Along with the various diagnosis's you may hear at your rheumatologists office, one you may not be familiar with, but should be, is Addison's Disease or Adrenal Insufficiency. Both are very similar and both can be very dangerous. I have had experience the last few years with them and would like to share what I know of them with you. Please remember that I am not a medical professional, I am an autoimmune patient. Please speak to your doctor about any medical questions you may have about this article.
Three years ago I was visiting my parents in Pennsylvania. I awoke one morning and just did not feel right, sort of light-headed. I did not think much of it as like many of you, mornings are very rough until I get loosened up and my medications going. This day, nothing seemed to help though. I went from light-headed to a bit dizzy. Soon I had nausea and began to be violently ill. Dizziness progressed to the room spinning and I could not longer stand. My parents called 911 and I was soon in the local hospital with an IV of strong steroids flowing into my vein. After a look at my list of ailments and my just as long list of medications I was transferred to a major hospital about 70 miles away and placed in CCU. After many tests, and blood work I was told I was having an Addisonian Crisis. This was the first I had heard of such a thing. I was told by the Hospitalist that due to my long term use of steroids (40 mg of prednisone daily for many years) my adrenal glands had shut down, sending me into a spiral, as I started to wean off of Prednisone, that only a heavy dose of steroids could stop.
When you are on a long-term, heavy dose of steroids, your body will see these as the same steroids produced by your adrenal glands. In this case your adrenal glands can actually shut down and shrivel. The danger comes into play when you begin to wean off of the steroids, or you become ill and cannot keep oral steroids down. Suddenly your body does not have the steroids it needs to function.
So what is the difference between Addison's and Adrenal Insufficiency? According to Wikipedia:
"Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservation, potassium secretion, and water retention. Craving for salt or salty foods due to the urinary losses of sodium is common."
"Addison's disease is a rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids). It is characterized by a number of relatively nonspecific symptoms, such as abdominal pain and weakness, but under certain circumstances, these may progress to Addisonian crisis, a severe illness which may include very low blood pressure and coma."
Actually, as I can tell you from recent experience, while you are laying there extremely ill in a ER bed, and the hospital endocrinologist is explaining all this to you...... you really don't care. The difference pretty much boils down to being born with glandular issues (Addison's) or having auto immune issues and being on long term steroid use (Adrenal Insufficiency) And as they both can lead to an adrenal crisis, the immediate medical response is to give you large doses of steroids to get your system back on track. I have had several crises and they can be very dangerous. Your body depends on a constant supply of steroids, whether what you take daily in medication or what your adrenal glands produce naturally for you.
The outer portion of the adrenal gland is called the adrenal cortex; the inner portion of the gland is called the adrenal medulla. The adrenal cortex provides the life-sustaining function of providing hormones such as corticosteroids, androgens and aldosterone. The adrenal medulla provides hormones--adrenaline and noradrenaline--whose functions are important to a person's ability to deal with mental and physical stress.There are two corticosteroid hormones produced by the adrenal cortex: cortisol and corticosteroids. Cortisol controls the body's use of the major nutrients--fats, carbohydrates and proteins. Corticosteroids work with cortisol to suppress the body's responses to inflammation and has effects on the body's immune system.
Starting to see the connection here? We are treated for RA with steroids as they help to control inflammation and the immune system....... but a side effect can be the virtual turning off of our own natural steroid producing glands! Now this is no way means you should stop taking your medications as your doctor prescribed them. If your body was functioning correctly, you would not have RA to begin with, so follow your doctors orders!
The symptoms of adrenal insufficiency usually begin gradually. Early symptoms may include:
- Unusual fatigue and muscle weakness
- Dizziness when standing
- Nausea, vomiting and/or diarrhea
- Loss of appetite
Symptoms that may occur in the later stages of the disease include:
- Weight loss
- Dark tanning of the skin
- Craving for salt
When your body suddenly fails to have enough steroids to function correctly you can very quickly fall into what is called an "Addisonian crisis" or "adrenal crisis" which is a constellation of symptoms that indicates severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease or a disease process suddenly affecting adrenal function. It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment.
Characteristic symptoms are:
- Sudden penetrating pain in the legs, lower back or abdomen
- Severe vomiting and diarrhea, resulting in dehydration
- Low blood pressure
- Loss of consciousness or the ability to stand
- Confusion, psychosis, slurred speech
- Severe lethargy
If you have Addison's or Adrenal insufficiency. it is not something to be taken lightly. Your family members should know the signs and symptoms of a crisis. Your doctors need to monitor your steroid levels along with potassium, calcium and many other hormone levels as well. If you mainly take oral steroids like I do, you may want to speak to your doctor about carrying an emergency supply of injectable steroids. My first crisis was caused in part due to me not being able to keep my prednisone down. If this happens, or I am in a high stress situation (your doctor will let you know exactly how to use these types of steroids) I have a few vials of Dexamethasone that I can inject IM to keep my levels constant and keep myself out of the ER. According to Wikipedia the prognosis for either of these very similar diseases with proper medication, especially hormone replacement therapy, patients can expect to live relatively normal lives. People with adrenal insufficiency should always carry identification stating their condition in case of an emergency. This should alert emergency personnel about the need to inject 100 mg of cortisol if its bearer is found severely injured or unable to answer questions. The card should also include the doctor's name and telephone number and the name and telephone number of the nearest relative to be notified.
When traveling, a needle, syringe, and an injectable form of cortisol should be carried for emergencies. A person with Addison's disease also should know how to increase medication during periods of stress or mild upper respiratory infections. Immediate medical attention is needed when severe infections, vomiting, or diarrhea occurs, as these conditions can precipitate an Addisonian crisis. A patient who is vomiting may require injections of hydrocortisone, since oral hydrocortisone supplements cannot be adequately metabolized.
Please speak to your doctor if you believe you may have adrenal issues.