Thursday, October 7, 2010

Can Corticosteroids Cause Your Adrenal to Crash or an Acute Adrenal Crisis?

Someone found this blog searching for information on this and I want to slap something up for anyone else who lands here with the same question. Because the expert info on the internet is kind of vague, particularly if you are trying to decide to go to the ER or not.

Can corticosteroids cause an adrenal crisis or adrenal crash?

Short answer: Maybe.

Long answer: Most of the medical literature says it would be rare for an adrenal crisis to occur because the part of the adrenal gland that controls blood pressure is, allegedly, not suppressed by corticosteroids.

If your blood pressure stays normal, you (probably) won't have an adrenal crisis. It's when the blood pressure tanks that you know things are getting serious. My understanding is this is why they believe an adrenal crisis is rare, because your blood pressure should not be affected.

Note that rare is not the same as never.

In addition, there are a few (i.e. minority opinion) references in medical literature saying going off corticosteroids can cause an adrenal crisis. If your last dose of prednisone* was higher than 5mg, you may have a problem.

(*Unfortunately, I am not familiar with other steroid medications, but if you call your pharmacist they can work out what the prednisone equivalent is for your steroid.)

I have also experienced severe blood pressure drops and acute adrenal crisis type symptoms myself even though that's not supposed to happen on paper. So it probably varies from person to person.

The other thing to consider is Steroid Withdrawal which, while unpleasant, is temporary and generally not dangerous. If you have just stopped steroids and have any muscle pain, it may not be an adrenal crisis. It could be withdrawal. I will write a post addressing the difference and post it separately so we don't get too bogged down here.

If you are having issues, feeling like you're going to pass out, feeling weak with all the other symptoms of an adrenal crisis (which I am sure you have googled, otherwise you wouldn't be here) here's what you can do to help yourself.

1. Eat salt. Lots of salt. In fact, if you are feeling bad enough to google 'adrenal' crash' I want you to get up right now, go to your fridge and drink either pickle or olive brine--this is the fastest method of delivery in my experience. Chug it and then eat some pickles and olives just to be safe. If you have hot dogs, eat a few of those, they are very high in sodium. Once you have done that, come back and finish reading for the next steps.

Also, from this point forward, heavily salt your food at regular intervals during the day until you know your adrenal glands are 100%.

2. Eat some sugar. Drink a glass of juice, eat some chocolate, have some cake. Whatever you got. But not too much or you'll get a sugar high. It doesn't take a lot of sugar to raise your blood sugar.

3. Drink some water to keep fluid levels up in your body. Give all that salt you're eating something to retain to keep your blood pressure up.

4. Wait 15-20 minutes and see how you feel. If you don't feel better then either something else is going on or your adrenals are just not able to rally. Try repeating steps 1 through 3 again before moving on to #5.

5.Take some more corticosteroids, if you have any. This should rectify things in a hour or two. If it doesn't, either you need a higher steroid dose OR are too far gone to help yourself and need emergency care OR it's not your adrenals.

Tip: Ask your pharmacist what the "physiologic replacement dose" is for your particular steroid. Knowing this can be helpful in deciding what dose you need when the adrenals start to crash. For prednisone, I have read that the physiologic replacement dose is 5 to 7.5 mg. I try not to take more than that unless I'm having really serious problems.

When you take more than the physiologic replacement dose, you get more side effects from the steroids. Also, more is not always better because it just enables the continued suppression of the hypothalamus-pituitary-adrenal axis which is not the goal.

Note: In a serious adrenal crisis, the more steroids the better, but, for me, if I act fast, the second symptoms start, I have found I can do a lot with just a little steroid. This is a fine line to walk. If you are really concerned or not too experienced yet in how your body is handling things, go for the high dose, but know you'll have to taper longer, go through more steroid withdrawal and it will take even longer for the adrenals to come back.

You will know if the dose you took is helping or not within in a hour or so, you can always take more steroids if you need them. But again, if you are really really sick, it might be better to take a higher dose. It's really your call.

I have been fine doing what I've outlined here, it may not work as well in your body, you know? Be careful.

