by Lauren Taylor from In The Cloud Copy

Adrenal insufficiency, also called Addison’s disease, is a condition in which the body does not produce adequate amounts of certain necessary hormones. In this condition, the adrenal glands do not produce enough cortisol and frequently do not produce enough aldosterone. This condition can be life-threatening and the patient must take hormones to replace those that the body isn’t producing.

Symptoms of this condition are usually slow to develop and often go unnoticed until the body experiences an event such as illness, injury, or a major stress that causes the symptoms to worsen. Typically, signs and symptoms include extreme fatigue, weight loss, hyperpigmentation, hypoglycemia, low blood pressure, fainting, muscle and joint pain, irritability, gastrointestinal symptoms, and salt craving.

Adrenal Crisis or Addisonian Crisis

An acute adrenal crisis or an Addisonian crisis can occur in these patients and is considered a life-threatening emergency. An adrenal crisis occurs when there is not enough cortisol in the system. A crisis can be brought on by multiple things, including but not limited to infection or stress, extreme dehydration, suddenly stopping a glucocorticoid medication, adrenal insufficiency that is not treated properly, pituitary gland injury, untreated Addison’s disease, and more.

Typically, when the body experiences stress, it produces two to three times more cortisol in response, but in adrenal insufficiency, the body is unable to produce the extra cortisol, leading to a crisis.

Patients experiencing an adrenal crisis must be treated promptly or death can occur. The result of inadequate cortisol in response to stress can result in low blood sugar levels, low blood pressure, and high potassium levels. To combat an acute adrenal crisis, patients need to seek prompt medical attention and immediately be given hydrocortisone intravenously. They may also require intravenous fluid replacement to combat low blood pressure.

NHS Cards for Patients with Adrenal Insufficiency

The fact that these patients are at such risk of death if not treated quickly and correctly has prompted a movement in which all adult patients with primary adrenal insufficiency will now be issued an NHS steroid emergency card. This card details how to treat an adrenal crisis and also includes a QR code to scan for additional information.

These cards come after patient deaths and more patients admitted to critical care after issues with steroid replacement therapy and insufficient emergency care during an adrenal crisis. The cards should be available from prescribers in secondary care starting August 18, 2020 and primary care prescribers, including community pharmacies, on September 1, 2020.

The hope is that these cards will help to bring attention to this condition and help to educate and formalize treatment of the condition by clinicians. Patients experiencing an adrenal crisis may be too sick to explain the fact that they are likely experiencing a crisis, and thus, the card could do the explaining for them. Providers are often focusing on the chief complaint a patient presents with and may overlook the fact that the cause could be an adrenal crisis until it’s too late. The hope is that these cards will fill that gap and help with early identification and prompt treatment in such cases.

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