Addison Birmer's disease. How does Addison's disease manifest? What additional examination is needed?

Poteyko P.I., Kharkovskaya medical Academy postgraduate education, Department of Phthisiology and Pulmonology

Even in ancient times, 25 centuries ago, Hippocrates described changes in shape distal phalanges fingers, which were found in chronic pulmonary pathology (abscess, tuberculosis, cancer, pleural empyema), and called them “drum sticks”. Since then, this syndrome has been called by his name - Hippocratic fingers (Hippocratic fingers) (digiti Hippocratici).

Hippocrates finger syndrome includes two signs: “hour glass” (Hippocrates fingernails - ungues Hippocraticus) and club-shaped deformity terminal phalanges of the fingers according to the “ drumsticks"(Finger clubbing).

Currently, PG is considered the main manifestation of hypertrophic osteoarthropathy (HOA, Marie-Bamberger syndrome) - multiple ossifying periostosis.

The mechanisms of development of PG are currently not fully understood. However, it is known that the formation of PG occurs due to a violation of microcirculation, accompanied by local tissue hypoxia, impaired trophism of the periosteum and autonomic innervation against the background of prolonged endogenous intoxication and hypoxemia. In the process of formation of PG, the shape of the nail plates (“hour glasses”) first changes, then the shape of the distal phalanges of the fingers changes into a club-shaped or flask-shaped shape. The more pronounced the endogenous intoxication and hypoxemia, the more severely the terminal phalanges of the fingers and toes are modified.

Changes in the distal phalanges of the fingers according to the “drumstick” type can be established in several ways.

It is necessary to identify a smoothing of the normally existing angle between the base of the nail and the nail fold. The disappearance of the “window”, which is formed when the distal phalanges of the fingers are compared with their dorsal surfaces facing each other, is the most early sign thickening of the terminal phalanges. The angle between the nails does not normally extend upward more than half the length of the nail bed. As the distal phalanges of the fingers thicken, the angle between the nail plates becomes wide and deep (Fig. 1).

On unmodified fingers, the distance between points A and B should exceed the distance between points C and D. With “drumsticks” the relationship is the opposite: C - D becomes longer than A - B (Fig. 2).

Another important sign PG - the value of the angle ACE. On a normal finger this angle is less than 180°; with “drumsticks” it is more than 180° (Fig. 2).

Along with the “Hippocrates fingers”, in paraneoplastic Marie-Bamberger syndrome, periostitis appears in the area of the end sections of the long tubular bones(usually the forearms and legs), as well as the bones of the hands and feet. In places of periosteal changes, severe ossalgia or arthralgia and local palpation pain may be observed, with X-ray examination a double cortical layer is revealed, due to the presence of a narrow dense strip separated from the compact bone substance by a light gap (symptom of “tram rails”) (Fig. 3). It is believed that Marie-Bamberger syndrome is pathognomonic for lung cancer; less often it occurs in other primary intrathoracic tumors ( benign neoplasms lungs, pleural mesothelioma, teratoma, mediastinal lipoma). Rarely, this syndrome occurs in cancer. gastrointestinal tract, lymphoma with metastases to the lymph nodes of the mediastinum, lymphogranulomatosis. At the same time, Marie-Bamberger syndrome also develops in non-oncological diseases - amyloidosis, chronic obstructive pulmonary disease, tuberculosis, bronchiectasis, congenital and acquired heart defects, etc. One of distinctive features this syndrome in non-tumor diseases there is a long (over the course of years) development characteristic changes osteoarticular apparatus, while with malignant neoplasms this process is calculated in weeks and months. After radical surgical treatment Cancer Marie-Bamberger syndrome can regress and completely disappear within a few months.

Currently, the number of diseases in which changes in the distal phalanges of the fingers are described as “drumsticks” and nails as “watch glasses” has increased significantly (Table 1). The appearance of PG often precedes more specific symptoms. We especially need to remember the “sinister” connection of this syndrome with lung cancer. Therefore, identifying signs of PG requires correct interpretation and instrumental and laboratory methods examinations for timely establishment of a reliable diagnosis.

