Acute Adrenal Insufficiency - CRASH! Medical Review Series
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- Опубликовано: 30 сен 2024
- (Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
As a COPD patient I had been on a cruise and had been on a long course of methylprednisolone and a course of antibiotics. By the time we got I felt O.K. but the following day developed a terrible sore throat, which is very unlike me. I became very ill and started fainting daily...three or four times a day. I lost my appetite and food sounded repugnant. Foods that I had like all my life made me nauseated. I had utter and profound fatigue and was unable to even sit upright on the sofa. Vertigo was extreme. Various trips to the E.D...caused concerns about my brain so I had a full neuro workup. Normal. Then as the fainting continued and my what was once high blood pressure fell to 65/30 during one office visit. The nurse asked "how are you able to walk around." I wasn't. So they ordered a cardio workup...normal. The next step was that there must be something wrong with my inner ears. So I was diagnosed with vestibular neuritis. Nothing could be done. By this time I had lost 50 pounds. I was ill for a year, slowly recovering, but profoundly ill for a year. I started researching everything that could cause fainting and after ruling out all of the usual culprits, I read about "secondary adrenal insufficiency." I asked my doctor about it and she agreed that it could be the cause of everything. By the time I was finally referred to an endocrinologist my body was producing cortisol. He was convinced that I had had an adrenal insufficiency and stated that if I was ever placed on steroids again (I will be) that my taper must be quite long to avoid the same situation. From what i have been told was that I survived what was indeed a medical crisis. Sorry this is so lengthy but I wanted others to know how often this condition is undiagnosed.
pembroke2 Very interesting to know. Many things are so undiagnosed. I hope you're feeling better now. So u had developed it because of sudden stoppage of steroids?
thanks for sharing this.
May b if Intrested v can discuss send ur no if u feel support is reqd
Thank you for sharing, I'm sorry u had to go through all of this, thank god your body was able to recover from it even without medications I guess that makes u a legend who fought vigirously to survive
@@zireal6890 Dr in Boston Massachusetts said Dexamethisone induced adarenal shutdown is murder. i never recovered full 5 years ago from steroid injection for poison ivy. 1 inje- sshuting down my healthy adrenals. now i'm a h ridden uslesss suicidal idiot. God is not any more and does not help a full recovery. stil waking shaking sevier depression taking hours daily to come little bit out of. use to be healthy 5 years ago.
This is wrong. Emotional stress is as likely, if not more, to cause a crisis as physical stress. Please do your research. You should also note the need in the ER to immediately get a patient indicating adrenal crisis solucortef. A patient can go from walking and talking to dead in less than 15 minutes.
Psychological stress can trigger an Adrenal Crisis. Just having a close call that you were inches from a car accident or any other stressor can cause a crisis.
IN LONG FUCKING TIME MAYBE? BUT DEXAMETHISONE WILL DESTROY DRIVING A PERSON CRAZY . SUFFERING A DEATH VERY FAST. MY FRIEND SHOT HIM SELF IN THE HEAD BECAUSE OF DEXAMETHISONE INDUCED ADRENAL SHUT DOWN IS MURDER. HE WOULD NOT HAVE WISHED IT ION HITLER. CAP LOCK IS BECAUSE I WAS INJECTED WITH THIS FUCKING POISON.
Hence, concentration camp survivors often have low cortisol, often low enough that they need hydrocortisone…
Not true that px is always hypotensive, there can be paradoxical hypertension as circulation is failing. Not true that typically fever- low cortisol = no inflammatory pathway. Dexamethasone is wrong- slow onset - you need solucortef. See endocrine society. Most likely infection for post bla is urinary tract. Please note, many many post bla patients die due to doctors refusing to give immediate iv steroids. Please fix this. You need to ekg to ensure no arrhythmia. If you inject solucortef, it has mineralcorticosteroids. The advice on doubling is incorrect. If there is a fever, it needs to be tripled and a triple dose at 4 am is needed as well. No wonder we have such a hard time getting treatment.
Many peoples immune Reject man made Hormones. Explain ?
Agree. Hypotension is also usually only seen with primary adrenal insufficiency and less common with secondary adrenal insufficiency. As a general rule, avoid the use of terms like "always". New guidelines are triple every 6 hours.
All three of the episodes that landed me in the ER were treated like panic attacks and I was sent home. Including the very first one that showed my serum cortisol as being VERY low at 11pm. Mind you, this was 7dys after I'd received a cortisone injection for a skin infection, so it was actually artificially "high". Two weeks later my new GP couldn't even get a good read on what my adrenals were producing until the Kenalog shot cleared my system. This is something like 90-120 days! The Kenalog shot (glucocorticoid Triamcinolone acetonide) lead to that ER visit because it had shut down my adrenals ability to produce any cortisol on their own, at all upon stress, so I crashed. They should have administered some steroids knowing that piece of information. I don't even remember getting home and was sick for days after the fact. Months later and I'm basically bedridden because I can't get anyone to do the ACTH test I need. Hell, not even a 4xdly saliva test to look at my rhythm throughout the day.
Even more scary is that there was literally NO mention from the doc on call at the ER of my serum level, despite it literally being denoted on the labs as "*LOW". I only learned this months later when I requested my medical records. They didn't even order salt, potassium, aldosterone. All this despite TELLING THEM I thought I was suffering from adrenal insufficiency upon walking in. I was completely disoriented, presented with ALL of the classic symptoms. I had blacked out and woken up on the floor in a shock-like state, was barely able to speak and couldn't even stand to do the orthostatic hypotension test.
