Addison’s disease

ℹ️ Understanding Cortisol: The Stress Hormone Explained

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The Double-Edged Sword of Cortisol

Cortisol often receives negative attention, typically branded as the “stress hormone.” This steroid hormone plays a crucial role in the body’s ability to manage stress. However, many people remain unaware of the signs of elevated cortisol levels and what they might signify.

Recognising Elevated Cortisol Levels

You may have encountered social media trends that equate certain physical features, like facial puffiness, with high cortisol, often referred to as “cortisol face” or “moon face.” These viral portrayals have sparked curiosity and concern, but they may not paint the complete picture. Experts emphasize understanding cortisol’s broader role in health.

According to Dr. Jeannette M. Bennett, an associate professor in psychological science at the University of North Carolina at Charlotte, cortisol is vital for regulating inflammation and supporting immune function. It helps us fend off illnesses by managing the body’s responses to toxins and pathogens. This hormone also has significant effects on metabolism, blood pressure, blood sugar regulation, and the sleep-wake cycle.

As Dr. Nia Fogelman, associate research scientist at the Yale Stress Center, points out, cortisol enables the body to respond effectively to immediate dangers, providing the energy needed for fight-or-flight responses. However, certain medical conditions can lead to abnormal cortisol levels, either too high or too low, such as Cushing’s syndrome or Addison’s disease.

Identifying Symptoms of High Cortisol

Elevated cortisol levels don’t manifest through a single, obvious symptom, making them tricky to pinpoint. Nonetheless, there are several signs to watch for, including:

Sleep Disturbances**: Difficulty falling asleep or frequent awakenings can be indicative of high cortisol levels, though the relationship remains unclear.

Physical Changes**: Symptoms such as weight gain around the face and abdomen, increased hair growth, fat accumulation between the shoulders, and the appearance of purplish stretch marks may occur.

Mood Swings**: Increased irritability or overreacting to minor annoyances can signal high cortisol levels.

Food Cravings**: A strong desire for sugary, salty, and fatty foods can be a coping mechanism for underlying stress.

Persistent Fatigue**: Increased fatigue, headaches, and muscle weakness may also hint at elevated cortisol levels, particularly in the arms and thighs.

Hidden Issues**: High blood pressure, elevated blood sugar, and bone fragility are silent symptoms that require medical diagnosis.

 Understanding the Root Causes of High Cortisol

Several factors can lead to heightened cortisol levels:

Chronic Stress**: Unlike temporary stress, chronic stress can keep cortisol levels elevated long after a stressor has passed. Chronic stress may result from traumatic events or ongoing pressures in one’s personal or professional life.

*Mental Health Issues**: Conditions such as chronic alcohol abuse, depression, and anxiety can similarly elevate cortisol levels.

Cushing’s Syndrome**: This rare condition results from prolonged high cortisol levels and can lead to serious complications, including diabetes and bone loss. It may arise from high doses of corticosteroid medications or specific tumors that induce excess hormone production.

When and How to Test Cortisol Levels

Cortisol testing is not routinely done during medical check-ups, and there currently aren’t any at-home tests available to assess cortisol levels. Most healthcare providers only recommend testing for cortisol if there are symptoms indicative of conditions like Cushing’s syndrome.

If you experience symptoms linked to high cortisol, your doctor may suggest conducting tests to investigate further. Keeping track of your stressors and observable symptoms can help guide this conversation. Noticing that your symptoms worsen with increased stressors might indicate you’re not dealing with chronically elevated cortisol.

Several methods exist for testing cortisol levels, and they often involve multiple assessments due to natural fluctuations in cortisol throughout the day. These methods include:

Blood Tests**: Useful for diagnosing adrenal insufficiency and Cushing’s syndrome, but the timing of tests is crucial.

ACTH Stimulation Test**: Measures how well the adrenal glands respond to ACTH, requiring blood samples before and after an injection.

Urine Tests**: A 24-hour urine collection can be used to screen for Cushing’s syndrome.

Saliva Tests**: These are often done at home and can help identify risk for Cushing’s syndrome.

What Constitutes Normal Cortisol Levels?

Cortisol levels are typically highest in the morning and decline throughout the day, reaching their lowest point around midnight. The interpretation of cortisol levels depends on the specific tests performed.

It is essential to discuss test results with your doctor, who can help determine if your levels fall within a healthy range or indicate potential health issues.

The Importance of Awareness

Cortisol is integral to our body’s response to stress and various essential functions. However, persistently high levels can lead to multiple health concerns, including fatigue, weight gain, and mood fluctuations. If you suspect your cortisol levels may be elevated, it is advisable to consult your physician for evaluation and possible testing.