The relationship between PG and chronic lung diseases accompanied by long-term endogenous intoxication and respiratory failure(DN), is considered obvious: their formation is especially often observed in pulmonary abscesses - 70–90% (within 1–2 months), bronchiectasis - 60–70% (within several years), pleural empyema - 40–60% (for 3–6 months or more) (“rough” fingers of Hippocrates, Fig. 4).

In tuberculosis of the respiratory organs, PGs are formed in the case of a widespread (more than 3–4 segments) destructive process with a long or chronic course(6–12 months or more) and are characterized mainly by the “watch glass” symptom, thickening, hyperemia and cyanosis of the nail fold (“delicate” Hippocratic fingers - 60–80%, Fig. 5).

In idiopathic fibrosing alveolitis (IFA), PG occurs in 54% of men and 40% of women. It has been established that the severity of hyperemia and cyanosis of the nail fold, as well as the very presence of PG, indicate an unfavorable prognosis with ELISA, reflecting, in particular, the prevalence of active damage to the alveoli (ground-glass zones detected with computed tomography) and the severity of proliferation of vascular smooth muscle cells in areas of fibrosis. PG is one of the factors that most reliably indicates high risk the formation of irreversible pulmonary fibrosis in patients with IFA, also associated with a decrease in their survival.

At diffuse diseases connective tissue with the involvement of the pulmonary parenchyma, PH always reflect the severity of DN and are an extremely unfavorable prognostic factor.

For other interstitial lung diseases, the formation of PG is less typical: their presence almost always reflects the severity of DN. J. Schulze et al. described this clinical phenomenon in a 4-year-old girl with rapidly progressive pulmonary histiocytosis X. V. Holcomb et al. revealed changes in the distal phalanges of the fingers like “drumsticks” and nails like “watch glasses” in 5 out of 11 patients examined with pulmonary veno-occlusive disease.

As lung lesions progress, PGs appear in at least 50% of patients with exogenous allergic alveolitis. It should be emphasized the leading importance of a persistent decrease in the partial pressure of oxygen in the blood and tissue hypoxia in the development of HOA in patients suffering from chronic lung diseases. Thus, in children with cystic fibrosis, the partial pressure of oxygen in arterial blood and forced expiratory volume in 1 second were the smallest in the group with the most pronounced changes in the distal phalanges of the fingers and nails.

There are isolated reports of the appearance of PG in bone sarcoidosis (J. Yancey et al., 1972). We observed more than a thousand patients with sarcoidosis of the intrathoracic lymph nodes and lungs, including skin manifestations, and in no case was the formation of PG detected. Therefore, we consider the presence/absence of PG as a differential diagnostic criterion for sarcoidosis and other organ pathologies chest(fibrosing alveolitis, tumors, tuberculosis).

Changes in the distal phalanges of the fingers like “drum sticks” and nails like “watch glasses” are often recorded when occupational diseases occurring with the involvement of the pulmonary interstitium. Relatively early appearance GOA is characteristic of patients with asbestosis; this sign indicates a high risk of death. According to S. Markowitz et al. , during a 10-year follow-up of 2709 patients with asbestosis, with the development of PG, their probability of death increased by at least 2 times.
GHGs were detected in 42% of the examined coal mine workers who suffered from silicosis; some of them, along with diffuse pneumosclerosis foci of active alveolitis were discovered. Changes in the distal phalanges of the fingers like “drum sticks” and nails like “watch glasses” have been described in workers of factories producing matches who were in contact with rhodamine used in their production.

The connection between the development of PH and hypoxemia is confirmed by the repeatedly described possibility of the disappearance of this symptom after lung transplantation. In children with cystic fibrosis, characteristic changes in the fingers regressed during the first 3 months. after lung transplantation.

