Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Adrenal Insufficiency (Adrenal gland failure) The adrenal glands are two very important glands that are located on top of your kidneys. The adrenal glands make a hormone called CORTISOL that your body must have in order to survive severe illnesses or injuries. Cortisol is especially important at times of severe physical stress such as surgery, trauma, heart attack, or serious infection. Under normal conditions, the adrenal glands secrete a small amount of cortisol into your bloodstream. Under conditions of severe physical stress, the adrenal glands secrete approximately 10 times the usual amount of cortisol. Without this increased production of cortisol, we could not survive these severe physical stresses. This is why cortisol is called a “stress hormone”. The adrenal glands can fail for three reasons. (1.) The adrenal glands themselves can be damaged. (2.) The pituitary gland (which controls the adrenals) can be damaged. (3.) The adrenal glands can also fail if the pituitary is temporarily shut down when a patient takes high doses of steroid medications such as Prednisone for more than a few weeks. If adrenal failure occurs for any of these reasons, the body’s cortisol must be replaced with medication such as hydrocortisone or prednisone. Under normal conditons, patients with adrenal failure take a low dose of hydrocortisone or prednisone pills by mouth every day—sometimes once a day and sometimes twice a day. Under conditions of mild physical stress such as bronchitis with fever, intestinal infection or food poisoning causing diarrhea, or sinus infection, the oral hydrocortisone/prednisone dose should be doubled until the mild stress has resolved-this usually takes from 2 to 3 days. You should also try to drink extra fluids such as sports drinks that contain salt and electrolytes. This is especially important if you are experiencing fever, diarrhea, or vomiting. When severe physical stresses occur (surgery, trauma, heart attack, serious infection, etc.), 10 times the usual hydrocortisone/prednisone dose must be injected INTRAVENOUSLY (directly into a vein) by a doctor, nurse, or emergency medical technician. If this large dose is not given quickly for severe physical stress, the patient may not survive. (Emotional stress does not require any increase in the hydrocortisone/prednisone dose.) Patients with adrenal failure should wear a MEDIC-ALERT bracelet or necklace (or another form of medical identification) in case they cannot speak because of acute injury or illness (call 1-800-ID ALERT). This will allow medical people at the scene to immediately identify this problem and quickly start the proper emergency treatment (intravenous high dose steroid replacement). Family members and close friends should also be aware of the problem so that they can tell medical personnel if the patient cannot. The patient with adrenal failure should quickly make this known to any doctor that treats him/her for any medical problem. Patients with adrenal failure caused by adrenal damage usually have to take another hormonal medication called fludrocortisone (also called Florinef). The dose of Florinef does not have to be increased for mild or severe physical stress if the dose of hydrocortisone is doubled. Patients with adrenal failure due to pituitary gland damage often have to take other hormones like thyroid hormone but do not require fludrocortisone. Patients with temporary adrenal failure caused by high doses of prednisone or another steroid do not need to take anything other than hydrocortisone or prednisone. S h a ri C. Fo x, MD, FACE S o u th De n ve r En d o c rin o lo g y P h o n e : 720-381-3344 Fa x: 303-220-3709