urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.5.125WHHIRCurmj-1612Research ArticleЛитературные обзоры | Literature reviewsLiterature reviewsОстрая надпочечниковая недостаточность в детском возрасте: этиопатогенез, клиника, интенсивная терапияAcute Adrenal Insufficiency in Childhood: Etiopathogenesis, Clinical Picture, and Intensive Carehttps://orcid.org/0000-0003-4705-3823БыковЮ. В.BykovYu. V.

Юрий Витальевич Быков — кандидат медицинских наук, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Yuri V. Bykov - Candidate of Sciences (Medicine), Assistant of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

yubykov@gmail.comhttps://orcid.org/0000-0002-9990-7272ОбединА. Н.ObedinA. N.

Александр Николаевич Обедин — доктор медицинских наук, доцент, заведующий кафедрой анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Alexander N. Obedin - Doctor of Sciences (Medicine), Associate Professor, Head of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

volander@mail.ruhttps://orcid.org/0000-0003-1494-1613ФишерВ. В.FischerV. V.

Василий Владимирович Фишер — кандидат медицинских наук, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Vasily V. Fischer - Candidate of Sciences (Medicine), Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

vvfisher26@gmail.comhttps://orcid.org/0000-0002-9841-6930ВолковЕ. В.VolkovE. V.

Евгений Владимирович Волков — кандидат медицинских наук, доцент, ассистент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Evgeny V. Volkov - Candidate of Sciences (Medicine), Associate Professor, Assistant of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

volkov26@mail.ruhttps://orcid.org/0000-0001-5482-8581ЯцукИ. В.YatsukI. V.

Иван Викторович Яцук — кандидат медицинских наук, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Ivan V. Yatsuk - Candidate of Sciences (Medicine), Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

yatsukiv@gmail.comhttps://orcid.org/0000-0002-4460-870XМуравьёваА. А.MuravyevaA. A.

Алла Анатольевна Муравьёва — кандидат медицинских наук, доцент, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь

Alla A. Muravyeva - Candidate of Sciences (Medicine), Associate Professor, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

muravyeva81@mail.ruhttps://orcid.org/0000-0003-4729-5101ЗинченкоО. В.ZinchenkoO. V.

Олег Васильевич Зинченко — кандидат медицинских наук, доцент, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

Ставрополь,

Oleg V. Zinchenko - Candidate of Sciences (Medicine), Associate Professor, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education

Stavropol

regionar2008@yandex.ruСтавропольский государственный медицинский университетРоссияStavropol State Medical UniversityRussian Federation202418102024235125–142Copyright © Быков Ю.В., Обедин А.Н., Фишер В.В., Волков Е.В., Яцук И.В., Муравьёва А.А., Зинченко О.В., 20242024Быков Ю.В., Обедин А.Н., Фишер В.В., Волков Е.В., Яцук И.В., Муравьёва А.А., Зинченко О.В.Bykov Y.V., Obedin A.N., Fischer V.V., Volkov E.V., Yatsuk I.V., Muravyeva A.A., Zinchenko O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1612

Введение. Острая надпочечниковая недостаточность (ОНН) — тяжелая эндокринопатия, поражающая пациентов, в т. ч. детей и подростков, с невысокими показателями заболеваемости, но потенциальным риском развития летального исхода. Рассмотрение вопросов оказания неотложной помощи детям с этой патологией является актуальным направлением детской анестезиологии-реаниматологии.Цель работы — определение современного состояния проблемы этиопатогенеза, клинико-лабораторной диагностики и интенсивной терапии при ОНН в детском возрасте.Материалы и методы. Выполнен поиск и анализ научных работ с использованием баз данных Cochrane Library, PubMed и Medscape по поисковым словам: «острая надпочечниковая недостаточность, дети и подростки, глюкокортикоиды, интенсивная терапия, инфузионная терапия». Для обзора отобрано 65 источников.Результаты и обсуждение. Патофизиология ОНН обусловлена резким дефицитом кортизола (и минералокортикоидов), который запускает воспалительную реакцию, электролитный дисбаланс и гемодинамические нарушения. Клинические проявления ОНН включают в себя признаки эксикоза, тошноту, рвоту, болевой синдром, снижение артериального давления, тахикардию, судороги и нарушение сознания вплоть до комы. При лабораторном исследовании у детей часто диагностируются гиперкалиемия, гипонатриемия, гипогликемия и гиперкальциемия. Основой интенсивной терапии в отделении анестезиологии и реанимации при ОНН является парентеральное введение ГК (препарат выбора — гидрокортизон, внутривенно). При стабилизации состояния ребенка спустя 2–3 дня производят перевод на пероральные формы гормонов. Параллельно осуществляется инфузионная терапия для повышения объема циркулирующей крови и купирования эксикоза за счет назначения кристаллоидных растворов длительностью до 2–3 дней.Заключение. Более полное понимание аспектов этиопатогенеза, клинических проявления и диагностических особенностей при ОНН, а также знание алгоритмов неотложной помощи позволят повысить качество оказания экстренной помощи при рассматриваемой патологии в педиатрической практике.

Introduction. Acute adrenal insufficiency (AAI) is a severe endocrinopathy whose victims include children and adolescents and which can be life-threatening despite its low incidence. Analysis of issues associated with intensive care of children with this pathology is of vital interest for pediatric anesthesiology and critical care medicine. The aim of this work was to assess current views on the etiopathogenesis, clinical pathology and intensive treatment of pediatric AAI.Materials and methods. The topic was researched by analyzing publications found in the Cochrane Library, PubMed and Medscape using the following search terms: “acute adrenal insufficiency, children and adolescents, intensive therapy, fluid management”, with 65 published sources chosen.Results and discussion. In AAI, caused by a sharp deficiency of cortisol (and mineralocorticoids), which triggers an inflammatory reaction, electrolyte imbalance and hemodynamic disorders. AAI presents with dehydration, nausea and vomiting, feelings of pain, hypotension, tachycardia, seizures and impaired consciousness up to coma. Laboratory tests in children often reveal hyperkalemia, hyponatremia, hypoglycemia and hypercalcemia. Intensive management of AAI in the ICU relies on parenteral corticosteroids (preferably intravenous hydrocortisone). Two or three days later, when the child is stable, they are switched to oral hormones. Meanwhile, fluid management is performed over 2 to 3 days to increase the circulating blood volume and relieve dehydration with crystalloid fluids.Conclusion. A clearer understanding of the etiopathogenesis, clinical manifestations and diagnostic features of AAI, along with knowledge of emergency care algorithms, will improve the quality of intensive therapy of pediatric patients with this condition.

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The authors declare that there are no conflicts of interest present.