The appearance of PG in a patient with interstitial disease lungs, especially with long experience illness and in the absence clinical signs activity of lung damage, requires a persistent search for a malignant tumor in lung tissue. It has been shown that in lung cancer that developed against the background of ELISA, the frequency of GOA reaches 95%, while in cases of damage to the pulmonary interstitium without signs of neoplastic transformation, it is found more rarely - in 63% of patients.

Fast development changes in the distal phalanges of the fingers like “drum sticks” are one of the indications for the development of lung cancer even in the absence precancerous diseases. In such a situation, clinical signs of hypoxia (cyanosis, shortness of breath) may be absent and this sign develops according to the laws of paraneoplastic reactions. W. Hamilton et al. demonstrated that the likelihood of a patient having PG increases by 3.9 times.

GOA is one of the most common paraneoplastic manifestations of lung cancer; its prevalence in this category of patients can exceed 30%. The dependence of the frequency of detection of PG on morphological form lung cancer: reaching 35% with the non-small cell variant, with the small cell variant this figure is only 5%.

The development of GOA in lung cancer is associated with overproduction of growth hormone and prostaglandin E2 (PGE-2) tumor cells. Partial pressure of oxygen in peripheral blood however, it may remain normal. It has been established that in the blood of patients lung cancer with a symptom of PG, the level of transforming growth factor β (TGF-β) and PGE-2 significantly exceeds that in patients without changes in the distal phalanges of the fingers. Thus, TGF-β and PGE-2 can be considered relative inducers of PG formation, relatively specific for lung cancer; Apparently, this mediator is not involved in the development of the discussed clinical phenomenon in other chronic pulmonary diseases with DN.

The paraneoplastic nature of the “drumstick” type changes in the distal phalanges of the fingers is clearly demonstrated by the disappearance of this clinical phenomenon after successful resection lung tumors. In turn, the reappearance of this clinical sign in a patient in whom treatment for lung cancer was successful is a likely indication of tumor recurrence.

PG can be a paraneoplastic manifestation of tumors localized outside the lung area, and may even precede the first clinical manifestations malignant tumors. Their formation is described in malignant tumors of the thymus, cancer of the esophagus, colon, gastrinoma, characterized by clinically typical Zollinger-Ellison syndrome, and pulmonary artery sarcoma.

The possibility of PG formation in malignant breast tumors and pleural mesothelioma, which is not accompanied by the development of DN, has been repeatedly demonstrated.

PGs are detected in lymphoproliferative diseases and leukemia, including acute myeloblastic, in which they were noted on the arms and legs. After chemotherapy, which stopped the first attack of leukemia, the signs of GOA disappeared, but reappeared after 21 months. in case of tumor recurrence. In one of the observations, regression of typical changes in the distal phalanges of the fingers was stated with successful chemotherapy and radiation therapy lymphogranulomatosis.

Thus, PG, along with various types of arthritis, erythema nodosum and migratory thrombophlebitis are among the frequent extraorgan, nonspecific manifestations of malignant tumors. The paraneoplastic origin of changes in the distal phalanges of the fingers like “drumsticks” can be assumed when they form quickly (especially in patients without DN, heart failure and in the absence of other causes of hypoxemia), as well as when combined with other possible extra-organ, nonspecific signs of a malignant tumor - an increase in ESR, changes in the peripheral blood picture (especially thrombocytosis), persistent fever, articular syndrome and recurrent thrombosis various localizations.

One of the most common reasons The appearance of PG is considered to be congenital heart defects, especially the “blue” type. Among 93 patients with pulmonary arteriovenous fistulas observed at the Mauo Clinic for 15 years, similar changes in the fingers were recorded in 19%; they exceeded hemoptysis in frequency (14%), but were inferior to noises over pulmonary artery(34%) and shortness of breath (57%).

R. Khouzam et al. (2005) described ischemic stroke embolic origin, which developed 6 weeks after birth in an 18-year-old patient. The presence of characteristic changes in the fingers and hypoxia, which required respiratory support, led to a search for an anomaly in the structure of the heart: transthoracic and transesophageal echocardiography revealed that the inferior vena cava opened into the cavity of the left atrium.

