Addisons Crisis and Addison’s disease
Medical Emergency: Adrenal Crisis (Addisonian Crisis)
Cortisol is a hormone that helps to control blood pressure in your body, and which your body releases from the adrenal gland in response to stress. The process is regulated by the pituitary gland in your brain. If this, or the adrenal gland is damaged, a crisis can result. If an adrenal crisis is not treated quickly enough, patients can go into shock, where there is a lack of blood flow to the body’s organs. Clearly, this is a life-threatening medical emergency, but if treated quickly enough 4 out of 5 patients can recover.
Causes of Adrenal Crisis
There are various possible causes:
- Severe physical shock, e.g. a car accident
- Severe infection, e.g. flu with a high temperature
- Severe dehydration, e.g. stomach bug with vomiting
- Addison’s disease (discussed in more detail below)
Symptoms of an Adrenal Crisis
Unfortunately, a crisis is tough to diagnose. There are multiple symptoms including abdominal pain, dehydration, fatigue, nausea, or rapid heart rate to name a few. The concern then is that anyone without medical training and even those that have medical experience are not necessarily going to pick up on the fact that there is an ongoing medical emergency in these circumstances.
Concluding that the above complaints are evidence of adrenal crisis is difficult as there are certain ‘barn door’ symptoms doctors will look for, such as peculiar sodium and potassium levels, and skin tanning/ pigmentation that not all patients will have.
Treatment for adrenal crisis
In terms of treatment needed, it is crucial that patients receive an immediate steroid (hydrocortisone) injection to avoid damage to their vital organs. The steroid works in a similar way to the missing Cortisol and relieves the symptoms. However, the problem is that until such a time where a medical practitioner realises that their patient may well be having an adrenal crisis, this treatment is not one that is given as standard.
If you suffer from an adrenal crisis, you will need hospital treatment and monitoring until such a time as it is safe to discharge you home. It may even result in a diagnosis of Addison’s disease. The nature of this illness is such that you may not have realised you suffer from it until it gets to such a point that you are suffering from symptoms of adrenal crisis.
Symptoms/Signs of Addison’s disease
Addison’s disease is more common in women than men and more often seen between the ages of 30 and 50.
Early-stage symptoms of Addison’s disease are similar to other more common health conditions, such as depression or flu. You may experience:
- fatigue (lack of energy or motivation)
- muscle weakness
- low mood
- loss of appetite and unintentional weight loss
- increased thirst
Over time, these problems may become more severe, and you may experience further symptoms, such as dizziness, fainting, cramps and exhaustion. You may also develop small areas of darkened skin, lips or gums.
The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. It’s not clear why this happens, but it’s responsible for 70-90% of cases in the UK.
Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB), although this is uncommon in the UK.
Treatment for Addison’s disease
If you are diagnosed with Addison’s disease, it will be important to take your prescribed medication and carry medical ID detailing your adrenal insufficiency.
Addison’s disease does require treatment for the rest of your life. This treatment is taking medication to replace the missing hormone. With treatment, symptoms of Addison’s disease can largely be controlled. Most people with the condition live a normal lifespan and lead an active life, with few limitations.
However, many people with Addison’s disease also find they must learn to manage bouts of fatigue, and there may be associated health conditions, such as diabetes or an underactive thyroid.
People with Addison’s disease must pay attention and be aware of the risk of a sudden worsening of symptoms, and not delay in seeking medical review.
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