From https://aseannow.com/topic/1347298-understanding-cortisol-the-stress-hormone-explained/

 

ℹ️ Basics 911! Adrenal Crisis, Addison’s/Adrenal Insufficiency

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Cushing’s Help Podcast: Adrenal Crisis

Be sure to print this page to carry with you.

Definition:
Acute adrenal crisis is a life-threatening state caused by insufficient levels of cortisol, which is a hormone produced and released by the adrenal gland.

Alternative Names: Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

Causes, incidence, and risk factors:
The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the inner portion, called the medulla. The cortex produces three types of hormones, all of which are called corticosteroids.

Cortisol is a glucocortoid, a corticosteroid that maintains glucose (blood sugar) regulation, suppresses the immune response, and is released as part of the body’s response to stress. Cortisol production is regulated by a small gland just below the brain called the pituitary gland. Cortisol is essential for life. Acute adrenal crisis is a medical emergency caused by a lack of cortisol. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness.

Adrenal crisis occurs if the adrenal gland is deteriorating (Addison’s disease, primary adrenal insufficiency), if there is pituitary gland injury (secondary adrenal insufficiency), or if adrenal insufficiency is not adequately treated. Risk factors for adrenal crisis include physical stress such as infection, dehydration, trauma, or surgery, adrenal gland or pituitary gland injury, and ending treatment with steroids such as prednisone or hydrocortisone too early.

Symptoms:

  • Headache
  • Profound weakness
  • Fatigue
  • Slow, sluggish movement
  • Nausea
  • Vomiting
  • Low blood pressure
  • Dehydration
  • High fever
  • Shaking chills
  • Confusion or coma
  • Darkening of the skin
  • Rapid heart rate
  • Joint pain
  • Abdominal pain
  • Unintentional weight loss
  • Rapid respiratory rate (see tachypnea)
  • Unusual and excessive sweating on face and/or palms
  • Skin rash or lesions may be present
  • Flank pain
  • Loss of appetite

Signs and tests:

  • An ACTH (cortrosyn) stimulation test shows low cortisol.
  • The baseline cortisol level is low.
  • Fasting blood sugar may be low.
  • Serum potassium is elevated ( usually primary adrenal insufficiency).
  • Serum sodium is decreased (usually primary adrenal insufficiency).

Treatment:
In adrenal crisis, an intravenous or intramuscular injection of hydrocortisone (an injectable corticosteroid) must be given immediately. Supportive treatment of low blood pressure with intravenous fluids is usually necessary. Hospitalization is required for adequate treatment and monitoring. If infection is the cause of the crisis, antibiotic therapy may be needed.

Expectations (prognosis):
Death may occur due to overwhelming shock if early treatment is not provided.

Complications:

  • shock
  • coma
  • seizures

Calling your health care provider:
Call your health care provider if you have Addison’s disease and are unable to retain usual medications because of vomiting.Go to the emergency room or call the local emergency number (such as 911) if symptoms of acute adrenal crisis develop.

Prevention:
People who have Addison’s disease should be taught to recognize signs of potential stress that may cause an acute adrenal crisis. Most people with Addison’s disease are taught to give themselves an emergency injection of hydrocortisone or increase their dose of oral prednisone in times of stress.

It is important for the individual with Addison’s disease to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.

Never omit medication. If unable to retain medication due to vomiting, notify the health care provider.

Health Alert: Adrenal Crisis Causes Death in Some People Who Were Treated With hGH

Recently, doctors conducting the follow-up study of individuals treated with hGH looked at causes of death among recipients and found some disturbing news. Many more people have died from a treatable condition called adrenal crisis than from CJD. THIS RISK DOES NOT AFFECT EVERY RECIPIENT. IT CAN AFFECT THOSE WHO LACK OTHER HORMONES IN ADDITION TO GROWTH HORMONE. Please read on to find out if this risk applies to you. Death from adrenal crisis can be prevented.

Adrenal crisis is a serious condition that can cause death in people who lack the pituitary hormone ACTH. ACTH is responsible for regulating the adrenal gland. Often, people are unaware that they lack this hormone and therefore do not know about their risk of adrenal crisis.

Most people who were treated with hGH did not make enough of their own growth hormone. Some of them lacked growth hormone because they had birth defects, tumors or other diseases that cause the pituitary gland to malfunction or shut down. People with those problems frequently lack other key hormones made by the pituitary gland, such as ACTH, which directs the adrenal gland to make cortisol, a hormone necessary for life. Having too little cortisol can be fatal if not properly treated.

