“Crisis addisoniana aguda secundaria a suspensión abrupta de corticoides”

Abstract

Adrenal cortical insufficiency is a rare pathology, however it can compromise the life of the patient. They usually show signs and symptoms of cortisol deficiency, a hormone belonging to the group of glucocorticoids, sometimes there is also aldosterone deficiency. The signs and symptoms characteristic of an adisonian crisis usually appear after infections, situations of stress, suspension of treatment or injuries that involve the loss of sodium, the clinic is usually pain in the lower back, abdomen or legs, decreased pressure arterial and in severe cases shock and loss of consciousness. The Adison crisis is endangering the patient's life because it lowers blood glucose levels. The treatment is usually based on the adequate administration of hydrocortisone, hydration and glucose. The present case describes a 20-year-old patient with a history of adrenal insufficiency for 12 years in treatment with prednisone, calcitriol and hydrocortisone, hypothyroidism 2 years ago without treatment. He comes to present diaphoresis about 24 hours, with accompanying symptoms of general malaise, vomiting three times of food content, paraesthesia of lower and upper extremities, physical examination patient conscious, oriented, vital signs within normal parameters, skin and slightly pale facets, soft abdomen depressible positive ureteral points with a result of infectious uroanalysis: bacteria +, leukocytes ++, pyocytes 25-30 / field; blood count: leukocytes 15,100 / mm3, neutrophils 79.8%, lymphocytes: 16.4%, hemoglobin 13.44g / dL. Electrolytes: sodium 121mmol / l, potassium 4.70 mmol / l, chlorine 87 mmol / l and calcium 6.55 mmol / l. The treatment was restitution of sodium and liquids, corticotherapy and antibiotic therapy, the evolution was favorable.