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Morbus Addison

Addison’s disease

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Da die klinischen Zeichen der primären Nebennierenrinden- (NNR-)Insuffizienz oft unspezifisch sind, gilt es v. a., an diese Diagnose zu denken. Der Nachweis erfolgt einfach über einen ACTH-Kurztest. In der Therapie wird meist Hydrocortison und Fludrocortison eingesetzt. In der Therapieeinstellung und -Überwachung sind zahlreiche Aspekte zu beachten, damit der Patient keine Komplikationen durch Über- oder Untersubstitution erleidet. Die wichtigsten Aspekte sind die Schulung des Patienten und seiner Angehörigen, das Ausstellen eines Notfallausweises und die Verschreibung eines Glukokortikoidnotfallsets. Bei akuter NNR-Insuffizienz (Nebennierenkrise), die auch als Erstmanifestation auftreten kann, ist der Patient lebensgefährlich erkrankt und benötigt eine sofortige Glukokortikoid- und Volumengabe. Die häufigsten auslösenden Faktoren einer Nebennierenkrise sind gastrointestinale und fieberhafte Infekte sowie das Absetzen oder Vergessen der Glukokortikoide. Dieser Artikel gibt eine Übersicht über die aktuellen diagnostischen und therapeutischen Aspekte beim Morbus Addison.

Abstract

The clinical signs and symptoms of primary adrenal insufficiency are unspecific often causing a delayed diagnosis or even misdiagnosis. In the diagnostic work-up the short synacthen test is regarded as the gold standard. Hydrocortisone and fludrocortisone are the preferred therapy for Addison’s disease. The management and surveillance of therapy requires experience and several aspects need to be followed to prevent side effects which might occur due to overtreatment or undertreatment. Very important aspects in therapy are the repeated teaching of the patient and relatives, the issuing of an emergency steroid card and the prescription of a glucocorticoid emergency set. Acute adrenal failure (adrenal crisis), which might be the first manifestation of adrenal insufficiency, is a life-threatening situation requiring immediate glucocorticoid administration and fluid substitution. The most common causes for an adrenal crisis are gastrointestinal infections and fever and discontinuation of glucocorticoid therapy. This article gives an up-to-date overview of diagnostic and therapeutic aspects of Addison’s disease.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der Autor hat eine Beratertätigkeit für Viropharma.

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Correspondence to M. Quinkler.

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Quinkler, M. Morbus Addison. Med Klin Intensivmed Notfmed 107, 454–459 (2012). https://doi.org/10.1007/s00063-012-0112-3

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  • DOI: https://doi.org/10.1007/s00063-012-0112-3

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