TREATMENT WITH HGH DOES NOT CAUSE ADRENAL CRISIS, but because a number of people lacking growth hormone also lack ACTH, adrenal crisis has occurred in some people who were treated with hGH. In earlier updates we have talked about how adrenal crisis can be prevented, but people continue to die from adrenal crisis, which is brought on by lack of cortisol. These deaths can be prevented. Please talk to your doctor about whether you are at risk for adrenal crisis.

  • Why should people treated with hGH know about adrenal crisis? Among the people who received hGH, those who had birth defects, tumors, and other diseases affecting the brain lacked hGH and often, other hormones made by the pituitary gland. A shortage of the hormones that regulate the adrenal glands can cause many health problems. It can also lead to death from adrenal crisis. This tragedy can be prevented.
  • What are adrenal hormones? The pituitary gland makes many hormones, including growth hormone and ACTH, a hormone which signals the adrenal glands to make cortisol, a hormone needed for life. If the adrenal gland doesn’t make enough cortisol, replacement medications must be taken. The most common medicines used for cortisol replacement are:
    • Hydrocortisone
    • Prednisone
    • Dexamethasone
  • What is adrenal crisis? Adrenal hormones are needed for life. The system that pumps blood through the body cannot work during times of physical stress, such as illness or injury, if there is a severe lack of cortisol (or its replacement). People who lack cortisol must take their cortisol replacement medication on a regular basis, and when they are sick or injured, they must take extra cortisol replacement to prevent adrenal crisis. When there is not enough cortisol, adrenal crisis can occur and may rapidly lead to death.
  • What are the symptoms of lack of adrenal hormones? If you don’t have enough cortisol or its replacement, you may have some of these problems:
    • feeling weak
    • feeling tired all the time
    • feeling sick to your stomach
    • vomiting
    • no appetite
    • weight loss

When someone with adrenal gland problems has weakness, nausea, or vomiting, that person needs immediate emergency treatment to prevent adrenal crisis and possible death.

• Why are adrenal hormones so important? Cortisol (or its replacement) helps the body respond to stress from infection, injury, or surgery. The normal adrenal gland responds to serious illness by making up to 10 times more cortisol than it usually makes. It automatically makes as much as the body needs. If you are taking a cortisol replacement drug because your body cannot make these hormones, you must increase the cortisol replacement drugs during times of illness, injury, or surgery. Some people make enough cortisol for times when they feel well, but not enough to meet greater needs when they are ill or injured. Those people might not need cortisol replacement every day but may need to take cortisol replacement medication when their body is under stress. Adrenal crisis is extremely serious and can cause death if not treated promptly. Discuss this problem with your doctor to help decide whether you need more medication or other treatment to protect your health.

• How is adrenal crisis treated? People with adrenal crisis need immediate treatment. ANY DELAY CAN CAUSE DEATH. When people with adrenal crisis are vomiting or unconscious and cannot take medicine, the hormones can be given as an injection. Getting an injection of adrenal hormones can save your life if you are in adrenal crisis. If you lack the ability to make cortisol naturally, you should carry a medical ID card and wear a Medic-Alert bracelet to tell emergency workers that you lack adrenal hormones and need treatment. This precaution can save your life if you are sick or injured.

• How can I prevent adrenal crisis?

• If you are always tired, feel weak, and have lost weight, ask your doctor if you might have a shortage of adrenal hormones.

• If you take hydrocortisone, prednisone, or dexamethasone, learn how to increase the dose when you become ill.

• If you are very ill, especially if you are vomiting and cannot take pills, seek emergency medical care immediately. Make sure you have a hydrocortisone injection with you at all times, and make sure that you and those around you (in case you’re not conscious) know how and when to administer the injection.

• Carry a medical ID card and wear a bracelet telling emergency workers that you have adrenal insufficiency and need cortisol. This way, they can treat you right away if you are injured.

Remember: SOME PEOPLE WHO LACKED GROWTH HORMONE MAY ALSO LACK CORTISOL, A HORMONE NECESSARY FOR LIFE. LACK OF CORTISOL CAN CAUSE ADRENAL CRISIS, A PREVENTABLE CONDITION THAT CAN CAUSE DEATH IF TREATED IMPROPERLY .

Deaths from adrenal crisis can be prevented if patients and their families recognize the condition and are careful to treat it right away.

