Der Anaesthesist

, Volume 61, Issue 6, pp 503–511

Perioperative Addison-Krise

Kasuistiken

Zusammenfassung

Die Addison-Krise bezeichnet eine akute lebensbedrohliche Nebennierenrindeninsuffizienz. Als Ursache kommt hierbei neben der Dekompensation einer chronischen Insuffizienz infolge einer Stresssituation, eines Infarkts oder einer Blutung der Nebennierenrinde auch das abrupte Absetzen der chronischen Glukokortikoidtherapie in Betracht. Es wird über einen 25-jährigen Patienten mit M. Crohn berichtet, der nach eigenverantwortlicher Beendigung seiner medikamentösen Therapie mit Prednisolon während einer Notfalllaparotomie eine Addison-Krise mit Hypotonie, Hyponatriämie und Hypoglykämie entwickelte. Dies machte neben einer Initialtherapie mit 100 mg Hydrokortison, 8 g Glucose und einer kontinuierlichen Katecholaminapplikation auch eine aggressive Volumentherapie erforderlich.

Schlüsselwörter

Primäre adrenokortikale Insuffizienz Hydrokortison Glukokortikoide Hypothalamus-Hypophysen-System Hypophysen-Nebennieren-System 

Perioperative Addisonian crisis

Abstract

An Addisonian crisis marks an acute adrenocortical failure which can be caused by decompensation of a chronic insufficiency due to stress, an infarct or bleeding of the adrenal cortex and also abrupt termination of a long-term glucocorticoid medication. This article reports the case of a 25-year-old patient with Crohn’s disease who suffered an Addisonian crisis with hypotension, hyponatriemia and hypoglycemia during an emergency laparotomy after he had terminated prednisolone medication on his own authority. This necessitated an aggressive volume therapy in addition to an initial therapy with 100 mg hydrocortisone, 8 g glucose and a continuous administration of catecholamines. Under this treatment regimen hemodynamic stabilization was achieved. Reduction of the administration of hydrocortisone after 3 days resulted in cardiovascular insufficiency which required an escalation of the hydrocortisone substitution.

Keywords

Primary adrenocortical insufficiency Hydrocortisone Glucocorticoids Hypothalamo-hypophyseal system Pituitary-adrenal system 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie und Operative IntensivmedizinUniversitätsklinikum Halle (Saale)HalleDeutschland

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