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Adrenal Insufficiency/Crisis

Definition
Insufficiency: Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones.
Crisis: Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol, a hormone produced by the adrenal glands.

The Adrenal Glands
The Adrenal gland is a small triangular shaped gland situated on top of the kidney. It's functions are many but it's primary roles are to maintain a proper balance of potassium and sodium and to mediate the body's response to stress, both short and long term. The term fight or flight is used to describe the "adrenalin rush" a person experiences when placed in extremely stressful situations and it is this role that most of you would be familiar with in regard to the Adrenal gland.

Causes
Primary Adrenal insufficiency has a number of causes including Addison's disease, cancer and hereditary factors but the cause of most significance to people here is referred to as Exogenous Adrenal Insufficiency. This type of insufficiency occurs when the adrenal glands release too little of the hormone cortisol, but there is no problem with the glands themselves. The reason this condition develops is due to the use of Steroid medications called glucocorticoids (such as prednisone, hydrocortisone, and dexamethasone).
Once steroids are taken for more than seven days there must to be a taper in order to minimise the risks of developing insufficiency or crisis.
Once a taper is completed, and depending on the length of the original course and taper, the risk of insufficiency and crisis can still be present for up to one or two years.

Symptoms
Insufficiency symptoms may include and are not restricted to:
  • Decreased ability to respond to emotional or physical stress
  • Fatigue
  • Joint pains (arthralgias)
  • Low blood pressure (hypotension), which may cause light-headedness or fainting when you stand after sitting or lying down
  • Muscle pains (myalgias)
  • Nausea and vomiting
  • Shock
  • Weakness
  • Obesity around the waist
  • Round face
  • Streaks on the stomach area
  • Hypoglycaemia (low blood sugar)
  • Low cortisol level
  • Low sodium, which may lead to salt cravings
  • Lower-than-normal response to ACTH
  • Skin rash or lesions

Crisis symptoms may include and not restricted to:
  • Dizziness
  • Nausea and Vomiting
  • Extreme fatigue
  • Low blood pressure.

Treatment
The treatment for insufficiency and crisis is to use increased doses of glucocorticoids. These higher doses are sometimes needed when tapering, due to withdrawal symptoms, or during stressful situations such as infections, before and after surgery, injury or traumatic personal situations. Steroid doses may need to be doubled or tripled. Symptoms normally improve quite quickly once treated.
An Adrenal crisis can be life threatening and requires immediate medical attention.


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