Adrenal crisis is a medical emergency. Know the symptoms and how to adjust your medication when you are ill. TAKING THESE PRECAUTIONS CAN SAVE YOUR LIFE.

 

 

DebMV suggested that you should have a Medic Alert bracelet from medicalert.org

Toll free number in the USA is: by phone 7 days a week, 24 hours a day: 888-633-4298
209-668-3333 from outside the U.S.

Lorrie got this important info for us.

Alternative names:

adrenal crisis; Addisonian crisis; acute adrenal insufficiency

Definition:

An abrupt, life-threatening state caused by insufficient cortisol, a hormone produced and released by the adrenal gland.

Causes, incidence, and risk factors:

The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the inner portion, called the medulla. The cortex produces three types of hormones, which are called corticosteroids. The androgens and estrogens affect sexual development and reproduction. The glucocorticoids maintain glucose regulation, suppress the immune response, and provide for the response to stress (cortisol). The mineralocorticoids regulate sodium and potassium balance. These hormones are essential for life.

Acute adrenal crisis is an emergency caused by decreased cortisol. The crisis may occur in a person with Addison’s disease, or as the first sign of adrenal insufficiency. More uncommonly, it may be caused by a pituitary gland disorder. It may also be caused by sudden withdrawal of corticosteroids, removal or injury of the adrenal glands, or destruction of the pituitary gland. Risk factors are stress, trauma, surgery, or infection in a person with Addison’s disease, or injury or trauma to the adrenal glands or the pituitary gland. The incidence is 4 out of 100,000 people.

Prevention:

People who have Addison’s disease should be taught to recognize signs of potential stress that may precipitate an acute adrenal crisis (cause it to occur suddenly and unexpectedly). Most people with Addison’s disease are taught to give themselves an emergency injection of hydrocortisone in times of stress. It is important for the individual with Addison’s disease to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency. Never omit medication. If unable to retain medication due to vomiting, notify the health care provider.

Symptoms:

  • headache
  • profound weakness
  • fatigue
  • slow, sluggish, lethargic movement
  • nausea
  • vomiting
  • low blood pressure
  • dehydration
  • high fever
  • chills shaking
  • confusion or coma
  • darkening of the skin
  • rapid heart rate
  • joint pain
  • abdominal pain
  • unintentional weight loss
  • rapid respiratory rate
  • unusual and excessive sweating on face and/or palms
  • skin rash or lesion may be present
  • flank pain
  • appetite, loss

Signs and tests:

  • An ACTH (cortrosyn) stimulation test shows low cortisol.
  • The cortisol level is low.
  • The fasting blood sugar may be low.
  • The serum potassium is elevated.
  • The serum sodium is decreased.
  • This disease may also alter the results of the following tests:
    • sodium, urine
    • 17-hydroxycorticosteroids

Treatment:

In adrenal crisis, an intravenous or intramuscular injection of hydrocortisone (an injectable corticosteroid) must be given immediately. Supportive treatment of low blood pressure is usually necessary. Hospitalization is required for adequate treatment and monitoring. Low blood pressure may be treated with intravenous fluids. If infection is the cause of the crisis, antibiotic therapy is indicated.

Expectations (prognosis):

Death may occur due to overwhelming shock if early treatment is not provided.

Complications:

  • shock
  • coma
  • seizures

For more personal experiences, see the message boards

A Personal Experience

Shauna Wrote…What adrenal crisis feels like

As with most mornings, this one began with nausea. I’m used to it, so didn’t think much about it. I made it to the bathroom and was feeling really awful. Decided to just go to the toilet because I had that impending feeling.

Next thing I knew I was waking up, but it wasn’t like a normal awakening. I remember being in a tunnel and then thinking, “Well, this isn’t where I normally sleep.” Then I realized of course it wasn’t where I normally slept! Normally I sleep in a bed, not wedged between a wall and the toilet. (Not that I was that coherent).

I was completely disoriented as to time, place, etc. I had one big yell in me and yelled “HELP”. My four year old brought me the phone and my son got me a towel. I called 911 (thank God I had a 911 sticker on the phone because I really couldn’t remember the number). I kept telling the dispatcher I was in adrenal crisis. Of course, that meant nothing to him. I had my son get my shot but somewhere I knew that I wasn’t together enough to give myself the shot. So I puked a few more times and told my son to take my daughter upstairs so she wasn’t scared when the ambulance came.

