My mom has had Addison’s for 35 years and takes her daily dose of hydrocortisone and fludrocortisone regularly. In the past two months she has become increasingly overwhelmed with various psychological problems such as anxiety, paranoia, confusion, and irritability. She reluctantly agreed to increase her dosage for a few weeks, but has now tapered back to normal and is completely resistant to help from anyone, including family members, friends, and doctors. Is anyone familiar with this type of reaction and how to deal with it? She was committed to a psychiatric hospital for three days following an outburst, which only seemed to worsen her case. Upon release to the family she asked to take a short local vacation by the sea to relax and recuperate. I took off work to help her rest for a week and she showed dramatic signs of improvement. Now that she is home again, however, her psychological symptoms have returned and she is pushing everyone away now, including me, for suggesting that she visit the endocrinologist. We are desperate for help. Does anyone have any suggestions?
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I don’t mean to be personal but what is the age of your mom? Do you know
what her dosage is, how she takes it (schedule) and if that schedule is
being followed? There are extreme mental symptoms around hormone imbalan=
ce.
Was she any better mentally at the increased dose?=0D
=0D
Renee=0D
=0D
-------Original Message-------=0D
=0D
From: anonamous5000=0D
Date: 2/7/2008 5:47:12 PM=0D
To: greyhoundlover@gmail.com=0D
Subject: [addisons] Psychological manifestation of Addison’s in family
member resistant to help=0D
=0D
IT sounds like an event that may be caused by too much steroid make sure that she is on the proper minimal dose she can handle. I have heard of roid rage but not from cortico steroids it usually happens from anabolic steroid use but it can happen if the person is on a high enough dose. I hope this info helps BIGMIKE
----- Original Message -----
From: anonamous5000mailto:addisons-cpt7716@lists.careplace.com
To: mh8kh8@msn.commailto:mh8kh8@msn.com
Sent: Thursday, February 07, 2008 3:47 PM
Subject: [addisons] Psychological manifestation of Addison’s in family member resistant to help
BigMike,
Yes it absolutely happens with corticosteroids. I was so volatile it was
amazing. I could go from unable to stop the giggles to tears to ready to rip
hubby’s head of in 2.2 seconds. I was misdiagnosed bipolar. Here is an
abstract from http://jpp.sagepub.com/cgi/content/abstract/20/4/334
Renee
"Journal of Pharmacy Practice, Vol. 20, No. 4, 334-340 (2007)
DOI: 10.1177/0897190007304981
© 2007 SAGE Publications
Corticosteroid- and Anabolic Steroid—Induced Mental Status Disturbances
Paul J. Perry, PhD, BCPP, FCCP
College of Pharmacy, Touro University, Vallejo, California, PPerry@touro.edu
, Carver College of Medicine, Department of Psychiatry, University of Iowa,
Iowa City
Corticosteroids and anabolic steroids can induce remarkably similar
presentations in the mental status changes that they precipitate. Most
individuals demonstrate affect and mood changes consistent with patients
diagnosed with either bipolar or unipolar affective disorder. In addition,
affective changes can be accompanied by delusions in the minority of
subjects. Presentation of the drug-induced disorder is dose dependent.
Patients experiencing corticosteroid-induced mental status changes are
commonly ingesting the equivalent of approximately 60 mg/d of prednisone
orally with the symptoms appearing in most patients within a week of
starting the drug. In addition, women are more likely to experience these
mental status changes. Subjects abusing anabolic steroids generally do not
exhibit any mental status changes until a dose equivalent to intramuscular
testosterone 600 mg/wk has been reached. Unlike corticosteroids, high-dose
exposure of anabolic steroids is accompanied by increased aggressive
behavior that is problematic from not only a medical but also a legal
standpoint."
