Tuesday, March 31, 2009

This week's Grand Rounds: You'll want to read it!

Running a hospital: Grand Rounds -- When things go awry is the name of this week's Grand Rounds post. Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, is known for his stance on transparency within the medical community. He is also known as "A man with a heart". His topic for the week certainly goes along with that.

In the spirit of Dr. Ernest Codman, I asked doctors, nurses, and other providers to write about incidents in which they made or were present for a medical error. What were the circumstances, and what did you do in response to the situation? How did you feel about the event, and how did it change your practice of medicine afterward.

Likewise, I asked patients who have been the victim of, or loved-ones who have seen, clinical harm to tell their stories. How did your provider(s) respond, how has the event has changed your view of the practice of medicine, and what advice you would give to the profession?
Take some time to peruse and read the his post, visiting all the links from the contributors. They are well worth reading. Make a comment, too, if you wish.

Tuesday, March 31, 2009

Addison's Alert, March 31, 2009

The Insomniac's guide to Ambulances: Every Day's a School Day
By Ben Yatzbaz
A few months ago we were given a new drug protocol which included administering hydrocortisone to patients in Addison's Crisis. To be perfectly honest, not only did I not know what it was, I'd never even heard of it until a few months ...
The Insomniac's guide to Ambulances - http://insomniacmedic.blogspot.com/

Friday, March 27, 2009

Addison's Blog Alert

Health and lifestyle
By Adminovich
Addison's disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland doesn't produce enough steroid hormones (glucocorticoids and often ...
Health and lifestyle - http://health-vienna.blogspot.com/

Monday, March 23, 2009

Addison's Alerts

Sam's Story - Addison's Disease - GreenPassion.org - Dedicated to ...
By Mogie
My name is Sam I’m 18 y/o and live in Florida. I have a disease called Addison's Disease, a very rare condition which causes the immune system to attack and destroy the.
GreenPassion.org - Dedicated... - http://www.greenpassion.org/


Testing for addison's - HealthBoards Message Boards
By topsy123
Testing for addison's Addison's Disease. ... Old 03-21-2009, 07:08 AM. topsy123. Senior Member. (female). Join Date: May 2006. Location: england uk. Posts: 123. Testing for addison's ...
HealthBoards Message Boards -... - http://www.healthboards.com/boards/

Monday, March 23, 2009

Addisons disease - symptoms, diagnosis, and treatment

From http://www.examiner.com/x-1713-Hartford-Special-Needs-Kids-Examiner~y2009m3d21-Addisons-disease--symptoms-diagnosis-and-treatment

Addison's disease is an endocrine or hormonal disorder that occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and nonexposed parts of the body.  Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. The disease is also called adrenal insufficiency, or hypocortisolism.
Cortisol is normally produced by the adrenal glands, located just above the kidneys. It belongs to a class of hormones called glucocorticoids, which affect almost every organ and tissue in the body. Scientists think that cortisol has possibly hundreds of effects in the body. Some of cortisols important jobs are:

  • help the body respond to stress
  • helps maintain blood pressure and cardiovascular function
  • helps slow the immune system's inflammatory response
  • helps balance the effects of insulin in breaking down sugar for energy
  • helps regulate the metabolism of proteins, carbohydrates, and fats
  • helps maintain proper arousal and sense of well-being

Because cortisol is so vital to health, the amount of cortisol produced by the adrenals is precisely balanced. Like many other hormones, cortisol is regulated by the brain's hypothalamus and the pituitary gland, a bean-sized organ at the base of the brain. First, the hypothalamus sends "releasing hormones" to the pituitary gland. The pituitary responds by secreting hormones that regulate growth and thyroid and adrenal function, and sex hormones such as estrogen and testosterone. One of the pituitary's main functions is to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands. When the adrenals receive the pituitary's signal in the form of ACTH, they respond by producing cortisol. Completing the cycle, cortisol then signals the pituitary to lower secretion of ACTH.
The symptoms of adrenal insufficiency usually begin gradually. Characteristics of the disease are:

  • chronic, worsening fatigue
  • muscle weakness
  • loss of appetite
  • weight loss
  • About 50 percent of the time, one will notice
  • nausea
  • vomiting
  • diarrhea

Other symptoms include:

  • low blood pressure that falls further when standing, causing dizziness or fainting
  • skin changes in Addison's disease, with areas of hyperpigmentation, or dark tanning, covering exposed and nonexposed parts of the body; this darkening of the skin is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes

Addison's disease can cause irritability and depression. Because of salt loss, a craving for salty foods also is common. Hypoglycemia, or low blood glucose, is more severe in children than in adults. In women, menstrual periods may become irregular or stop.  Because the symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse. This is called an addisonian crisis, or acute adrenal insufficiency. In most cases, symptoms are severe enough that patients seek medical treatment before a crisis occurs. However, in about 25 percent of patients, symptoms first appear during an addisonian crisis.
Symptoms of an addisonian crisis include:

  • sudden penetrating pain in the lower back, abdomen, or legs
  • severe vomiting and diarrhea
  • dehydration
  • low blood pressure
  • loss of consciousness

Left untreated, an addisonian crisis can be fatal.
In its early stages, adrenal insufficiency can be difficult to diagnose. A review of a patient's medical history based on the symptoms, especially the dark tanning of the skin, will lead a doctor to suspect Addison's disease.  A diagnosis of Addison's disease is made by laboratory tests. The aim of these tests is first to determine whether levels of cortisol are insufficient and then to establish the cause. X-ray exams of the adrenal and pituitary glands also are useful in helping to establish the cause.

ACTH Stimulation Test
This is the most specific test for diagnosing Addison's disease. In this test, blood cortisol, urine cortisol, or both are measured before and after a synthetic form of ACTH is given by injection. In the so-called short, or rapid, ACTH test, measurement of cortisol in blood is repeated 30 to 60 minutes after an intravenous ACTH injection. The normal response after an injection of ACTH is a rise in blood and urine cortisol levels. Patients with either form of adrenal insufficiency respond poorly or do not respond at all.

CRH Stimulation Test
When the response to the short ACTH test is abnormal, a "long" CRH stimulation test is required to determine the cause of adrenal insufficiency. In this test, synthetic CRH is injected intravenously and blood cortisol is measured before and 30, 60, 90, and 120 minutes after the injection. Patients with primary adrenal insufficiency have high ACTHs but do not produce cortisol. Patients with secondary adrenal insufficiency have deficient cortisol responses but absent or delayed ACTH responses. Absent ACTH response points to the pituitary as the cause; a delayed ACTH response points to the hypothalamus as the cause.  In patients suspected of having an addisonian crisis, the doctor must begin treatment with injections of salt, fluids, and glucocorticoid hormones immediately. Although a reliable diagnosis is not possible while the patient is being treated for the crisis, measurement of blood ACTH and cortisol during the crisis and before glucocorticoids are given is enough to make the diagnosis. Once the crisis is controlled and medication has been stopped, the doctor will delay further testing for up to 1 month to obtain an accurate diagnosis.
Treatment of Addison's disease involves replacing, or substituting, the hormones that the adrenal glands are not making. Cortisol is replaced orally with hydrocortisone tablets, a synthetic glucocorticoid, taken once or twice a day. If aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid called fludrocortisone acetate (Florinef), which is taken once a day. Patients receiving aldosterone replacement therapy are usually advised by a doctor to increase their salt intake. Because patients with secondary adrenal insufficiency normally maintain aldosterone production, they do not require aldosterone replacement therapy. The doses of each of these medications are adjusted to meet the needs of individual patients.

During an addisonian crisis, low blood pressure, low blood glucose, and high levels of potassium can be life threatening. Standard therapy involves intravenous injections of hydrocortisone, saline (salt water), and dextrose (sugar). This treatment usually brings rapid improvement. When the patient can take fluids and medications by mouth, the amount of hydrocortisone is decreased until a maintenance dose is achieved. If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate.

To learn more or find support please visit


Yale Medical Group

Saturday, March 07, 2009

Addison’s Disease and Disability

from http://www.socialsecurityhome.com/disabilityblog/2009/03/07/292/

Addison’s disease is also called adrenal insufficiency, adrenocortical hypofunction, and hypocortisolism.  Addison’s disease is a disease that affects your adrenal glands.  Your adrenal glands are located right above your kidneys.  The outside layer of these glands make hormones that help your body regulate your salt and water balance and your blood pressure.  These hormones also help your body respond to stress.  Addison’s disease occurs when your adrenal glands do not make enough of these hormones.

     If you, your spouse, or your child with disability has been diagnosed with Addison’s disease, you may be in need of financial help.  This may be especially true if Addison’s disease has become so serious a problem that it is the reason for the disability of you, your spouse, or your child with disability.

     In fact, you may have applied for a social security disability benefit or disability benefit from the social security administration because of the disability caused by Addison’s disease.

     If you were denied, and are planning on reapplying or appealing the denial by the social security administration, you will need the help and skill of an experienced disability lawyer who will work with you through this involved procedure.

     This is a Web site where you can find a capable disability lawyer.  The expert disability lawyer who will work with you or your spouse through SocialSecurityHome.com can assist you in reapplying or appealing the denial for a social security disability benefit or disability benefit for you, your spouse, or your child with disability because of the disability caused by Addison’s disease.

     It will be good for you to know what you can about Addison’s disease.  The more you know about the condition that you have, the better prepared you will be to deal and get help with Addison’s disease.