I decided to rest on the floor of the bathroom. I had, at first, tried to go to the couch but I was much, much too weak. So my son directed the medics into the bathroom. They eventually carried me to the couch. I kept telling them about my shot, but couldn’t remember where I had my letter from Dr. Cook. They thought I was an overdose or a psych case (they told me later). They had all my pills lined up and were asking when I took this or that one last. I finally told them to look at the friggin date on the bottle and see that they were all 3/4 full. (I was agitated, too)

They put the heart monitor on me and inserted an IV and took me to the hospital. I puked one more time in the ambulance and when we arrived (though my tummy was empty). My brother and sister-in-law where there (hospital) when I arrived and my mom had arrived at my house to take care of the kids as we were leaving. Then she met us up there.

Before we arrived at the hospital, my husband had faxed a copy of Dr. Cook’s letter on how to treat me over (Brian was at work when this happened). So they came in and inserted another fluid bag. Then about ten minutes later (after my brother told the doctor, “I fully expect that my sister will have her shot withing the next ten minutes” – patient advocates are a good thing because I could’ve cared less at that point) I had my 100 mg shot of solu-medrol. I was lucky because my doctor in the ER knew about adrenal crisis.

Then I had another bag and repeated tests of my bp and heartrate. It wasn’t pretty – every time my bp was low, generally around 80/50, sometimes lower and my heart rate was 120+. They decided to admit me, but I fought and fought. Once I got a shot of Zofran (anti-nausea, best in the world) and my cortisone and some fluid, I was feeling decent. I look and feel like I’ve been through a war, but I’m alive.

As to why this happened, we’re not entirely sure at this point. I have one urine test that they’re culturing or something. I might also have shingles, but again – that’ll show up in due time (a day or two, if I have it). Or, as Dr. Cook said when I talked to him, sometimes we just don’t know. I was doing so well on my meds, back up to 27.5 and feeling good. Now I’m on 40 for the next day, and 30 for a week. Frustrating.

Adrenal crisis is awful. It’s terrifying. And what makes me want to cry as I write this (who am I kidding, I am crying) is that I couldn’t have cared less if I lived or died. I was not in my right mind, I felt so horrid. All the surgeries combined, today was the worst day I’ve ever had. And it was a huge wake-up call. I need to have a better medic-alert bracelet because they had no idea what “Stress dose steroids” were. I need to have a list of what to do in crisis on my fridge, in my purse and with every family member. Same with the letter from my endo on how to treat me. Because when I’m in crisis, I don’t know any better. I need to have things that speak for me. Thank God for family that knows, and for good doctors.

Anyway, I didn’t post this to scare anyone but Adrenal Crisis is not something to take lightly. When I felt myself hurting the night before (back pain, possibly shingles though I doubt it) I should’ve just taken an extra 5 mgs. Would’ve been a heck of a lot easier than what happened today.

A few funny parts of the day: My daughter had to dress herself and my mom was in a hurry to get her to daycare and come see me. So my daughter spent the day at daycare in tights, too small shorts and a turtleneck (none of which came close to matching). Oh, and black patent leather shoes.

Also, the medics asked what I weighed. Out of habit, I said 222 (my highest Cushing’s weight). They ALL did a double take and said no way. One guessed 140 – bless his heart. I never did get myself weighed so I don’t even know.

Oh, and if any of you called at about 8 am and spoke with a medic, call me back. lol I had a blocked call at 8am, and I vaguely remember the medic talking to someone but I wasn’t with it enough to ask who called. lol

Something I don’t say enough: I love and value you all.

 

More personal experiences.

Sue sent this along:

Early Crisis Intervention

 

The following is from the June 2002 issue of Addison News. Joan Hoffman, editor/publisher, kindly sent this issue to me and I wanted to share this with you.

This is a flow chart to show the pathway of events in a crisis. It is very important to intervene as early as possible. Use your injectable and head for the hospital! The rate at which these events take varies with individuals and circumstances. The chart is a variation of one found in a nursing encyclopedia.

 

 

Helpful Doctors: Dr. Ricardo Correa

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Ricardo Correa, MD, MEd, has been recognized as a 2023 Castle Connolly Top Doctor — the first time he has received the prestigious Top Doctor honor.

CLEVELAND, OH, October 19, 2023 /24-7PressRelease/ — Ricardo Correa, MD, MEd, has been recognized as a 2023 Castle Connolly Top Doctor — the first time he has received the prestigious Top Doctor honor. Only about 7 percent of the nation’s licensed physicians are selected annually as Castle Connolly Top Doctors in their regions for their specialties.

Dr. Correa is an endocrinologist, Endocrinology Fellowship program director, and Health Equity and Inclusive director with the Cleveland Clinic Endocrinology & Metabolism Institute.

