Yoğun Bakımda Adrenal Yetmezlik
Özet
Adrenal bezler iki farklı kısımdan oluşmaktadır. Bunlar adrenal korteks ve adrenal medulladır. Adrenal korteksten, glukokortikoidler, mineralokortikoidler ve seks steroidleri salgılanmaktadır. Kortizol, enerji metabolizması, stres yanıtı, üreme, bağışıklık ve bilişsel işlevler gibi fizyolojik süreçlerin önemli bir düzenleyicisidir. Adrenal yetmezlik, adrenal hipofonksiyon ile karakterize edilen bir endokrin hastalıktır ve bu durum, özellikle kortizol olmak üzere glukokortikoidlerin yetersiz üretimine yol açar. Özellikle kortizol eksikliğiyle ilişkilendirilen ana semptomlar arasında yorgunluk, hipotansiyon ve kilo kaybı yer alır. Ayrıca adrenal kriz olarak bilinen akut bir acil durum şeklinde de kendini gösterebilir. Yoğun bakımda adrenal yetmezlik, önceden adrenal yetmezlik tanısı olan hastalarda veya akut hastalığın doğrudan bir sonucu olarak ortaya çıkabilir. Ketokonazol veya etomidat gibi steroidogenezi olumsuz etkileyen ilaçların kullanımına bağlı ortaya çıkabilir. Kritik hastalıklarda Hipotalamus-Hipofiz-Adrenal aksı stres tepkisinin bozulmasını tanımlamak için kullanılan kritik hastalık kaynaklı kortikosteroid yetersizliği kritik hastalarda görülebilir. Yeterli sıvı resüsitasyonu ve vazopressör desteğine rağmen hemodinamik instabilitesi olan hastalarda adrenal yetmezlikten şüphelenilmelidir.
The adrenal glands consist of two different parts. These are the adrenal cortex and the adrenal medulla. The adrenal cortex secretes glucocorticoids, mineralocorticoids and sex steroids. Cortisol is an important regulator of physiological processes such as energy metabolism, stress response, reproduction, immunity and cognitive function. Adrenal insufficiency is an endocrine disorder characterized by adrenal hypofunction, leading to inadequate production of glucocorticoids, particularly cortisol. The main symptoms specifically associated with cortisol deficiency include fatigue, hypotension and weight loss. It can also present as an acute emergency known as an adrenal crisis. Adrenal insufficiency in intensive care can occur in patients with a previous diagnosis of adrenal insufficiency or as a direct consequence of acute illness. It may occur due to the use of drugs that adversely affect steroidogenesis, such as ketoconazole or etomidate. Critical illness-induced corticosteroid insufficiency, a term used to describe impairment of the Hypothalamic-Pituitary-Adrenal axis stress response in critical illness, can occur in critically ill patients. Adrenal insufficiency should be suspected in patients with hemodynamic instability despite adequate fluid resuscitation and vasopressor support.
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