Adrenal crisis is a life-threatening emergency requiring immediate treatment with high glucocorticoid doses. In diagnosed Addisons disease between 3.8% and 29% of patients are estimated to need emergency hospital treatment per annum (Arlt & Allolio, 2003; Fleming & Ostergaard Kristensen, 1999).
In 2003 we conducted the largest international survey of diagnosed Addisons patients to date (N=868), enquiring about the causes and frequency of adrenal emergencies. Vomiting and diarhhoea accounted for 55% of adrenal emergencies, followed by flu-like illness and other major infections (18%). Surgical procedures carried out with insufficient steroid medication were the next most frequent cause of adrenal emergencies (6%), more than the proportion caused by accidental injury (4%).
Survey findings suggest that some Addisons patients are less stable than others, for reasons we do not understand. We asked respondents how many times they had needed hospital treatment for adrenal emergency and analysed the results by years since diagnosis.
Among those diagnosed more than 50 years ago (N=6), 1 person had never experienced an adrenal emergency. 73% of those diagnosed more than 30 years ago (N=80) reported 1 or more adrenal emergencies requiring hospital treatment. 33% of those diagnosed under 5 years ago (N=236) had needed emergency hospital treatment, with 5% reporting 4 or more adrenal emergencies. On average, men and women reported similar frequencies for adrenal emergency: 55% of women (N=555) and 51% of men (N=162) had needed emergency hospital treatment at least once (mean years since diagnosis=8).
Despite the predictable frequency of adrenal emergency, many patients are poorly prepared to manage illness or injury. Only 43% had an up-to-date emergency injection kit; 13% had no form of emergency jewellery (e.g. MedicAlert). Many could not clearly describe the sick-day rules for when to increase their dosage for illness.