How to deal with adrenal breakthrough. A guide for patients and doctors

What is adrenal breakthrough and what are its causes?

Adrenal hyperplasia occurs when the body is unable to produce enough cortisol, a hormone responsible for regulating stress response, metabolism, blood pressure and water and electrolyte balance. It can be caused by:

• Physical stress: infections (e.g., flu, COVID-19), trauma, surgery, severe pain, dehydration.
• Emotional stress: heavy experiences, sudden changes in life situation.
• Errors in therapy: skipping drug doses, under-dosing hydrocortisone, failing to adjust the dose in stressful situations.
• Poisoning: vomiting and diarrhea leading to electrolyte loss and dehydration.

Symptoms of adrenal breakthrough

Recognizing adrenal breakthrough is crucial, as quick action can prevent serious complications and even death. Typical symptoms include:

• Severe weakness, loss of strength.
• Nausea, vomiting, diarrhea.
• A drop in blood pressure, leading to shock.
• Syncope or confusion, disorientation.
• Severe abdominal pain, sometimes mimicking acute appendicitis.
• Hypoglycemia (low blood sugar).
• Hyponatremia (low concentration of sodium in the blood), hyperkalemia (high concentration of potassium).

How to react in case of adrenal breakthrough?

First Aid:

1. Administer hydrocortisone intramuscularly or intravenously: a rescue dose of 100 mg hydrocortisone injection is recommended.
2. Provide fluids: If the patient is able to drink, give saline fluid (e.g., water with salt). If not, quickly give intravenous 0.9% NaCl solution.
3. Call emergency services immediately: adrenal hyperplasia requires hospitalization and intensive care.

Emergency kit - why should every patient have one?

Having an emergency kit is a key element in managing adrenal disease. It should include:

• Ampoules of hydrocortisone (e.g., Corhydron 100 powder and solution for injection and infusion 100 mg).
• Syringes and needles for intramuscular administration.
• Instructions for use for the patient and his relatives.

Why is the kit essential?

• Adrenal hyperplasia can occur suddenly, often when medical help is unavailable.
• Having a kit allows for immediate intervention, which can prevent serious complications.
• Just as people with diabetes have access to glucagon, patients with Addison's disease should have easy access to injectable hydrocortisone.

Education of patients and their relatives

Every patient with adrenal insufficiency should receive training in the use of an emergency kit. This includes:

• Teaching the technique of administering injections.
• Recognizing the early signs of adrenal breakthrough.
• Preparing family and loved ones to help in an emergency situation.

Examples of so-called "good practices" from other countries

In many countries, such as the UK, Germany and Canada, patients with Addison's disease have access to emergency kits as standard. Systematic training for patients and their relatives is the norm there. These practices have significantly reduced the number of complications associated with adrenal breakthroughs.

Conclusions and appeal to Polish decision makers

The introduction of mandatory emergency kits and education programs for patients with adrenal insufficiency in Poland is not only a necessity, but also a step toward saving lives. As with glucagon for people with diabetes, injectable hydrocortisone should be standard.

Education, availability of medications and increased awareness among patients and doctors are key elements in minimizing the risk of adrenal breakthroughs. This is not only a safety issue, but also a matter of improving patients' quality of life.