Adrenal Bez Hastalıkları
Özet
Adrenal bez patolojileri acil serviste nadir görülse de, akut hormon eksikliği ya da fazlalığı üzerinden hızla hemodinamik instabilite, elektrolit bozukluğu ve metabolik düzensizlik oluşturarak yüksek morbidite-mortaliteye yol açabilir. Retroperitoneal yerleşimli adrenal bez; kortekste mineralokortikoid (aldosteron), glukokortikoid (kortizol) ve androjenleri, medullada ise katekolaminleri sentezler. Bu nedenle adrenal hastalıklarda karın ağrısı çoğu zaman primer abdominal patolojiye bağlı olmaksızın ortaya çıkar ve inflamatuvar “akut batın” ağrısından farklı olarak metabolik, vasküler ve nöroendokrin mekanizmalarla gelişir. Primer adrenal yetmezlik ve adrenal krizlerde kortizol/aldosteron eksikliği hiponatremi, hiperkalemi, hipoglisemi ve hipotansiyona neden olur; visseral hipoperfüzyon ve düz kas disfonksiyonu üzerinden yaygın, lokalize edilemeyen karın ağrısı, bulantı-kusma ve genel durum bozukluğu görülebilir. Adrenal hemorajide zengin vasküler yapı ve venöz drenaj özellikleri nedeniyle retroperitoneal kanama gelişebilir; ani başlayan şiddetli karın/yan ağrısı, hemoglobin düşüşü ve hemodinamik bozulma tabloya eşlik edebilir. Feokromositomada ise katekolamin fırtınası yaygın vazokonstriksiyon ve mezenterik spazm ile intestinal iskemiye yol açarak ataklar halinde şiddetli karın ağrısı, hipertansif kriz, taşikardi, terleme ve baş ağrısı ile prezente olabilir. Tanısal yaklaşımda açıklanamayan karın ağrısına sistemik bulgular eşlik ediyorsa, adrenal patolojiler ayırıcı tanıya alınmalıdır. Acil serviste öncelikli yaklaşım ABC stabilizasyonu, uygun laboratuvar değerlendirme (elektrolitler, glukoz, kortizol vb.), klinik şüphede gecikmemek; stres doz steroid ve sıvı resüsitasyonu şeklinde olup, bu erken yaklaşım, yanlış tanıyı ve tedavi gecikmesini azaltarak yaşam kurtarıcı olabilir.
Although adrenal pathologies are rare in the emergency department, acute hormone deficiency or excess can rapidly lead to hemodynamic instability, electrolyte disturbances, and metabolic derangements, resulting in high morbidity and mortality. The adrenal glands, located retroperitoneally, synthesize mineralocorticoids (aldosterone), glucocorticoids (cortisol), and androgens in the cortex, and catecholamines in the medulla. Therefore, abdominal pain in adrenal disorders often occurs without a primary intra-abdominal pathology and, unlike inflammatory “acute abdomen” pain, arises through metabolic, vascular, and neuroendocrine mechanisms. In primary adrenal insufficiency and adrenal crisis, cortisol and/or aldosterone deficiency causes hyponatremia, hyperkalemia, hypoglycemia, and hypotension; diffuse, poorly localized visceral abdominal pain may occur due to visceral hypoperfusion and smooth muscle dysfunction, often accompanied by nausea, vomiting, and general deterioration. In adrenal hemorrhage, the rich vascular supply and venous drainage characteristics predispose to retroperitoneal bleeding; sudden severe abdominal or flank pain, a drop in hemoglobin, and hemodynamic compromise may be present. In pheochromocytoma, catecholamine surges can cause widespread vasoconstriction and mesenteric spasm leading to intestinal ischemia, presenting with paroxysmal severe abdominal pain together with hypertensive crisis, tachycardia, sweating, and headache. From a diagnostic standpoint, adrenal pathologies should be included in the differential diagnosis when unexplained abdominal pain is accompanied by systemic findings. The priority approach in the emergency department is ABC stabilization, appropriate laboratory evaluation (electrolytes, glucose, cortisol, etc.), and not delaying in addressing clinical suspicion; stress dose steroids and fluid resuscitation. This early approach can save lives by reducing misdiagnosis and treatment delays. Early recognition and management can reduce misdiagnosis and treatment delays and may be life-saving.