Adrenal insufficiency is real. You don't have to have full blown Addison's disease to become completely debilitated.
So terrible situation you had . I’ve had something similar, and still trying figure out myself what is wrong with me . Our drs . Currently wlll not even let you book an appt . Sad we have to suffer needlessly :(
Yes I went through hell also the same. the Doctors were afraid to put any more man made cortisol Hormones metabolically in me. it would have eventually killed me with a lot of suffering before death with my body attacking its own organs out of immunity confusion .
Thanks!! Although i have ai, and been on both florinf, prednisone, and midodrine since 2009, i still do not understand it. Burned my throat from vomit, and the er, and doctors for my back pains. We need a pamphlet on how to live with this.
there is an AI support group on FB with a lot of useful information for patients with AI.
facebook.com/groups/184620951620985/?ref=share
My mail pharmacy sent me a vial of cortef for emergencies but not a syringe! Said I didn’t have a prescription for a syringe so how am I suppose to inject the med? Geeze
I lol'd
Hope you're ok
My pharmacy didn't give me a syringe saying it had to be given by medical personnel. I explained this is an emergency injection for me to use while waiting for emergency medical personnel, like an epi pen. They gave me the syringe after that.
@@jessicathomas1276 But you can get free syringes downtown in any city if you are an addict; they pass them out?
@@Katy-ye1zr I doubt an addicts type of needle is the same I need for intramuscular injections. Plus what does that have to do with anything? I'm not going downtown to hang out in a line with addicts for a free needle that won't even work for my medication, when I can go to the pharmacy and get exactly what I need.
So how do you know when you need it? I'm still new to all things adrenal insufficiency but pretty sure I'm diving head first into crisis
Thank you.
Jamima! My mom! I deleted the messages of bilawal bhutto zardari because he is a shia guy and he makes me to cry thats why about the posts of benazir all like that but in reality mqm is a shia cast not sindhi are
Yep, gotta endo peds test in an hour. Your video is the bomb!!(3rd year nursing student)
I HAVE ADDISON DISEASE SINCE 1980...!!
You must be taking a regular doses of Hydrocortisone because your Adrenal Glands don't support your own Cortisol? Do you take Adderall? my body rejects metabolic steroids and can't keep steady because my adrenals do give some cortisol but hard to keep levels accurate.
And jamima goldsmith Khan is a jew my mom!
Thank you for the video!!!
You're awesome thank you
Been going to the doctors for 4 years for intense fatigue, dylusions, insomnia, stomach pain (like a literal knife) dizziness, constant thirst and sever diareha, oh and I feel like my kidney is bloated (have been told by ultrasound its bloated) and yet my doctors still laugh at me say it's just IBS or salt deficiency because I'm way below average on my blood test. I'm thinking maybe something like this or even a brain tumor because I'm always anxious and off put. Not like me at all. I don't know what to do but I feel like I might be from what ever I have and no one is doing anything! I'm only 20 but I feel like I'm I a 60yr body...
Adrenal Crisis is an acute event and wouldn't be present for 4 years. Have you had your thyroid checked before? Any weight loss? You could also make sure you meet diet demands and depending on where you're from, parasites are not impossible as a chronic option.
Go see an Endocrinologist
@@amindonardi4470 you can be low on cortisol and experience these symptoms before you have an adrenal crises
thank you..
Thank you Dr. Bolin, really great lectures!
If a patient is in adrenal crisis and does not have a pituitary gland do you still look at cortisol levels?
Not all of this is accurate in patients with Panhypopituitarism and they have adrenal crises too!
so informative thank you for this video
And syed mehrban Ali shah was not sindhi
He was a liar!
İsn't the hyperpigmentation caused by acth metabolic derivative pomc(proopiomelanocortine) ?
But its not enough to show or get Atention.
Hi Paul great video
I remember in one of your videos u mentioned dexamethasone suppressing cortisol production then why do we still give in adrenal crisis
Thanks
A lot of the literature information recommends / suggests not using it to treat adrenal disorders. It is a synthetic glucocorticoid, and therefore has a longer half-life in the body.
thank you
Are you familiar with the pupillary reflex test to check adrenal function? If so, can you confirm whether it's a valid test?
The cortisol reflex test where they take a baseline blood draw then give you ACTH and redraw after 30 minutes, then again after 60 minutes is a diagnostic test. It will also tell you the type of (primary or secondary) adrenal insufficiency.
@@jessicathomas1276 If you can find someone who will A. order it, and B. administer the test.
It's generally ordered by an endocrinologist. But, if your primary care doesn't put the symptoms together, or do even baseline tests AND INTERPRET THEM CORRECTLY (think, functional medicine MD), then endocrinologists aren't likely to take you on as a patient. There need to be "clinical findings"....that primary care doctors are absolutely not trained to look for. I don't know how things are state to state, insurance company to insurance company, but with my former insurance (Blue Shield - Covered CA exchange) you CANNOT get them to cover the ACTH test ($3,000+) out of network at places like Stanford Medical Center (since most local hospitals do not administer it) if you haven't first been to a specialist (endocrinologist), and/or the order comes from that endo.
It's an endless nightmare that must kill people each year because they never get an accurate diagnosis, if one at all.
I am sending this to my doctor.@@NonyaSmith