PGs can “discover” the existence of pathological shunting from the left side of the heart to the right, including that formed as a consequence cardiac surgery. M. Essop et al. (1995) observed characteristic changes in the distal phalanges of the fingers and increasing cyanosis for 4 years after balloon dilatation of rheumatic fever. mitral stenosis, the complication of which was a small defect interatrial septum. During the period since the operation, its hemodynamic significance increased significantly due to the fact that the patient also developed rheumatic stenosis of the tricuspid valve, after correction of which these symptoms completely disappeared. J. Dominik et al. noted the appearance of PG in a 39-year-old woman 25 years after successful elimination atrial septal defect. It turned out that during the operation the inferior vena cava was mistakenly directed to the left atrium.

PG is considered one of the most typical nonspecific, so-called extracardiac, clinical signs infective endocarditis(IE). The frequency of changes in the distal phalanges of the fingers like “drumsticks” in IE can exceed 50%. Evidence in favor of IE in a patient with PG high fever with chills, increased ESR, leukocytosis; Anemia, a transient increase in serum activity of hepatic aminotransferases, and various types of kidney damage are often observed. To confirm IE, transesophageal echocardiography is indicated in all cases.

According to some clinical centers, one of the most common causes of the phenomenon of PG is cirrhosis of the liver with portal hypertension and progressive dilatation of the vessels of the pulmonary circulation, leading to hypoxemia (the so-called pulmonary-renal syndrome). In such patients, GOA is usually combined with cutaneous telangiectasias, often forming “fields of spider veins» .
A connection has been established between the formation of HOA in liver cirrhosis and previous alcohol abuse. In patients with liver cirrhosis without concomitant hypoxemia, PG is usually not detected. This clinical phenomenon is also characteristic of primary cholestatic liver lesions requiring liver transplantation. childhood, including congenital atresia bile ducts.

Repeated attempts have been made to decipher the mechanisms of development of changes in the distal phalanges of the fingers like “drumsticks” in diseases, including those mentioned above ( chronic diseases lungs, congenital heart defects, IE, liver cirrhosis with portal hypertension), accompanied by persistent hypoxemia and tissue hypoxia. Hypoxia-induced activation of tissue growth factors, including platelet growth factors, plays a leading role in the formation of changes in the distal phalanges and fingernails. In addition, in patients with PH, an increase in the serum level of hepatocyte growth factor was detected, as well as vascular factor growth. The connection between the increase in the activity of the latter and a decrease in the partial pressure of oxygen in arterial blood is considered the most obvious. Also, in patients with PH, a significant increase in the expression of hypoxia-inducible factors type 1a and 2a is found.

In the development of changes in the distal phalanges of the fingers of the “drumstick” type, endothelial dysfunction associated with a decrease in the partial pressure of oxygen in the arterial blood may have a certain significance. It has been shown that in patients with GOA, the serum concentration of endothelin-1, the expression of which is induced primarily by hypoxia, is significantly higher than that in healthy people.
The mechanisms of PG formation in chronic diseases are difficult to explain. inflammatory diseases intestines, for which hypoxemia is not typical. However, they are often found in Crohn's disease (with ulcerative colitis they are not typical), in which a “drumstick” type change in the fingers may precede the actual intestinal manifestations diseases.

Number probable causes, causing changes in the distal phalanges of the fingers like “watch glasses”, continues to increase. Some of them are very rare. K. Packard et al. (2004) observed the formation of PG in a 78-year-old man who took losartan for 27 days. This clinical phenomenon persisted when losartan was replaced by valsartan, which allows us to consider it undesirable reaction for the entire class of angiotensin II receptor blockers. After switching to captopril, changes in the fingers completely regressed within 17 months. .

