As a COPD patient I had been on a cruise and had been on a long course of methylprednisolone and a course of antibiotics. By the time we got I felt O.K. but the following day developed a terrible sore throat, which is very unlike me. I became very ill and started fainting daily...three or four times a day. I lost my appetite and food sounded repugnant. Foods that I had like all my life made me nauseated. I had utter and profound fatigue and was unable to even sit upright on the sofa. Vertigo was extreme. Various trips to the E.D...caused concerns about my brain so I had a full neuro workup. Normal. Then as the fainting continued and my what was once high blood pressure fell to 65/30 during one office visit. The nurse asked "how are you able to walk around." I wasn't. So they ordered a cardio workup...normal. The next step was that there must be something wrong with my inner ears. So I was diagnosed with vestibular neuritis. Nothing could be done. By this time I had lost 50 pounds. I was ill for a year, slowly recovering, but profoundly ill for a year. I started researching everything that could cause fainting and after ruling out all of the usual culprits, I read about "secondary adrenal insufficiency." I asked my doctor about it and she agreed that it could be the cause of everything. By the time I was finally referred to an endocrinologist my body was producing cortisol. He was convinced that I had had an adrenal insufficiency and stated that if I was ever placed on steroids again (I will be) that my taper must be quite long to avoid the same situation. From what i have been told was that I survived what was indeed a medical crisis. Sorry this is so lengthy but I wanted others to know how often this condition is undiagnosed.

Psychological stress can trigger an Adrenal Crisis. Just having a close call that you were inches from a car accident or any other stressor can cause a crisis.

All three of the episodes that landed me in the ER were treated like panic attacks and I was sent home. Including the very first one that showed my serum cortisol as being VERY low at 11pm. Mind you, this was 7dys after I'd received a cortisone injection for a skin infection, so it was actually artificially "high". Two weeks later my new GP couldn't even get a good read on what my adrenals were producing until the Kenalog shot cleared my system. This is something like 90-120 days! The Kenalog shot (glucocorticoid Triamcinolone acetonide) lead to that ER visit because it had shut down my adrenals ability to produce any cortisol on their own, at all upon stress, so I crashed. They should have administered some steroids knowing that piece of information. I don't even remember getting home and was sick for days after the fact. Months later and I'm basically bedridden because I can't get anyone to do the ACTH test I need. Hell, not even a 4xdly saliva test to look at my rhythm throughout the day. Even more scary is that there was literally NO mention from the doc on call at the ER of my serum level, despite it literally being denoted on the labs as "*LOW". I only learned this months later when I requested my medical records. They didn't even order salt, potassium, aldosterone. All this despite TELLING THEM I thought I was suffering from adrenal insufficiency upon walking in. I was completely disoriented, presented with ALL of the classic symptoms. I had blacked out and woken up on the floor in a shock-like state, was barely able to speak and couldn't even stand to do the orthostatic hypotension test. Adrenal insufficiency is real. You don't have to have full blown Addison's disease to become completely debilitated.

This is wrong. Emotional stress is as likely, if not more, to cause a crisis as physical stress. Please do your research. You should also note the need in the ER to immediately get a patient indicating adrenal crisis solucortef. A patient can go from walking and talking to dead in less than 15 minutes.

Not true that px is always hypotensive, there can be paradoxical hypertension as circulation is failing. Not true that typically fever- low cortisol = no inflammatory pathway. Dexamethasone is wrong- slow onset - you need solucortef. See endocrine society. Most likely infection for post bla is urinary tract. Please note, many many post bla patients die due to doctors refusing to give immediate iv steroids. Please fix this. You need to ekg to ensure no arrhythmia. If you inject solucortef, it has mineralcorticosteroids. The advice on doubling is incorrect. If there is a fever, it needs to be tripled and a triple dose at 4 am is needed as well. No wonder we have such a hard time getting treatment.

Yep, gotta endo peds test in an hour. Your video is the bomb!!(3rd year nursing student)

Thank you for the video!!!

Thank you.

You're awesome thank you

Thank you Dr. Bolin, really great lectures!

thank you..

thank you

so informative thank you for this video

Thanks!! Although i have ai, and been on both florinf, prednisone, and midodrine since 2009, i still do not understand it. Burned my throat from vomit, and the er, and doctors for my back pains. We need a pamphlet on how to live with this.

If a patient is in adrenal crisis and does not have a pituitary gland do you still look at cortisol levels?

Hi Paul great video I remember in one of your videos u mentioned dexamethasone suppressing cortisol production then why do we still give in adrenal crisis Thanks

Been going to the doctors for 4 years for intense fatigue, dylusions, insomnia, stomach pain (like a literal knife) dizziness, constant thirst and sever diareha, oh and I feel like my kidney is bloated (have been told by ultrasound its bloated) and yet my doctors still laugh at me say it's just IBS or salt deficiency because I'm way below average on my blood test. I'm thinking maybe something like this or even a brain tumor because I'm always anxious and off put. Not like me at all. I don't know what to do but I feel like I might be from what ever I have and no one is doing anything! I'm only 20 but I feel like I'm I a 60yr body...

My mail pharmacy sent me a vial of cortef for emergencies but not a syringe! Said I didn’t have a prescription for a syringe so how am I suppose to inject the med? Geeze

İsn't the hyperpigmentation caused by acth metabolic derivative pomc(proopiomelanocortine) ?

I HAVE ADDISON DISEASE SINCE 1980...!!

Are you familiar with the pupillary reflex test to check adrenal function? If so, can you confirm whether it's a valid test?

Not all of this is accurate in patients with Panhypopituitarism and they have adrenal crises too!

Jamima! My mom! I deleted the messages of bilawal bhutto zardari because he is a shia guy and he makes me to cry thats why about the posts of benazir all like that but in reality mqm is a shia cast not sindhi are

And syed mehrban Ali shah was not sindhi

And jamima goldsmith Khan is a jew my mom!