He has special expertise in transgender medicine; neuroendocrinology; and caring for adults with adrenal disorders, such as Cushing’s syndrome, Addison’s disease, primary hyperaldosteronism, neuroendocrine tumors, and rare endocrine conditions.

Dr. Correa is certified by the American Board of Internal Medicine, with subspecialty certification in endocrinology, diabetes, and metabolism as well as nutrition. In addition, he is board certified in medical quality.

Dr. Correa is a Fellow of the American College of Physicians, the American Association of Clinical Endocrinology, the Academy for Physicians in Clinical Research, and the American College of Medical Quality.

In addition to his clinical activities, Dr. Correa serves as a clinical professor of medicine, director for longitudinal didactics, and director for mentoring and belonging — among many other roles — for the Lerner College of Medicine and the School of Medicine at Case Western Reserve University. He’s also a volunteer researcher at the Phoenix VA Medical Center and director of the Health Equity Fellowship at Creighton School of Medicine in Phoenix.

He leads Cleveland Clinic’s Endocrine Health Equity Initiatives and focuses on decreasing disparities among underrepresented minorities with diabetes, obesity, and rare endocrine conditions and health care.

Dr. Correa is a major and battalion surgeon with the U.S. Army Physician Reserve, 492nd CA Battalion.

Dr. Correa is involved in many local and national organizations and efforts related to caring for underserved communities and gender-diverse communities and promoting diversity, equity, and inclusion and volunteerism.

He speaks Spanish and English.

Dr. Correa earned his medical degree at the Universidad De Panama Faculty of Medicine in Panama City. He completed a three-year internal medicine residency at Miami’s Jackson Memorial Hospital, followed by a three-year fellowship in endocrinology, metabolism, and diabetes at the National Institutes of Health, where he focused on neuroendocrine disorders. He further trained with a one-year nutrition fellowship. He has completed multiple leadership fellowships including the Presidential Leadership Scholar Fellowship, NHMA Leadership Fellowship, and Climate Change and Health Equity Fellowship, among others.

He also holds a master’s degree (EdD) in education from the Universidad De Panama. He has published more than 100 articles in highly quality peer-reviewed journals and he is very involved in research with several grants and awards that he has earned.

Dr. Correa maintains active profiles on Instagram, Facebook, X (Twitter), and LinkedIn – offering valuable insights and updates to his professional network.

Top Doctors are nominated by peer physicians and selected by the physician-led Castle Connolly research team.

About Castle Connolly
Castle Connolly publishes its Top Doctors list at castleconnolly.com and in a variety of print and online partner publications. Nominations are open to all board-certified MDs, DOs, and DPMs. The Castle Connolly team chooses honorees based on nominee criteria that includes their medical education, training, hospital appointments, and disciplinary histories.

Doctors do not and cannot pay to be selected as a Castle Connolly Top Doctor.

Addisons Young People Webinar!

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Growing up, balancing school, friends, uni plans (and everything in between) can be tough with Addison’s or adrenal insufficiency, so this free online webinar is just for you. Join to connect with other people your age, hear from the experts and ask any questions you have.
✨ Ages 13-18
📅 Tuesday 14 October, 7-8.30pm
📍 Online (Zoom)
➡️ Register for your free ticket: https://loom.ly/hBNU_0I
Come along for more support and to meet others who “get it”!
Our second webinar is for parent’s and under 12’s. Please take a look at our event page for more details.

Basics: What Causes Abnormal Cortisol Levels?

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Cortisol isn’t bad; you need it to help regulate your responses to life. Regulation involves a very complex interplay of feedback loops between the hypothalamus, pituitary gland, and adrenal glands, says Dr. Singh.

“In general, cortisol levels tend to peak in the late morning and gradually decline throughout the day,” he explains. “When a stressful event occurs, the increased cortisol will work alongside our ‘fight or flight’ mechanisms to either upregulate or downregulate bodily functions. [Affected systems include] the central nervous system, cardiovascular system, gastrointestinal system, or immune system.”

In addition to normal processes that trigger or suppress cortisol release, levels can also be affected by different medical conditions, Dr. Singh says. For example, if someone has abnormally high levels of cortisol, this is called Cushing’s syndrome, which is typically caused by a tumor affecting any of the glands that take part in the process of cortisol production.

When people suffer from abnormally low levels of cortisol, it’s called Addison’s disease. It generally occurs due to adrenal gland dysfunction, but could also be the result of abnormal functioning of any of the other glands in the cortisol production process.