A. Harris et al. found characteristic changes in the distal phalanges of the fingers in a patient with primary antiphospholipid syndrome, while signs of thrombotic pulmonary lesions vascular bed he was not identified. The formation of PGs has also been described in Behçet's disease, although it cannot be completely ruled out that their appearance in this disease was accidental.
PGs are considered among possible indirect markers of drug use. In some of these patients, their development may be associated with a variant of lung damage or IE characteristic of drug addicts. Changes in the distal phalanges of the fingers like “drum sticks” are described in users of not only intravenous, but also inhaled drugs, for example, hashish smokers.

With increasing frequency (at least 5%), PG is registered in HIV-infected people. Their formation may be based on various forms of HIV-associated pulmonary diseases, but this clinical phenomenon is observed in HIV-infected patients with intact lungs. It has been established that the presence of characteristic changes in the distal phalanges of the fingers in HIV infection is associated with a lower number of CD4-positive lymphocytes in the peripheral blood; in addition, interstitial lymphocytic pneumonia is more often recorded in such patients. In HIV-infected children, the appearance of PG is a likely indication of pulmonary tuberculosis, which is possible even in the absence Mycobacterium tuberculosis in sputum samples.

The so-called primary, not associated with diseases, is known internal organs a form of GOA, often familial (Touraine-Solant-Gole syndrome). It is diagnosed only after excluding most of the causes that can cause the appearance of PG. Patients with the primary form of GOA often complain of pain in the area of the changed phalanges, increased sweating. R. Seggewiss et al. (2003) observed primary GOA involving the fingers only lower limbs. At the same time, when establishing the presence of PG in members of the same family, it is necessary to take into account the possibility that they have inherited birth defects heart (for example, patent ductus botellus). The formation of characteristic changes in the fingers can continue for about 20 years.

Recognizing the causes of changes in the distal phalanges of the fingers according to the “drumstick” type requires differential diagnosis various diseases, among which the leading position is occupied by those associated with hypoxia, i.e. clinically manifested DN and/or heart failure, as well as malignant tumors and subacute IE. Interstitial lung diseases, primarily ELISA, are one of the most common causes of PG; the severity of this clinical phenomenon can be used to assess the activity of lung damage. The rapid formation or increase in the severity of GOA necessitates the search for lung cancer and other malignant tumors. At the same time, one should take into account the possibility of the appearance of this clinical phenomenon in other diseases (Crohn's disease, HIV infection), in which it can occur much earlier than specific symptoms.

Symptoms of Addison-Biermer anemia (disease)

Clinic

Addison-Birmer anemia most often affects women aged 50-60 years. The disease begins slowly and gradually. Patients complain of weakness, fatigue, dizziness, headache, palpitations and shortness of breath when moving. In some patients in clinical picture dyspepsia dominates (belching, nausea, burning at the tip of the tongue, diarrhea), less often disorders nervous system(paresthesia, cold extremities, unsteadiness of gait).

Objectively, pale skin (with a lemon tint), slight yellowness of the sclera, puffiness of the face, sometimes swelling of the legs and feet and, almost naturally, soreness of the sternum when beating.

The patients' nutrition was preserved due to a decrease in fat metabolism. The temperature, usually low-grade, during a relapse rises to 38-39°C.

Characteristic changes in the digestive system. The edges and tip of the tongue are usually bright red with fissures and aphthous changes (glossitis). Later, the papillae of the tongue atrophy, causing it to become smooth and “varnished.” Due to atrophy of the gastric mucosa, achylia develops and, in connection with it, dyspeptic symptoms (less commonly, diarrhea). Half of the patients have an enlarged liver, and a fifth have an enlarged spleen.

Changes in the cardiovascular system are manifested by tachycardia, hypotension, heart enlargement, deafness of tones, systolic murmur above the apex and above the pulmonary artery, “spinning top noise” over the jugular veins, and in severe cases - circulatory failure. As a result dystrophic changes in the myocardium, the ECG shows low wave voltage and lengthening of the ventricular complex; T waves in all leads decrease or become negative.

