic preparation, can be injected intramuscularly, subcutaneously or sublingually, 0.05-0.2mg daily
(2) 11-deoxycorticosterone trimethyl acetate: intramuscular injection, 25-50mg each time, the effect can be maintained for 1 month
(3) Licorice infusion: can replace the effect of deoxycorticosterone to regulate water-electrolyte metabolism, 20-40ml daily
(3) Etiological treatment: active tuberculosis should be actively treated with anti-tuberculosis, other etiologies should be treated accordingly, secondary hyperaldosteronism should be treated by removing hypothalamus or pituitary tumor
(iv) Treatment of adrenal crisis
1. Hormone supplementation: rapidly administer soluble cortisol (e.g. hydrocortisone succinate) 100-200mg within 1-2 hours at first, then 100mg of hydrocortisone every 6 hours, i.e. 300-400mg of hydrocortisone should be given within the first 24 hours, and the dose should be reduced by half on the second day. The dose can be reduced by half, and then gradually reduced, and changed to oral physiological amount after four or five days.
2, rehydration: the first day should be rehydrated more than 2500-3000ml, and then adjust the dose after the second day depending on blood pressure, urine volume, etc.
3.Anti-infection: choose effective antibiotics.
4, symptomatic treatment: including the administration of oxygen, careful use of sedatives, etc., should not give morphine and barbiturates.
5.Anti-shock: If systolic blood pressure below 10.6kpa (80mmg) with shock symptoms cannot be corrected by rehydration and hormone treatment, vasoactive drugs should be given early.