     Addison’s disease is the failure of your adrenal glands to produce certain hormones.  These hormones give instructions to nearly every tissue and organ in your body.  Cortisol is one of the hormones not produced sufficiently in Addison’s disease.  Aldosterone is another hormone that there is too little of.

     Addison’s disease can happen at any age of life.  It usually occurs, however, in people between the ages of 30 and 50.

     The symptoms and signs of Addison’s disease may appear slowly over a period of several months.  Some of these indications of Addison’s disease are:

    * Craving salt
    * Irritability
    * Depression
    * Vomiting, nausea, or diarrhea
    * Low blood sugar (hypoglycemia)
    * Muscle fatigue and weakness
    * Decreased appetite and weight loss
    * Low blood pressure and possible fainting
    * Skin darkening (hyperpigmentation).

There are times, however, when the signs and symptoms of Addison’s disease can manifest themselves suddenly.  This happens with acute adrenal failure (addisonian crisis).  This may involve additional signs and symptoms like:

    * Low blood pressure
    * Loss of consciousness
    * Pain in your abdomen, legs, or lower back
    * Severe diarrhea and vomiting, resulting in dehydration.

     The most usual cause of Addison’s disease is the body attacking itself (autoimmune disease).  For some unknown reason your immune system looks at the outer layer (cortex) of your adrenal glands that produces essential hormones as something foreign to be attacked and destroyed.  Other possible causes of Addison’s disease are:

    * Cancer spread to the adrenal glands
    * Tuberculosis
    * Bleeding into the adrenal glands
    * Other infections of the adrenal glands.

The above listed things are possible causes of what doctors term primary adrenal insufficiency.  There is also what is termed secondary adrenal insufficiency.  This is caused by the failure of your pituitary gland to produce a hormone that stimulates the adrenal cortex to produce its hormones.  This can result in your adrenal cortex failing to produce its hormones even though your adrenal glands are not damaged.  This is what doctors call secondary adrenal insufficiency.  Another more likely cause of secondary adrenal insufficiency happens when you are taking corticosteroids for the treatment of chronic conditions like arthritis or asthma, and you abruptly stop taking them.

     Your doctor will probably ask you about your signs and symptoms and your medical history.  If your doctor thinks you may have Addison’s disease there are several tests you may be asked to take.  Some of these may include imaging tests, blood test, insulin-induced hypoglycemia test, and ACTH stimulation test.  All of this will help your doctor to diagnose Addison’s disease.

     Treatment for your Addison’s disease if diagnosed early may involve taking prescription corticosteroids.  Your doctor may also want you to take one or more hormones that your body is not producing sufficiently.  These are usually taken in amounts that are what the body would normally produce.  Stressful situations like an infection, minor illness, or an impending operation may require a temporary increase in your dosages.

     One of the dangers associated with Addison’s disease is an addisonian crisis.  This is a life-threatening situation that results in high blood levels of potassium, low blood pressure, and low blood sugar levels.  An addisonian crisis is usually treated with intravenous injections of saline solution, hydrocortisone, and sugar (dextrose).

     Hopefully, this information about Addison’s disease will be helpful in getting the assistance you, your spouse, or your child with disability needs because of your disability caused by Addison’s disease.

     As mentioned at the beginning, if you intend to apply for a social security disability benefit or disability benefit because of the disability caused by Addison’s disease, or you have already applied and been turned down, and you plan on reapplying or appealing the denial by the social security administration; you will need to enlist a competent disability lawyer to help and guide you through this process.

     This is the right Web site for finding a skilled disability lawyer.  The expert disability lawyer at SocialSecurityHome.com who will work with you or your spouse can help you in your claim for a social security disability benefit or disability benefit because of the disability caused by Addison’s disease.

     This is something important for you, your spouse, or your child with disability.  Do not put this off.  Contact a skilled disability lawyer at SocialSecurityHome.com today.

Tags: Addison's disease, Disability Attorney, Social Security Disability, Social Security Disability Lawyer

Monday, March 02, 2009

Addison's Alerts 3/2/2009

Addison's and Exercise - HealthBoards Message Boards
Addison's and Exercise Addison's Disease. ... Old 02-28-2009, 06:37 PM. MMK4. Newbie. (female). Join Date: Sep 2007. Location: Farmington Hills, Michigan, USA. Posts: 3. Addison's and Exercise ...
HealthBoards Message Boards - HIV/AIDS - http://www.healthboards.com/boards/

Endocrinology for Studs: Addison's Disease
By Phil
Addison's Disease. Low Na+, hyperkalemia. Treatment: hydrocortisone, fludrocortisone, increase dose in intercurrent illness. Posted by Phil at 4:51 PM. 0 comments:. Post a Comment. Older Post Home. Subscribe to: Post Comments (Atom) ...
Endocrinology for Studs - http://endocrinologyforstuds.blogspot.com/