6.Make an appointment with an endocrinologist or your regular physician to talk about Secondary Adrenal Insufficiency. You need a prescription for steroids and a plan to keep you upright until your body recovers.

You may have to push assertively on this. There are supposedly upwards of 6 million people in the US with Secondary Adrenal Insufficiency due to steroids, but, in my experience, doctors have never met them.

7.Buy a blood pressure monitor so you can track the drops at home. This also gives you more data points to feed your doctor. I also find it helpful to know what my BP is doing, usually once it drops to 100/70 I know I'm starting to have problems and can intervene before it gets bad.

These are the steps that have keep me out of the ER and mostly functioning normally. It is not easy, but it is better than going to the ER.

Now, if you are at the point of vomiting, then you probably aren't on the internet, but if you do end up vomiting after reading this along with all the other adrenal crisis symptoms, you should go to an ER.

Which probably won't know what to do with you, so bring someone who can say the words 'adrenal crisis' on your behalf. If you are alone, write it on your wrist in pen or Sharpie marker in case you pass out. (By the way, you really should have a medical ID bracelet.)

An acute adrenal crisis hits fast and it hits hard. From all the patient accounts I have read, there's not much warning and the window of time to help yourself is pretty narrow. For me, it has been very much a lightning bolt out of the blue. One second fine, the next BAM fighting to stay conscious. You must act very quickly to prevent a complete crash.

People who end up vomiting during an adrenal crisis, often seem to end up unconscious within seconds. So take any vomiting in conjunction with other adrenal crisis symptoms very seriously. Vomiting also makes self care difficult, if not impossible, which means it's automatically ER time; they can administer sodium, sugar and steroids that will improve things via IV.

The main goal is to take care of the problem before you ever get to the vomiting part. Adrenal stuff is pretty unusual and your ER may have never seen an adrenal crisis before. It's much better to deal with it early so you can stay home and out of the ER.

However, obviously, you should use your own judgment about when to go the ER. This is just a blog post, it has no idea how you feel, so don't take this as anything more than a guideline.

Good luck. I hope this post helped.

Related Posts

Steroid Withdrawal vs. Adrenal Suppression: How to Tell the Difference

3 comments:

  1. Thank you. my husband recently had an adrenal crisis (im sure of it) after going off of prednisone after taking it for the first time in his life for bronchitis. He nearly died.. he was so upset, it was horrible and of course the ER had no idea what had happened (he came out of it on his own without treatment and went the next day cause he was feeling so terrible) Thank you for your posts. it makes me realize that we are not crazy and he probably did have a serious complication to the prednisone.

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  2. Thank you for your blog. I just got out of the hospital 3 months ago with adrenal crisis. The idiot Dr. on call took me off the life saving Solu Cortef IV and sent me home. Then 10 hours later I was back in the ER in worse crisis. The Dr. on call still refused to treat me or see me and I had been screaming with the pain and was in respiratory acidosis with the second bout so the hospital staff doctor assumed care. Then my hospital records were falsified to cover up the first Endo's mistake. All told I have had 18 bouts of adrenal crisis in the past 9 years. With each bout I feel like I am going to die. I have been on prednisone for 18 years for what was misdiagnosed as lupus and turned out to be sarcoidosis. I also have LOCAH. Both sarcoidosis and LOCAH can cause adrenal problems as can long term steroid use.

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  3. Thank you so much for this information. I am tapering off prednisone to see if my adrenal glands will start working again. I am down to 1 mg. and feel like "death"... but hanging in there . Your articles have been the only ones on the internet with practical advice. I am managing my symptoms to avoid an adrenal crisis, with your help. Your information is also written in such a way as I can share it with family members so they can understand what I am going through. Thank you, Thank you, Thank you!!

    ReplyDelete

Thanks for your comment. I read all comments and do my best to respond to questions, usually in a new post.

If you have adrenal issues and want to connect with other patients the following message boards are wonderful resources:

http://www.mdjunction.com/forums/adrenal-insufficiency-discussions/general-support

http://www.addisonssupport.com/