Changes in the nervous system occur in approximately 50% of cases and are characterized by damage to the posterior and lateral columns spinal cord(funicular myelosis), manifested by paresthesia, decreased tendon reflexes, impaired deep and pain sensitivity, and in severe cases - paraplegia and dysfunction of the pelvic organs.

From the blood side - a high color index (up to 1.2-1.3). This is explained by the fact that the number of red blood cells decreases to a greater extent than the hemoglobin content. At qualitative analysis A blood smear reveals pronounced macroanisocytosis with the presence of megalocytes and even single megaloblasts, as well as sharp poikilocytosis. Red blood cells with remnants of nuclei are often found - in the form of Cabot rings and Jolly bodies. From the white blood side - leukopenia with hypersegmentation of neutrophil nuclei (up to 6-8 segments instead of 3). A constant sign Biermer's anemia is also thrombocytopenia. The amount of bilirubin in the blood is usually increased due to increased hemolysis of megaloblasts and megalocytes, the osmotic resistance of which is reduced.

Pernicious anemia (Addison-Biermer disease or megaloblastic anemia) is characterized by a disorder of hematopoiesis that occurs when there is a deficiency folic acid and vitamin B12 in the body. Previously, this pathological process was called malignant anemia. The nervous system and bone marrow are particularly sensitive to a deficiency of this vitamin. At the same time, many immature large precursors of megaloblasts (erythrocytes) are formed in the body.

Causes of pernicious anemia

In the body, vitamin B12 is absorbed in the area ileum, or rather in the lower part. Anemia can develop due to insufficient quantity of this vitamin in foods included in the diet. Also the reason for the development pathological process may be due to insufficient production of Carls factor (intrinsic) in the area of parietal gastric cells.

Vitamin B12 deficiency with the development of a clinical anemic picture or in its absence can cause the appearance of neurological disorders, which occurs due to the inevitable synthesis fatty acids. This may result in irreversible damage. nerve cells and demyelination, which is accompanied by tingling or numbness of the extremities, as well as ataxia.

Symptoms of pernicious anemia

The pernicious form of anemia develops slowly, therefore, at the very beginning of its occurrence it is not accompanied by pronounced severe symptoms. In this case, there are such manifestations as fatigue, weakness, rapid heartbeat, shortness of breath and dizziness.

Symptoms pernicious anemia as it progresses, the following symptoms appear:

pale icteric skin;
yellowness of the sclera;
swallowing disorder;
tongue pain;
development of glossitis ( inflammatory process language);
enlarged liver, spleen.

A characteristic symptom of pernicious anemia is damage to nerve cells, which is called funicular myelosis. As it develops, sensitivity is impaired and constant painful sensations in the area of the extremities, reminiscent of tingling. In this case, there is numbness and a feeling of “crawling goosebumps”. Patients note the presence of pronounced muscle weakness, which leads over time to gait disturbances and muscle atrophy.

Diagnosis of pernicious anemia

The diagnosis is made based on the results of the following research activities:

A blood test for pernicious anemia is the most informative method diagnostics, as it allows you to determine the level of vitamin B12 in the serum.
A urine test is a mandatory research measure, which also makes it possible to determine how much vitamin is excreted from the body.
Stool examination reveals the presence of helminthic infestations.

Diagnosis of pernicious anemia also includes determining the root cause of the disease. First of all, the state of the gastrointestinal tract is examined for the presence of gastritis, ulcers and other pathologies that affect absorption nutrients. IN mandatory the condition of the kidneys is checked, since in the presence of diseases such as pyelonephritis or renal failure Treatment with vitamin B12 injections does not produce results.

Treatment of pernicious anemia

Pernicious anemia requires timely treatment, otherwise there is Great chance spinal cord lesions. First, a symmetrical disruption of the functioning of systems and muscle structures in the lower extremities occurs, and then a disturbance of pain and superficial sensitivity develops.