Referanslar
Al-Khanaty, Abdullah et al. “Adrenal Anatomy and Physiology.” The Urologic clinics of North America vol. 52,2 (2025): 169-179. doi:10.1016/j.ucl.2025.01.001
Torpy, D. J., et al. "DeGroot's Endocrinology: Basic Science and Clinical Practice." (2023): 1553-68.
Tarı, Özden, and Mustafa Kürtül. "Klinikte önemli olan katekolamin ve türevlerinin yapilarinin incelenmesi." Journal of Faculty of Pharmacy of Ankara University 48.1 (2024): 366-383.
Megha, Rishi, et al. "Anatomy, abdomen and pelvis: adrenal glands (Suprarenal Glands)." StatPearls [Internet]. StatPearls Publishing, 2022.
Odluyurt, Hülya, et al. "Adrenal insufficiency." Archives of Basic and Clinical Research (2021).
Güzelce, Büşra. Adrenal Insidentaloma Hastalarında Mortalite Prevalansı ve Nedenleri. Diss. Dokuz Eylul Universitesi (Turkey), 2021.
Şişman, Pınar. "Primer adrenal yetmezliğin tanı ve tedavisi." (2017).
Dineen, Rosemary, Christopher J. Thompson, and Mark Sherlock. "Adrenal crisis: prevention and management in adult patients." Therapeutic advances in endocrinology and metabolism 10 (2019): 2042018819848218.
Hahner, Stefanie, et al. "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies." European journal of endocrinology 162.3 (2010): 597-602.
II, AT. "Adrenal Bez Hastalıkları." SAĞLIK & BİLİM 2023: İç Hastalıkları-II (2023): 7.
Elhassan, Yasir S., et al. "Approach to the patient with adrenal hemorrhage." The Journal of Clinical Endocrinology & Metabolism 108.4 (2023): 995-1006.
Simon, Daniel R., and Michael A. Palese. "Clinical update on the management of adrenal hemorrhage." Current urology reports 10.1 (2009): 78-83.
Ikeda, O., et al. "Acute adrenal hemorrhage after blunt trauma: O. Ikeda et al." Abdominal imaging 32.2 (2007): 248-252.
Di Serafino, Marco, et al. "Nontraumatic adrenal hemorrhage: the adrenal stress." Radiology Case Reports 12.3 (2017): 483-487.
Kovacs, K A et al. “Bilateral massive adrenal hemorrhage. Assessment of putative risk factors by the case-control method.” Medicine vol. 80,1 (2001): 45-53. doi:10.1097/00005792-200101000-00005
Kawashima, Akira, et al. "Imaging of nontraumatic hemorrhage of the adrenal gland." Radiographics 19.4 (1999): 949-963.
Baccot, S., et al. "Hémorragie surrénalienne bilatérale post-traumatique. À propos d’un cas avec insuffisance surrénale aiguë." Annales de chirurgie. Vol. 125. No. 3. Elsevier Masson, 2000.
Mehrazin, Reza, et al. "Adrenal trauma: elvis presley memorial trauma center experience." Urology 70.5 (2007): 851-855.
Gómez, Reynaldo G., Jack W. McAninch, and Peter R. Carroll. "Adrenal gland trauma: diagnosis and management." Journal of Trauma and Acute Care Surgery 35.6 (1993): 870-874.
Stawicki, Stanislaw P., et al. "Adrenal gland trauma is associated with high injury severity and mortality." Current surgery 60.4 (2003): 431-436.
Gavrilova-Jordan, Larisa P., et al. "Spontaneous adrenal hemorrhage during pregnancy: a review of the literature and a case report of successful conservative management." Obstetrical & gynecological survey 60.3 (2005): 191-195.
Bartikoski, Stephanie R., and Daniel J. Reschke. "Pheochromocytoma crisis in the emergency department." Cureus 13.3 (2021).
Hayıroğlu, Mert İlker, et al. "Hypertensive emergency due to pheochromocytoma crisis complicated with refractory hemodynamic collapse." Turk Kardiyol Dern Ars 43.8 (2015): 727-729.
García, Maria Isabel Del Olmo, et al. “Surgical and Pharmacological Management of Functioning Pheochromocytoma and Paraganglioma.” Paraganglioma: A Multidisciplinary Approach, edited by Renato Mariani-Costantini, Codon Publications, 2 July 2019. doi:10.15586/paraganglioma.2019.ch4
Referanslar
Al-Khanaty, Abdullah et al. “Adrenal Anatomy and Physiology.” The Urologic clinics of North America vol. 52,2 (2025): 169-179. doi:10.1016/j.ucl.2025.01.001
Torpy, D. J., et al. "DeGroot's Endocrinology: Basic Science and Clinical Practice." (2023): 1553-68.
