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Addison’s disease—crisis

The healthy human body has a healthy human immune system.  When a virus, infection or anything of that nature begins to effect the body, the immune system finds it and destroys it, repairs it, neutralises it.  An important part of the immune system is the adrenal cortex’s production of hydrocorticosteroids.  Ordinarily, the human immune system responds behind your back, so to speak, reacting to any cold viruses or infections you might catch or develop.  You might feel a bit run down at first, while the body pours its energy into ramping up the immune response. The biggest problem Addisonians face is the absence of this ramping up.  Addisonians keep their daily cortisol levels up through synthetic supplement tablets, taken through the day: when you catch a bug, or develop an infection, or have any kind of response that would ordinarily set off the immune system ramping-up, you have to remember to take extra cortisol levels — double, triple, even quadruple doses compared to the normal daily dose — and see the doctor if this isn’t enough.

Unfortunately, some conditions will devastate your body too quickly, or overwhelm what cortisol you can take, or you may be in a situation where you are unable to take extra tablets (for example, due to bad vomiting, or due to injury in a car accident).  A sudden insufficiency of cortisol can result in adrenal or Addisonian crisis.  This is a medical emergency. You need to get to a hospital, fast. Addisonians usually carry high doses of emergency corticosteroids, and syringes, with them in order to deal with potential crises: a broken limb or a car accident will warrant an injection of emergency corticosteroids en route to further medical attention.  It is essential that these emergency steroids are kept up-to-date, as much depends on them.

From the point of view of the sufferer, Addisonian crisis is both numbing and scary.  The fact is, that you’re aware something is badly wrong, but you feel to weak and empty-headed to be panicky or alarmed about it.  Mentally, it’s like your sense of self, your sense of internal monologue and rationality, is suddenly wrapped and muffled and smothered and drugged.  Physically, it’s like your body has been almost removed from your control, and you can only force it to do anything with huge, wrestling effort.  It begins with apathy and lethargy, and swiftly develops into muscle weakness and uncoordination.  Sitting up is a problem, standing is out of the question: the body has insufficient cortisol to ensure that oxygenated blood is getting to the brain, and will keep trying to lay you down.  Nausea creeps in, and usually vomiting. Your heart rate rockets, your breathing becomes quite shallow.  You just want to lay down and let it all pass, vaguely hoping that something quasi-miraculous will take place and it will all be fine. This is pretty bad: not only are you robbed of the strength to do anything about your situation, but it can become very difficult to even explain or convince anybody else that you need something done about it, until you reach the point of collapse.  I have been in Addisonian crisis twice: the first time was the situation that lead to my diagnosis, and the second was following a nasty bout of food poisoning, about eight months after my diagnosis.

Late 2008, I caught salmonella poisoning.  It developed so quickly that I didn’t have time to intervene by increasing my cortisol tablet dose, and even if I had, it wouldn’t have been much use, because I was struggling to keep anything in my system long enough to metabolise it adequately. My partner caught salmonella as well, which put him in the situation of freaking out for me but also being too weak and sick to help.  We were tended to by some loving and patient family, who took us each to the GP.  I was extremely fortunate in having a GP who recognised the signs of impending Addisonian crisis and sent me straight to the emergency clinic, where I was promptly hooked up to a drip of cortisol and admitted overnight. That awful sense of desperate exhaustion is horrible: all you can do is try and sit up in the emergency clinic, waiting for them to try and take your blood pressure.  When it becomes apparent that measuring your blood pressure is not really an option (because, frankly, you have none), they will move quickly.

Fortunately, if nabbed in time, Addisonian crisis can be diverted easily, usually with intravenous cortisol or other emergency steroids.  It’s a terrible threat to your body, but like all threats, it can be effectively negotiated.  My advice to Addisonians would be to know as much as you can about your condition and about your daily cortisol needs.  Get a Medic-Alert bracelet. And build up a good support network: make sure your family, housemates, even coworkers (perhaps just the first aid officers in your workplace, if you’re shy or concerned about everyone knowing) are aware that you have a medical condition that may require emergency treatment someday.  Help them know what signs to look for.  And I cannot over-emphasise the importance of having a good relationship with your GP and, if possible, your endocrinologist.  If you think you’re getting sick, or if you are fighting a virus or infection and just not feeling good despite the extra Cortisol supplements, then don’t hesitate to get to a doctor — doctors can usually call the hospital on your behalf and warn them you’re on the way, so that you get a headstart.