Clinic Addison’s disease. Forms of Addison’s Disease
A characteristic sign of the disease is a decrease in the weight of patients, which is expressed to a varying degree in all patients not treated with adrenal cortex drugs. However, weight loss never reaches the severity characteristic of toxic goiter or pituitary cachexia.
Cardiovascular disorders are one of the leading signs of the disease . In patients, as a rule, hypotension is observed, and mainly systolic pressure decreases, pulse pressure and minute blood volume decrease. The size of the heart is usually reduced, the tones are muffled. Changes in the electrocardiogram are expressed in a decrease in the voltage of the teeth, a shift in the S-T interval below the isoelectric line, a decrease in the T wave and the appearance of a negative or two-phase T wave. In this case, brown atrophy is observed in the myocardium.
Gastrointestinal disturbances in addison’s disease are observed in 40% of patients and are expressed in a decrease in appetite, nausea, diarrhea, and pain in the abdomen. The acidity of the gastric juice is usually reduced, the external secretion of the pancreas is reduced.
Significant deviations from the norm are also noted in the functional state of the liver, which is expressed in violation of its protein-forming, antitoxic, glycogen-forming function. A violation of carbohydrate metabolism is also characteristic: there is a low level of sugar in the blood on an empty stomach, a flat character of the sugar curve after a load of sugar, hypoglycemic sinking by the 3rd hour after a load. Glucose tolerance is increased, there is an increase in sensitivity to insulin, sometimes hypoglycemic conditions occur. Violations of electrolyte metabolism are accompanied by an increase in potassium and a decrease in sodium and chloride in the blood serum.
In some cases, acute psychoses are described . Renal function is usually not impaired, with the exception of a decrease in glomerular filtration and a decrease in reabsorption of sodium and chlorides. The function of the sex glands with a mild form of the disease and against the background of replacement therapy is disturbed quite rarely. This is evidenced by normal menstruation in most patients and the onset of pregnancy. In men, there is a slight decrease in sexual potency. Accordingly, a decrease in the function of the adrenal cortex in patients decreases the excretion of 17-keto- and 17-hydroxycorticosteroids in the urine, and the excretion of aldosterone decreases.
In addition to the forms typical of the clinical course of the disease , there are atypical “erased” forms of the disease. These include forms of the disease, proceeding as hypoaldosteronism. In this case, the disease is characterized by the usual clinical manifestations of the disease, but the excretion of 17-hydroxycorticosteroids usually remains normal or slightly increased, there is a significant increase in potassium levels and a decrease in serum sodium. This form of chronic insufficiency of the adrenal cortex is caused by dysfunction of the glomerular zone in intact bundle and mesh. Increased excretion of cortisol metabolites is an expression of the body’s compensatory reaction.
Another form of dissociated hypocorticism is secondary adrenal cortex insufficiency – a diencephalic-pituitary form of the disease in which the function of the bundle and reticular zones is damaged as a result of decreased ACTH production. Clinically, this form is characterized by milder manifestations of the disease, less pronounced pigmentation, the absence of a sharp decrease in blood pressure, a positive Thorn test and the preservation of potential reserves of the adrenal cortex. In contrast to the primary lesion of the adrenal cortex, the content of ACTH in the blood plasma is reduced. The atypical forms of the disease include the non-pigmite form of Addison’s disease, characterized by the presence of all manifestations of the disease, except for typical pigmentation. The latter is so weakly expressed that it is usually not fixed during the examination. This form of the disease is diagnosed only on the basis of laboratory data. According to the clinical course of Addison’s disease, it is divided into mild, moderate and severe forms.