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Boala Addison: Insuficienta CSR Cronica Primara

This document discusses Addison's disease, which is chronic primary adrenal insufficiency. It causes deficiencies in mineralocorticoids, glucocorticoids, and androgens. Symptoms include hyperpigmentation, fatigue, low blood pressure, digestive issues, and weight loss. Diagnosis involves low levels of cortisol and other hormones. Treatment consists of replacing the deficient hormones with glucocorticoid and mineralocorticoid analogs such as prednisone and fludrocortizone. Acute adrenal insufficiency can result from stress, illness, or treatment interruptions and requires intravenous glucose and hydrocortisone.

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Adina Si Sergiu
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86 views17 pages

Boala Addison: Insuficienta CSR Cronica Primara

This document discusses Addison's disease, which is chronic primary adrenal insufficiency. It causes deficiencies in mineralocorticoids, glucocorticoids, and androgens. Symptoms include hyperpigmentation, fatigue, low blood pressure, digestive issues, and weight loss. Diagnosis involves low levels of cortisol and other hormones. Treatment consists of replacing the deficient hormones with glucocorticoid and mineralocorticoid analogs such as prednisone and fludrocortizone. Acute adrenal insufficiency can result from stress, illness, or treatment interruptions and requires intravenous glucose and hydrocortisone.

Uploaded by

Adina Si Sergiu
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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BOALA ADDISON

= insuficienta CSR cronica primara

ETIOLOGIE
-SUPRARENALITA AUTOIMUNAsdr poliglandular -SUPRARENALITA TBC-secundara diseminata -IATROGENA chirurgie,inhibitori enzimatici -HEMORAGII, INFARCTE -BOLI INFILTRATIVE-amiloidoza,hemocromatoza -METASTAZE NEOPLAZICE -DEFECTE ENZIMATICE CONGENITALE

Fiziopatologie
Deficitul de mineralcorticoizi :
-

Scaderea reabsorbtiei de sodiu si clorhTA cu tendinta la colaps + hiperhidratare intracelularaedem cerebral, greata; Scade eliminarea urinara de KHK-mie astenie musculara si modificari EKG

Fiziopatologie
Deficitul de glucocorticoizi:
-

hipoglicemie, scaderea rezervelor de glicogen hepatic si muscular; Scaderea turnoverului de aa si a sintezei proteice; Scaderea depozitelor de grasime, a lipemiei si colesterolului.

Fiziopatologie
Deficitul de hormoni androgeni :
-

Afectarea mentinerii sexualizarii; Accentuarea starii de astenie fizica.

TABLOU CLINIC
-

Hiperpigmentare cutaneo-mucoasa Astenie fizica si psihica Hipotensiune arteriala Tulburari digestive Scadere ponderala Rarirea/disparitia pilozitatii axilare si pubiene

DIAGNOSTIC POZITIV
-

Cortizol plasmatic scazut 17OHCS scazuti Aldosteron plasmatic si urinar scazut DHEAS si androstendion scazuti 17 CS scazuti Testul de stimulare cu ACTH - negativ

DIAGNOSTIC POZITIV
-

Ionograma serica si urinara Glicemie scazuta Eozinofilie EKG : P aplatizat, QRS largi, T ascutite IDR la tuberculina Rx lombara-calcificari in suprarenalita TBC Anticorpi anticorticosuprarenalieni

TRATAMENT
-

Regim igieno-dietetic - evitarea suprasolicitarilor fizice si psihice - regim normo- sau hipersodat Analogi de glucocorticoizi : - Prednison 7,5 10 mg/zi - hidrocortizon 25 mg/zi - dexametazona 1 mg/zi Analogi de mineralocorticoizi - Fludrocortizon (Astonin) 0,5-1 mg/zi

Reguli de tratament

Echivalenta dozelor:
20mg cortizol=5mg Prednison =5mg Supercortizol =4mg Triamcinolon =1mg Superprednol

Reguli de tratament

Capacitatea de retentie sodica :


Comparativ cu Cortizolul si Cortizonul - Prednisonul si Prednisolonul au capacitate de doua ori mai mica - Triamcinolonul, Superprednolul si Diprophosul nu au efect

Reguli de tratament
Capacitatea de a inhiba hipofiza corticotropa:
- cel mai puternic efect il au Superprednolul si Diprophosul

Reguli de tratament

Doza de substitutie corespunde secretiei fiziologice a CSR in conditii normale; Se respecta ritmul circadian de secretie Doza se dubleaza/tripleaza in conditii de stres, infectii,suprasolicitari,etc In insuficienta primara CSR se substituie si mineralcorticoizii

INSUFICIENTA CSR ACUTA

Este provocata de : Suprasolicitari fizice sau psihice Boli intercurente Tulburari digestive Traumatisme accidentale sau chirurgie Intreruperea terapiei substitutive Tratamente intempestive-laxative, diuretice

INSUFICIENTA CSR ACUTA


-

PEV cu glucoza 10% si SF 50ml/kg corp HHC 100mg in bolus , apoi 100mg la 8 ore Cand doza scade sub 100mg/zi se asociaza mineralocorticoizi Monitorizarea este clinica starea generala, TA, apetitul si paraclinica - ionograma

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