Endocrine Abstracts

Background: Addison’s disease necessitates lifelong glucocorticoid replacement and proactive stress-dose management to prevent adrenal crises. Self-management becomes challenging when comorbid functional neurological disorders mimic crisis symptoms such as loss of consciousness, nausea and light headedness and weakness, leading to diagnostic confusion, frequent hospitalisations and diminished patient confidence.

Case: A 34-year-old male with Addison’s disease, postural orthostatic tachycardia syndrome, autism spectrum disorder, and learning difficulties, experienced recurrent functional dissociative seizures confirmed by video electroencephalography. Despite optimised hydrocortisone replacement (Hydrocortisone 10mg in AM, 5mg midday, 5mg PM and Fludrocortisone 100 mg BD) with reassuring day curves and biochemistry, he had recurrent admissions (7/month over one year), receiving parenteral hydrocortisone each time. Episodes featured light-headedness, weakness and collapse lasting up to 45 minutes. Recurrent episodes generated profound anxiety about distinguishing seizures from true adrenal crises.

Intervention: The endocrine team developed a personalised “traffic-light” sick-day protocol:Green: episodes <10 minutes, feeling well — no hydrocortisone adjustment. Amber: episodes >10 minutes or mild systemic symptoms (nausea, lethargy, hypotension) - take 10 mg oral hydrocortisone, increase fluids, monitor. Red: seizures >10 minutes or definite crisis features (persistent vomiting, systolic blood pressure (BP) <90 mmHg or diastolic BP < 50 mmHg) — 100 mg intramuscular hydrocortisone and seek emergency care. Implementation was supported by regular nurse-led follow-ups to reinforce education and protocol adherence.

Outcomes: Acute admissions decreased from ~84 to one annually. The patient demonstrated improved discrimination between dissociative seizures and adrenal crises, with reduced anxiety, enhanced symptom recognition, and increased confidence in self-management.

Conclusion: Personalised ‘sick-day’ protocols effectively enhance self-management in Addison’s disease complicated by overlapping functional comorbidities. This structured approach, supported by continuous education, substantially reduces unnecessary emergency care utilisation while empowering patients and improving overall quality of life. This model may benefit similar complex cases.