Treatment of pernicious anemia should be carried out under the supervision of a physician. All measures are aimed at eliminating the causes of development pathological changes. First of all, measures are taken to treat diseases of the gastrointestinal tract, and the patient is also prescribed balanced diet. To normalize hematopoiesis in the area bone marrow replacement therapy is prescribed, which consists of inflammation of vitamin B12 deficiency.

After the first injections, there is an improvement in well-being and normalization of blood levels.

The duration of treatment ranges from 1 month or more, which depends not only on the stage of the disease, but also on the intermediate results of therapy. In order to achieve stable remission it is necessary to carry out therapeutic measures for six months, it is recommended to adhere to the following actions:

Administer cyanocobalamin daily for 2 months.
After 2 months, inject the drug once every 2 weeks.

Secondly, patients have circulating autoantibodies: in 90% - to the parietal cells of the stomach, in 60% - to the intrinsic factor of Castle. Antibodies to parietal cells are also detected in every second patient with atrophic gastritis without impaired absorption of vitamin B12 and in 10-15% of randomly selected patients, but they, as a rule, do not have antibodies to internal factor Castle.

Thirdly, relatives of people with Addison-Birmer disease are more likely to suffer from this disease, and even those who do not have anemia can detect antibodies to intrinsic Castle factor.

The clinical picture consists primarily of signs of vitamin B12 deficiency (see "Vitamin B12 deficiency: general information"). The disease begins gradually and progresses slowly. Laboratory examination reveals hypergastrinemia and absolute achlorhydria (hydrochloric acid is not produced even in response to the administration of pentagastrin), as well as changes in the blood picture and other laboratory parameters (see “Megaloblastic anemia: diagnosis”).

Replacement therapy completely and permanently eliminates disorders caused by vitamin B12 deficiency in these patients, except in cases where irreversible changes V nerve tissue occurred before treatment. However, patients are extremely predisposed to adenomatous polyps of the stomach and are approximately twice as likely to develop gastric cancer. They are shown observation, including regular guaiac testing, and, if necessary, additional studies.

Addison-Beermer disease is chronic illness, characterized by progressive anemia, damage to the nervous system and gastric achylia.

Addison-Biermer disease is the result of a violation of the hematopoietic function of the bone marrow due to a deficiency of vitamin B12 in the body. In some cases, the disease develops due to a lack of folic acid.

Addison-Beermer disease - symptoms

The onset of Addison-Biermer disease is accompanied by rapid fatigue, weakness, shortness of breath and palpitations when moving, and dizziness. Against the background of symptoms of anemia, dyspeptic symptoms are often observed: burning at the tip of the tongue, nausea, belching, diarrhea, and in some cases, disorders of the nervous system are observed (unsteadiness of gait, coldness of the extremities, paresthesia).

Patients with Addison-Biermer disease have pale skin with a lemon-yellow tint. No exhaustion is observed; in some cases, nutrition is increased. There is swelling in the area of the feet, the face is puffy.

From the outside digestive tract some changes are observed. The tongue is usually bright red and cracked. Research gastric juice allows you to identify achylia.

Palpation reveals an enlarged spleen and liver. There may be pain in the heart area. Long course diseases can lead to fatty degeneration of the heart.

Changes in the activity of the nervous system are characterized by damage to the lateral and posterior columns of the spinal cord - funicular myelosis. It is manifested by decreased tendon reflexes, paresthesia, disturbances of pain and deep sensitivity with dysfunction of the pelvic organs.

Diagnosis of Addison-Biermer disease

Diagnosis of the disease consists of identifying large red blood cells (megalocytes), red blood cells and megaloblasts with nuclear remains in the blood. Due to the predominance of megablasts, the bone marrow punctate is hyperplastic.

Addison-Birmer disease - treatment

In the treatment of Addison-Biermer disease greatest effect benefits from the use of vitamin B12. Within a day after the first injection, improvement occurs. The drug is injected intramuscularly. Favorable results can also be achieved by taking vitamin B12 orally in combination with gastromucoprotein (bifacton, biopar, mucovit).