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Nebennierenkrise

Adrenal crisis

  • Schwerpunkt: Notfälle in der Endokrinologie/Diabetologie
  • Published:
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Zusammenfassung

Die chronische Nebenniereninsuffizienz ist mit einer reduzierten Lebensqualität sowie einer erhöhten Mortalität assoziiert. Ein Zusammenhang zwischen der erhöhten Mortalität und dem Auftreten von Nebennierenkrisen wird angenommen. Nebennierenkrisen, bedingt durch einen Kortisolmangel, treten in einer Frequenz von 8,3 Krisen/100 Patientenjahre auf. Hauptauslöser sind Infekte. Die Pathophysiologie der Entstehung ist bis dato nicht vollständig geklärt, eine fehlende immunsuppressive Wirkung mit überschießender Zytokinwirkung sowie eine Hypotonie, bedingt durch den Mineralokortikoidmangel und das adrenomedulläre Defizit, werden diskutiert. Die Therapie der Nebennierenkrise beinhaltet die schnellstmögliche parenterale Verabreichung von Hydrokortison in Kombination mit Volumensubstitution. Zur Prävention von Nebennierenkrisen ist eine regelmäßige Patientenschulung inklusive Ausstattung der Patienten mit einem Notfallset und Notfallausweis essenziell.

Abstract

Patients with chronic adrenal insufficiency suffer from reduced quality of life and increased mortality. An association between mortality and adrenal crisis is assumed. The frequency of adrenal crisis is about 8/100 patient years. The main causes are infectious disease. Pathophysiology is poorly understood to date. An association with an exaggerated inflammatory response due to a lack of glucocorticoid modulation as well as mineralocorticoid deficiency and diminished adrenomedullary function are discussed. The therapy of adrenal crisis includes prompt parenteral administration of hydrocortisone combined with isotonic saline. To prevent adrenal crisis, patients are equipped with an emergency card and set and educated in glucocorticoid dose adjustment.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik, Schwerpunkt Endokrinologie und Diabetologie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland

    S. Burger-Stritt &  S. Hahner

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  1. S. Burger-Stritt
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Correspondence to S. Hahner.

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Interessenkonflikt

S. Burger-Stritt und S. Hahner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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H. Lehnert, Lübeck

M. Reincke, München

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Burger-Stritt, S., Hahner, S. Nebennierenkrise. Internist 58, 1037–1041 (2017). https://doi.org/10.1007/s00108-017-0307-z

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