Senkopla Başvuran Genç Kadında Açıklanamayan Hipoglisemi ve Sonrasında Gelişen Adrenerjik Kriz: Nadir Bir Olgu
Özet
23 yaşında, primer adrenal yetmezlik (Addison hastalığı) tanılı bir kadın hasta, senkop ve hipoglisemi ile acil servise getirilmiştir. Başvuruda kan basıncı 85/74 mmHg ölçülen hastada hipotansif şok bulguları, genel durum bozukluğu ve diffüz karın ağrısı saptanmıştır. Laboratuvarda lökositoz (WBC: 16.400/µL), CRP yüksekliği (221 mg/L), hipoglisemi ve Addison krizine özgü elektrolit bozuklukları (hiponatremi ve hiperpotasemi) dikkati çekmiştir. Akut batın şüphesiyle genel cerrahi, “adrenerjik kriz” (akut adrenal kriz) şüphesiyle endokrinoloji konsültasyonu yapılmıştır. Batın bilgisayarlı tomografisinde apendiks çapında acil cerrahi müdahale gerektirmeyen bir artış saptanmıştır. Yoğun bakımda IV hidrokortizon ve destek tedavileri başlanarak hızla klinik düzelme sağlanmış, altta yatan olası enfeksiyon etkenine yönelik antibiyotik tedavisi verilmiş ve hasta birkaç gün içinde tamamen toparlanarak taburcu edilmiştir.
A 23-year-old female patient with a known diagnosis of primary adrenal insufficiency (Addison’s disease) was admitted to the emergency department with syncope and hypoglycemia. On admission, her blood pressure was measured at 85/74 mmHg, and she presented with signs of hypotensive shock, impaired general condition, and diffuse abdominal pain. Laboratory findings revealed leukocytosis (WBC: 16,400/µL), elevated CRP (221 mg/L), hypoglycemia, and electrolyte abnormalities characteristic of Addisonian crisis (hyponatremia and hyperkalemia). General surgery was consulted due to suspected acute abdomen, and endocrinology was consulted with a suspicion of “adrenergic crisis” (acute adrenal crisis); abdominal computed tomography revealed an increase in the appendix diameter that did not require emergency surgical intervention. In the intensive care unit, intravenous hydrocortisone and supportive therapies were initiated, leading to rapid clinical improvement; empirical antibiotic therapy was administered for a possible underlying infectious trigger, and the patient fully recovered and was discharged within a few days.
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