Adrenal Crisis

[Reddev]

I am now on 8 mgs prednisolone. Due to reduce soon. Am I now in adrenal crisis zone? Had letter from GP surgery giving me advice on steroid emergency card I am now supposed to carry. A little bit anxious as I start to get to the point where my adrenal glands have to start to work.

[DorsetLady PMRGCAuk volunteer]

Read this link - I think GPs have been advised to notify their patients on steroids about the emergency card which Is relatively new - and I would suggest have not explained your situation very well.Probably because they don’t really understand it themselves.

healthunlocked.com/pmrgcauk...

Hopefully it will reassure you - and no you are not in adrenal crisis.

[Sunnyspells in reply to DorsetLady]

I was advised to get an emergency card 10 years ago, when I first started on steroids at 15 mg. I asked in the chemist, and the girl looked at me as if I was bonkers, but the pharmacist came out and said he didn't keep them, but could get me one, which he did!

[DorsetLady PMRGCAuk volunteer in reply to Sunnyspells]

Patients with PMR or GCA have had the (Blue) Steroid Treatment card for years - had my first in 2012...and that’s what the charity sends out with info packs and membership annual renewals (in UK).

But this is the new steroid emergency card which came out in August 2020 and is aimed at those who are steroid dependent...

[Whippetygirl in reply to DorsetLady]

I have not heard any thing from my GP surgery and I bet a lot of other people haven’t either. Makes you wonder what on earth they are doing.

[DorsetLady PMRGCAuk volunteer in reply to Whippetygirl]

Do you mean about the new emergency steroid card?

My understanding is that it is primarily targeted at those patients who have been diagnosed as having adrenal insufficiency ...and in our case in the vast majority we aren’t....

...our adrenals do stop working on high doses, but that doesn’t mean they are incapable and in the main do start working again once we get to lower doses.

So we need to carry the (blue) steroid TREATMENT card....not the STEROID EMERGENCY card - unless the doctor that prescribes your medication deems it necessary.

I would hazard a guess, most don’t.

[Reddev in reply to DorsetLady]

Thank you for your reply. This is the first time in three years they have given me a blue card. I have carried one since I was put on steroids but only because I researched my illness.

[DorsetLady PMRGCAuk volunteer in reply to Reddev]

That’s bad that you had to do the research.....whoever prescribes/dispenses the first dose should give you the card alongside the meds.

In my case it was the hospital dispensary....subsequent ones I got either from my local pharmacy or charity...but that was between 2012-2016.

[PMRpro Ambassador in reply to DorsetLady]

Mmm - but it does also mean they may not be able to respond in the event of a serious emergency event such as accident, illness, surgery or so on. Or if for some reason you were unconscious and admitted to hospital, unable to communicate with healthcare professionals you might not be given your normal daily dose - and be at risk f an adrenal crisis. I understand they are targetted at anyone on long term steroid therapy, not just patients with Addisons or other reasons for adrenal insufficiency.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

True, but the blue treatment cards gives current dose (provided patients has kept it up to date), new emergency card doesn’t list dose at all, just reason why on steroids. Needs a bit of a rethink maybe to combine the two....

[Reddev in reply to DorsetLady]

The emergency card gives you instant information on the treatment if some one is in adrenal crisis. All clinical staff may not be as aware as they should be.

[DorsetLady PMRGCAuk volunteer in reply to Reddev]

The consensus of opinion I got before I wrote post linked above is that the new card is more for medical staff info and advice.

[Whippetygirl in reply to DorsetLady]

Thank you, that is a lot clearer now.

[York54]

The pharmacy at the hospital gave me one with my medication. I keep it inside my phone case just in case of an emergency.

[Reddev in reply to York54]

Thank you.

[Hidden in reply to York54]

That's where I keep mine. I've also updated my phone ICE info with steroid doses and the fact that I'm taking MTX. My husband has a note of both on his phone in case he needs to know if there's an emergency.

[Reddev]

Thank you everyone for your help. I have now put it on my phone as wallpaper.

[PMRpro Ambassador]

You should have had a card since you started on pred - anyone on pred for more than a couple of months and at pretty much any dose is at risk of an adrenal crisis if for any reason their regular dose is missed - as the result of an accident or illness that makes them unable to speak to the medical staff caring for them. Or, as one friend did, forgot to take the pred with her on holiday and went for a week without her pred dose! She got told off roundly - and felt a lot better after restarting the pred!

It is also possible to have an adrenal crisis if you are subjected to severe trauma - and that can be an accident, illness or even physical or emotional stress. Normally your adrenal glands produce a large spike of cortisol to help the body cope with the stress but once you have been on pred for any length of time the response is blunted and there just isn't enough to go round so the system crashes.

There have been cases in the UK of adrenal crisis because the old card hadn't been handed out or used reliably so last August a new one was put out and a push started to get healthcare providers to do it properly. The letter is probably a bog standard generic one - so someone with Addison's disease will have had the same as you.

[Reddev in reply to PMRpro]

Thank you for your help. I am at the point now where I will be reducing from 8mg. So I will do it slowly and reduce by 0.5mg. Thank you once again.

[Amkoffee]

The average person with adrenal insufficiency (aka Addison's disease) takes the equivalent of 5mg pred a day. And based on that I would think you will be safe for a little while yet. But certainly talk with your doctor.