Download Adrenal Insufficiency (Adrenal gland failure)

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