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Die Nebennierenkrise

Diagnostisches und therapeutisches Management der akuten Nebennierenrindeninsuffizienz

  • Schwerpunkt: Endokrine und metabolische Krisen
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Zusammenfassung

Die akute Nebennierenrinden(NNR)-Insuffizienz ist selten, aber lebensbedrohlich, und entwickelt sich als Folge einer inadäquaten adrenalen Steroidproduktion. Die rechtzeitige Diagnosestellung ermöglicht eine effektive Therapie, die das Überleben der Patienten sichert. Die oft wenig spezifische klinische Symptomatik führt bei nicht vorbekannter NNR-Insuffizienz häufig zu Fehldiagnosen und diagnostischen Maßnahmen, die den Patienten zusätzlich gefährden (z. B. invasive Diagnostik, explorative Laparotomie). Bei Patienten mit bekannter chronischer NNR-Insuffizienz ist das Auftreten krisenhafter Entgleisungen zwar selten, kann aber nur durch adäquate Patientenschulung insbesondere zur Dosisanpassung der Substitutionstherapie bei Stress vermieden werden. Die Prognose der akuten Nebennierenkrise ist v. a. abhängig von der klinischen Kompetenz und der raschen und zielgerichteten Therapieeinleitung durch den behandelnden Arzt.

Abstract

Acute adrenal insufficiency is a rare but life-threatening disorder that develops as a result of inadequate adrenal steroid production. Early diagnosis is key for effective and life-saving treatment of the affected patients. The main clinical features are non-specific, thus often leading to misdiagnosis and invasive diagnostic work up, in particular in patients with previously unknown disease. Adrenal crisis in patients with known chronic adrenal insufficiency is nowadays rare, but can only be prevented by structured patient education on stress-related glucocorticoid dose adjustment. Outcome of adrenal crisis is crucially determined by the physician's clinical competence and immediate initiation of specific treatment.

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Hahner, S., Arlt, W. & Allolio, B. Die Nebennierenkrise. Internist 44, 1243–1252 (2003). https://doi.org/10.1007/s00108-003-1050-1

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