Finally, if you use corticosteroid medications such as prednisone or dexamethasone, prolonged use will result in excessive cortisol production, Dr. Singh says.

“If the medication is not adequately tapered down when discontinued, the body’s ability to create cortisol can become permanently impaired,” he says.

From https://www.yahoo.com/lifestyle/manage-pesky-stress-hormone-cortisol-184900397.html

 

📽 Video: How an Emergency Injection works!

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What should you do if an Addison crisis threatens? How do you prepare an emergency injection and how do you administer it?

If you have a gastrointestinal infection, accompanied by diarrhea and vomiting, there is a big risk of an Addison crisis.

Always discuss with your specialist what you have done and what else needs to be done. Explain to your family, colleagues and friends what illness you have, and what they should do if necessary.

Show them the animated clip below.

⁉️ Myths and Facts about Cushing’s: It is MY fault that I got Cushing’s…

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Myth: “It is MY fault that I got Cushing’s. I did something wrong that caused me to be sick! If I would have just done XYZ, this would not be happening to me!”

myth-busted

Fact: This is a very controversial topic because we don’t like to talk about it. However, many people struggle with this myth. We NEED to dispel this myth my friends! Patients themselves assume responsibility, accountability, and self blame for becoming ill.

To compound all of that, patients are often told by loved ones, family, and sometimes even their churches or other supports that there is something that THEY could be doing or haven’t done that has caused their declining health. “If you would just follow that raw food diet, then all of your symptoms would go away”, “Juicing is the answer! I told you to juice and you wouldn’t get those tumors!”, Sometimes, you are told that if you would just pray harder or have greater faith, then there is no way that you would be sick right now. And my absolute favorite, “you are just too obsessed with being sick and having Cushing’s!  Stop thinking that you have it and it will go away!”.

Now, don’t get me wrong, I find value in “positive thinking” and affirming health, wealth, and all kinds of great things. This helps build up strength and personally keeps me motivated, especially during the times that I feel like absolutely throwing in the towel and giving up!

However, I am NOT the reason and YOU are not the reason for this war with this dreadful disease. What many people don’t understand is how tenacious, brave, courageous, and INDOMITABLE you are! Cushing’s patients do not just get surgery and then everything is magically OK.

Many patients have to go through multiple surgeries, sometimes radiation, sometimes years of testing to find the ultimate source of the disease, even after having several organs messed with. Even after patients obtain their “cure”, they are faced with residual and lingering negative effects of the illness, other hormone dysregulation issues, and the anxiety and fear of a recurrence which is based in absolute reality.

There are people, like myself, who are in remission from Cushing’s, BUT we now have Addison’s Disease/Adrenal Insufficiency as a result of removing vital organs in order to save our lives from Cushing’s. So, are we to think that Adrenal Insufficiency is ALSO our faults every time we near death after an adrenal crisis?! NO! NO! NO!

This is NOT your fault! This is NOT your doing! STOP blaming yourself! The best you can do is to FIGHT! Take an empowered stance by saying “NO” to those who won’t listen. Say “NO” to those who project blame onto you and tell you that this is just a “fat person’s excuse to stay fat”. You are not just a “fat person”! YOU are an amazing person who is fighting for your life!

Let me be clear that this blaming is common and we all do it. In my “5 stages of Loss” series on Youtube; I address the “Bargaining” stage of loss, in which we assume responsibility for getting sick or even for getting better.

Everyone should watch this to understand why and how we do this:

Remember, you are a survivor! YOU are Indomitable!!! This is NOT your fault! You WILL overcome!

⁉️ Myth: After a “cure” for Cushing’s, everyone heals and goes back to normal.

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Myth: After a “cure” for Cushing’s, everyone heals and goes back to normal. All Cushing’s patients can easily heal with no repercussions after Cushing’s. After pituitary surgery or a Bilateral Adrenalectomy (BLA), life is great and being “cured” means having a “normal” life! After all, surgery is a “cure” and about 6 weeks later, you are back to normal. “Say, you had surgery XYZ long ago! Shouldn’t you be better by now?!!!!”

myth-busted

Fact: I can not even tell you how many people asked me “aren’t you better yet?!” after both of my surgeries! There are too many to count! There is a misperception that surgery means a cure and therefore, healing should happen magically and quickly. No! No! No! This is far from the truth.

The sad reality is that even some medical doctors buy into this myth and expect quick healing in their patients. However, they are not living in their patients bodies nor have they obviously read the extensive research on this. Research has shown that the healing process after surgery is a long and extensive one. One endocrinologist, expert from Northwestern, even referred to the first year after pituitary surgery for patients as “the year from hell”! He literally quoted that on a slide presentation.