Tarı, Özden, and Mustafa Kürtül. "Klinikte önemli olan katekolamin ve türevlerinin yapilarinin incelenmesi." Journal of Faculty of Pharmacy of Ankara University 48.1 (2024): 366-383.
Megha, Rishi, et al. "Anatomy, abdomen and pelvis: adrenal glands (Suprarenal Glands)." StatPearls [Internet]. StatPearls Publishing, 2022.
Odluyurt, Hülya, et al. "Adrenal insufficiency." Archives of Basic and Clinical Research (2021).
Güzelce, Büşra. Adrenal Insidentaloma Hastalarında Mortalite Prevalansı ve Nedenleri. Diss. Dokuz Eylul Universitesi (Turkey), 2021.
Şişman, Pınar. "Primer adrenal yetmezliğin tanı ve tedavisi." (2017).
Dineen, Rosemary, Christopher J. Thompson, and Mark Sherlock. "Adrenal crisis: prevention and management in adult patients." Therapeutic advances in endocrinology and metabolism 10 (2019): 2042018819848218.
Hahner, Stefanie, et al. "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies." European journal of endocrinology 162.3 (2010): 597-602.
II, AT. "Adrenal Bez Hastalıkları." SAĞLIK & BİLİM 2023: İç Hastalıkları-II (2023): 7.
Elhassan, Yasir S., et al. "Approach to the patient with adrenal hemorrhage." The Journal of Clinical Endocrinology & Metabolism 108.4 (2023): 995-1006.
Simon, Daniel R., and Michael A. Palese. "Clinical update on the management of adrenal hemorrhage." Current urology reports 10.1 (2009): 78-83.
Ikeda, O., et al. "Acute adrenal hemorrhage after blunt trauma: O. Ikeda et al." Abdominal imaging 32.2 (2007): 248-252.
Di Serafino, Marco, et al. "Nontraumatic adrenal hemorrhage: the adrenal stress." Radiology Case Reports 12.3 (2017): 483-487.
Kovacs, K A et al. “Bilateral massive adrenal hemorrhage. Assessment of putative risk factors by the case-control method.” Medicine vol. 80,1 (2001): 45-53. doi:10.1097/00005792-200101000-00005
Kawashima, Akira, et al. "Imaging of nontraumatic hemorrhage of the adrenal gland." Radiographics 19.4 (1999): 949-963.
Baccot, S., et al. "Hémorragie surrénalienne bilatérale post-traumatique. À propos d’un cas avec insuffisance surrénale aiguë." Annales de chirurgie. Vol. 125. No. 3. Elsevier Masson, 2000.
Mehrazin, Reza, et al. "Adrenal trauma: elvis presley memorial trauma center experience." Urology 70.5 (2007): 851-855.
Gómez, Reynaldo G., Jack W. McAninch, and Peter R. Carroll. "Adrenal gland trauma: diagnosis and management." Journal of Trauma and Acute Care Surgery 35.6 (1993): 870-874.
Stawicki, Stanislaw P., et al. "Adrenal gland trauma is associated with high injury severity and mortality." Current surgery 60.4 (2003): 431-436.
Gavrilova-Jordan, Larisa P., et al. "Spontaneous adrenal hemorrhage during pregnancy: a review of the literature and a case report of successful conservative management." Obstetrical & gynecological survey 60.3 (2005): 191-195.
Bartikoski, Stephanie R., and Daniel J. Reschke. "Pheochromocytoma crisis in the emergency department." Cureus 13.3 (2021).
Hayıroğlu, Mert İlker, et al. "Hypertensive emergency due to pheochromocytoma crisis complicated with refractory hemodynamic collapse." Turk Kardiyol Dern Ars 43.8 (2015): 727-729.
García, Maria Isabel Del Olmo, et al. “Surgical and Pharmacological Management of Functioning Pheochromocytoma and Paraganglioma.” Paraganglioma: A Multidisciplinary Approach, edited by Renato Mariani-Costantini, Codon Publications, 2 July 2019. doi:10.15586/paraganglioma.2019.ch4
