Who ends up going through adrenal crises? Can emotional stress trigger a crisis? Doctors insist it is not possible and advise us to rarely adjust our steroid replacement upwards in times of stress, especially emotional.

I'm please to see this recent article from December 2014 that addresses both questions. And yes, emotional stress can lead to adrenal crisis!!  Just like we Cushies, who adjust our medication daily to keep up with our lives, said. 

http://www.healio.com/endocrinology/adrenal/news/online/%7B779ddc1d-cd37-43cd-9b9e-9d7d7949b8c0%7D/high-rates-of-adrenal-crisis-seen-in-patients-with-chronic-insufficiency

High rates of adrenal crisis seen in patients with chronic insufficiency

Hahner S. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2014-3191.

• December 8, 2014

Adrenal crisis occurs in a large proportion of patients with chronic adrenal insufficiency, even if they are educated about managing the disease, according to research published in TheJournal of Clinical Endocrinology & Metabolism.

Deaths associated with adrenal crisis occurred in approximately 6% of cases, emphasizing the need for improved management of the life-threatening complication in patients with chronic adrenal insufficiency, German researchers wrote.

"Using for the first time a prospective approach, our study provides unequivocal evidence of a high incidence of [adrenal crisis] in patients with chronic adrenal insufficiency receiving standard replacement therapy," the researchers wrote.

Stefanie Hahner, MD, of the University of Wuerzburg, and colleagues recruited 423 patients with adrenal insufficiency (primary adrenal insufficiency, n=221; secondary adrenal insufficiency, n=202) and followed them for 2 years.

At baseline and every 6 months thereafter, patients were assessed through general questionnaire. Patients received detailed written instructions on glucocorticoid dose adaptation during stress at the outset of the study; those reporting adrenal crisis were contacted by phone.

Entire data sets were available for 364 patients (86%); 64 cases of adrenal crisis during 767.5 patient-years were documented (8.3 crises/100 patient-years).

Gastrointestinal infection, fever and emotional stress accounted for most precipitating causes (20%, respectively); other stressful events — major pain, surgery, strenuous physical activity, heat and pregnancy — or unexplained sudden onset of adrenal crisis also were documented (7%).

Patients with previous adrenal crisis were at higher risk (OR=2.85; 95% CI, 1.5-5.5); no further risk factors were identified.

During follow-up, 10 patients died, and four of these deaths were associated with adrenal crisis (0.5 adrenal crisis-related deaths/100 patient-years).

"Risk factor analysis has limited potential to identify patients at risk for [adrenal crisis], and education in glucocorticoid adjustments for stressful events will not obviate the occasional need for parenteral hydrocortisone to treat impending [adrenal crisis]," the researchers summarized. "Advances in comprehensive patient education including self-administration of parenteral hydrocortisone will be crucial to eliminate death from [adrenal crisis]."

Disclosure: This work was supported by the Else Kröner Fresenius Foundation project grant and the Federal Ministry of Education and Research.

Boom & Bust: Stress Fuels Market Crisis

As a blogger and patient advocate, I always strive to explain the Cushing's experience in a way that caregivers, family and friends will understand. My hope has always been that if they really understood the damage we face, perhaps our support system would encircle us and protect us as we walk a very difficult road to remission. This does not happen as often as it should, despite nearly four years of blogging, but I am hard-headed. So, I keep trying.

To that end, I am thrilled to share this article, "Boom & Bust: Stress fuels market crisis." This article provides  fascinatingly detailed look at the roles stress and cortisol played during the financial crisis. Cortisol is cited for changing the bodies and personalities of risk-seeking stockbrokers as they faced an uncertain market future. 

The author even names cortisol "the molecule of irrational pessimism." 

I hope you will take a few moments to read this article, and please understand that the changes these brokers faced during the crisis are the same struggles we Cushing's patients face every day, for years and years. While I am not asking for empathy for stockbrokers, per se, I am asking you to read this article with Cushies in place of the stockbrokers. Reading about their symptoms may help you see your Cushie in a new way. If it does, hold her or him a little tighter, and admit you learned something about this illness. Your stock is sure to rise, as it will be music to your loved one's ears. 

Click through to the original article on the Montreal Gazette.

Day 26: Endocrine System Overview

In order to understand Cushing's, a patient must have a solid understanding of the endocrine system.  Today I share with you a very informative site describing the endocrine system.  This site has very cool diagrams; in fact, they are some of the best I've seen.  It includes information I have not seen on any other site that I have found.

The cellular stuff is hard for me to grasp, even after 60 months of living and studying this stuff.  However, I still try to learn.  Don't worry if you can't learn it all either.  For Cushies, learning new information and retaining what we learn or know is one of the most difficult mental tasks we face.  Always just do the best you can.

The Adrenal Glands: where they are and what hormones are made

How the Adrenal Glands Respond to Short-term and Long-term Stress