It takes at least one year after pituitary surgery, for instance, to even manage hormones effectively. Surgery is invasive and hard. However, the hardest part comes AFTER surgery. This is when the body is compensating for all of the years of hormonal dysregulation and the patient is trying to get his/her levels back to normal.

There is a higher rate of recurrence of Cushing’s then we once thought. This means that after a patient has achieved remission from this illness, it is likely to come back. In these cases, a patient faces other treatments that may include radiation, the same type of surgery, or an alternative surgery.

For many pituitary patients who experience multiple recurrences, the last resort is to attack the source by removing both adrenal glands. This procedure is known as a Bilateral Adrenalectomy or BLA. In these cases, it is said that the patient “trades one disease for another”, now becoming adrenally insufficient and having Addison’s Disease. Both Pituitary and Adrenal patients are faced with a lifetime of either Secondary or Primary Adrenal Insufficiency.

Adrenal Insufficiency is also life threatening and adrenal crises can potentially lead to death. Additionally, research says that BLA patients take, on average, 3-5 years for their bodies to readjust and get anywhere near “normal”. Most patients will tell you that they never feel “normal” again!

Think of these facts the next time you feel tempted to ask your friend, family, or loved one, “why is it taking so long to get better after surgery?”. Remember that in addition to the aforementioned points; problems from Cushing’s can linger for years after surgery! One Cushing’s patient stated, “I’m 5 years post-op and I STILL have problems!” This mirrors the sentiments of many of us in the Cushing’s community. Please be conscious of this when supporting your loved one after treatment.

You can find more information in the following links:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2011.04124.x/abstract;jsessionid=CC58CF32990A60593028F4173902EC47.f03t03?deniedAccessCustomisedMessage&userIsAuthenticated=false

http://press.endocrine.org/doi/abs/10.1210/jc.2013-1470

http://press.endocrine.org/doi/abs/10.1210/jc.2012-2893

 

Written by Dr. Karen Thames of  Empowering People with Invisible Chronic Illness – The EPIC Foundation

📞 Webinar: The Art of Parenting While Sick

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Are you a parent with adrenal insufficiency?

If you’ve ever struggled with how to talk to your child about adrenal insufficiency, you’re not alone. In this free webinar with Hilary Hodge, she will discuss:

  1. What adrenal insufficiency is and how you manage it
  2. What an adrenal crisis is and what to do if you have one
  3. Household guidelines that can help you manage your condition, and more.

Thursday 27 March 2025: 7-8pm (UK Time.  3pm Eastern)

 Register now 

This webinar is perfect for parents who would love to have age-appropriate strategies and scripts in their back pocket for whenever they need to talk about their condition with their child.

There will be time for a Q&A at the end where you can bring any questions you may have.

This webinar is offered by ​​​​​​​Hilary Hodge, who has adrenal insufficiency herself, hear more about how to talk to children about adrenal insufficiency and how you manage it; how to explain what an adrenal crisis is and what they should do if you have one; how to set household guidelines to help you manage your condition, and more.

Register here: https://www.addisonsdisease.org.uk/Event/the-art-of-parenting-while-sick

📞 Webinar on How to Stay Alive Without Adrenals (BLA and Addison’s)

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YOU’RE INVITED! GoodHormoneHealth Webinaron How to Stay Alive (and flourish) if have no adrenals (BLA and Addison’s)-in memory of Dr. Friedman’s patients who passed away from adrenal insufficiency 

Dr. Theodore Friedman (The Wiz) will be giving an updated webinar on how to flourish if you have adrenal insufficiency.

Topics to be discussed include:

  • How do you optimally replace adrenal hormones?
  • What laboratory tests are needed to monitor replacement?
  • When and how do you stress dose?
  • What do you if you are having surgery?
  • What do you if you are hospitalized?
  • What about subcut cortisol versus cortisol pumps?
  • There will be an opportunity for patients to share their experience on Facebook

Sunday • January 19• 6 PM PST
Via Zoom Click here to join the meeting or
https://us02web.zoom.us/j/4209687343?pwd=amw4UzJLRDhBRXk1cS9ITU02V1pEQT09
passcode 111116
OR
+16699006833,,4209687343#,,,,*111116#
Slides and updated information sheet will be available before the webinar and recording after the meeting at slides
OR
Join on Facebook Live – https://www.facebook.com/goodhormonehealth at 6 PM