Living With Adrenal Fatigue Insufficiency

 Living with adrenal insufficiency may or may not be difficult. You can manage your symptoms of Adrenal Fatigue insufficiency by taking your medicine exactly as prescribed and following precautions. The patient should prefer carrying a medical alert tag or card at all times as it can ensure you get proper treatment at the right time in case of an emergency. Keep an emergency kit with a shot of cortisol with you when traveling.

Those of you who have adrenal insufficiency should learn about their condition as much as possible and should be well aware of the early signs and symptoms of hormone deficiency. It is also wise to educate your acquaintance about it too, as they might help identify the indications in the act of adrenal crisis or other worse symptoms.



General precautions

People suffering from adrenal insufficiency must wear a medical alert bracelet wherever they go. Also, they must carry an emergency medical information card that contains a list of your family and friends' names to contact in case of an emergency and medicines and their daily doses. It is essential to identify early adrenal insufficiency and adrenal crisis; a clinician can describe subtle symptoms that should not be ignored.

Emergency precautions

People with primary adrenal insufficiency may experience an adrenal crisis, even with thorough medications and medical monitoring. To avoid any dangerous situations, the patient should always carry a syringe and a vial of dexamethasone (or another glucocorticoid) as a safety measure. It would be best if you always kept these stored at your home, work, or school and in your backpack or hand carry.

When and how to take it

The patient or their caretakers should give this injection into a muscle, usually the thigh muscle, if the patient experiences any of the following situations:

  • Encountering a significant injury following a substantial blood loss, fracture, or shock.
  • Experiencing an episode of nausea and vomiting and if oral medications are thrown up.
  • Facing any signs or symptoms of adrenal crisis
  • Fainting or unconsciousness

Usually, people with adrenal insufficiency go years without needing an injection. However, the experts recommend injection if there is any reason to believe you need it. There is very little or no risk of taking an extra dose of a glucocorticoid injection, but having low glucocorticoid levels has significant risks. After taking the injection, you should seek medical care as soon as possible. If you are located in the United States, you can access official emergency care by calling 911.

Illnesses, medical procedures, and surgery

The adrenal glands typically increase the production of cortisol when the body is stressed due to illnesses, major medical procedures, or surgery. However, during adrenal insufficiency, the glands do not have this ability.

During cold or flu, it is usually safe to increase the daily dose of glucocorticoid for a couple of days without calling the doctor. However, if symptoms worsen during that time, or if it is impossible to return to the usual glucocorticoid dose on the fourth day, you must call your health care provider for advice.

It is essential to call the provider if there are any signs of a stomach illness with nausea, diarrhea, or vomiting. It is also necessary to contact them before going for any medical procedures or surgery.

Pregnancy

The majority of women suffering from primary adrenal insufficiency can have a healthy pregnancy, labor, and delivery. If you are pregnant, make sure that an obstetrician and endocrinologist with expertise in adrenal insufficiency monitor you regularly.

It is essential to take medications regularly and carefully monitor the growing fetus and the woman's adrenal insufficiency during this time. You may require adjustments in glucocorticoid doses as you enter your third trimester and go into labor. Women who face severe morning sickness may need to switch from oral medication to inject medication until the illness subsides.

When should you call your healthcare provider?

Any kind of mental or physical stress on you can affect how much medicine you need. You should call your health care provider if:

  • You feel ill, symptoms like fever, vomiting, or diarrhea show
  • You are pregnant
  • You require surgery

Get medical assistance instantly if you have severe symptoms of adrenal insufficiency suddenly.

Treating Adrenal Insufficiency

Treatment of adrenal insufficiency depends on its symptoms and causes in each patient. Your doctor can best figure this out based on:

  • Patient's age, medical history, and overall health
  • Severity of illness
  • The reaction of the patient's to certain medicines, therapies, or procedures
  • Duration of illness
  • Other problems

Treatment of adrenal insufficiency involves replacing the hormones that your adrenal glands are not making, usually cortisol. The goal is to relieve the symptoms of hormone deficiency. The treatment goes on for a lifetime usually. The correct use of these hormones is essential to minimize symptoms and adrenal crisis. In the case of Addison's disease, you may also need to take aldosterone.

Primary adrenal insufficiency

Primary adrenal insufficiency, also known as Addison's disease, can be fatal if not treated at the right time. Treatment of Addison's usually starts with IV fluids and drugs called corticosteroids. You can take these medicines orally or intravenously. Doctors may recommend you to take them for the rest of your life. Other medications like fludrocortisone can also be prescribed to keep your body's sodium and potassium levels normal. In some cases, people may be recommended to go for androgen replacement therapy. Continue to read to know the details of each of these treatments.

Glucocorticoids

There are several options for replacing glucocorticoids. Our specialized doctors will help you choose the proper treatment to determine the most effective, convenient regimen that causes minimal side effects. Its dosage is adjusted throughout the day to mimic the normal variation in blood cortisol levels. Because hydrocortisone is available in various doses, the amount of hydrocortisone can be adjusted easily, which may be an advantage over the long-acting glucocorticoids. It is essential to note down the following through this treatment:

  • Monitoring throughout the treatment is very important as there are consequences of overdosing like weight gain, a puffy face, and decreased glucocorticoid dose. It may further increase the risk of bone thinning, leading to osteoporosis.
  • The dosage of any glucocorticoids is tailored to the patient's needs, body weight, and age, which indicates that obese people may need a higher dose, while slim ones may need a lower dose. There are chances that your doses will go through several adjustments when starting treatment.

Mineralocorticoids

Mineralocorticoids are replaced orally with a synthetic mineralocorticoid drug called fludrocortisone. Just like glucocorticoids, the dose of mineralocorticoids varies in people for fluid balance. Adequate doses have no problems. However, a high dose can cause swelling in the ankles, high blood pressure, or low blood potassium levels. In this case, the dose of fludrocortisone should be decreased.

Hormone Replacement Therapy

Hormone Replacement therapy is sometimes recommended for people with primary adrenal insufficiency. Doctors may describe a daily dose of DHEA for improving libido and well-being. However, you should know about the potential side effects of Vaginal DHEA, which include acne, facial hair, and deepened voice.

Secondary and tertiary adrenal insufficiency

People with secondary and tertiary adrenal insufficiency require only glucocorticoid replacement, not mineralocorticoid or androgen replacement. Doses may be adjusted more than often in the beginning. Treatment may also include the replacement of other deficient pituitary hormones.

What will happen if adrenal insufficiency is left untreated for long?

If adrenal insufficiency is left untreated for long, you may experience severe symptoms, known as the adrenal crisis. Adrenal crisis happens due to many reasons such as extreme stress, dehydration, illness, fever, or surgery. The symptoms of an adrenal crisis are the same as adrenal insufficiency, including an imbalance of sodium and potassium levels in the body. But it can lead to:

  • Shock
  • Seizures
  • Coma

Following initial treatment, it is essential to look for and treat any factors that may have triggered the crisis, such as infection.

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