She is 65 years old and takes 30 mg hydrocortisone and 0.1 mg (i think?) fludrocortisone in the morning and 12.5 mg hydrocortisone in the late afternoon. She is pretty regular about taking it but sometimes needs reminding. She doubled her hydrocortisone about one month after the symptons started and tapered down over a period of 10 days; was on normal dosage again but with the same symptoms for another couple weeks until she had an outburst and was transferred to the ER by the local mental health paramedics, where, not surprisingly, she was uncooperative and placed in the local psychiatric hospital on a 72-hour hold. Once in the psyciatric ward, she increased her dosage again by 1/2, but unfortunately they were not equipped to handle an Addisonian and botched the whole thing. It was a constant struggle from the outside to get them to give her the proper dose of cortisone and at the proper time. They diagnosed her as bipolar, which my family fought, until she was re-evaluated by a second psychiatrist and released. She is now back on her normal dose but the symptoms persist, though to a lesser degree now.
Renee - how did you overcome your disturbances? Did you take any anti-psychotics or do it just through regulation of hydrocortisone? We have purchased some over-the-counter DHEA to see if that helps. She is unwilling to see an endocrinologist or have a blood test of any sort.
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That is a BIG dose of HC. The average replacement dose is 20-25mg so she
has a lot of extra stuff in there and unless she has a condition(s) that
cause significant stress to her body that is WAY too much in my opinion. =
I
have no adrenal glands (surgically removed) and take 15/5 only adding ext=
ra
in the case of illness, severe injury or severe emotional trauma. (like
watching a child get hit and killed by a car) I will bet you lunch that =
she
is over medicated and is having Cushingnoid behavior. I had Cushing’s d=
ue
to a pituitary tumor and ultimately had to have the adrenals pulled becau=
se
we haven’t been able to quiet the tumors. I was a maniac with Cushing’s
that is why I asked the questions I did because your mom sounds a lot l l=
ike
me at that stage. I overcame by regulating the cortisol levels. To try =
to
be brief, back when my personality literally changed I was evaluated by a=
n
endocrinologist and told I was fine. I was referred to a psychiatrist wh=
o
asked about hormone imbalance (and excess cortisol or low cortisol are bo=
th
imbalances) and I told him the endo said I was fine. He dx’d me bipolar =
and
started me on heavy duty psychiatric meds. Nothing worked so the dose ke=
pt
rising. Ultimately I went toxic on one of them and now have significant
kidney damage that cannot be repaired. I would highly recommend working
with dosages before making decisions that could have horrible outcome for
the future.=0D
=0D
DHEA is strongly recommended by endocrinologists and I take a total of 25=
mg
split in 2 doses. DHEA contains the building blocks for the body to conv=
ert
to several different hormones and assuming your mom is post menopause the=
se
things tend to really drop.=0D
=0D
This is just a suggestion from a patient not medical advice!=0D
If she were my mom I’d start to wean her down on HC and talk to an
endocrinologist on the side. Cortisol withdrawal is hell. I won’t kid y=
ou.
It may get worse before it gets better. I would start reducing her dosa=
ge
by 2.5 mg and if you do not notice changes in her physical or mental
condition keep going slowly. You can drop fairly quickly to a point and
then it’s much harder. The fludro should remain the same unless otherwis=
e
directed by a physician. This manages fluid levels and electrolytes.=0D
=0D
I would take her doses of 30 and reduce every other day by 2.5 mg until s=
he
reaches 20 OR she develops serious physical problems like vomiting, diarr=
hea
confusion etc that is one of the signs it’s too much too fast. I’d do th=
e
same with her afternoon dose until you reach 5. That much HC WILL keep y=
ou
up all night. I don’t take any after 4pm.=0D
=0D
I would target 20mg spread out over the day. Many people take 3-6 doses
because it better mimics a normal day. Cortisol starts high in the morni=
ng
and slides a pretty steep slope into the evening and should be no higher
than 2 at midnight. Unless I’m sick less is better.=0D
=0D
Get her to the lowest possible dose she can take. Any excess steriods
causes severe problems with hypertension, diabetes (almost impossible to
manage glucose), cholesterol out of control (mine was 525 with 700ish
triglycerides on maximum medication to manage it) and one of the worst is
bone loss. I was diagnosed with osteoperosis at age 30. I’m still fight=
ing
with it to this day. Getting to that dose may be a royal pain but it’s
worth it in the long run. That much I can promise. If I hadn’t gotten m=
y
cortisol under control I wouldn’t be here to type this message.=0D
=0D
People with well controlled Addison’s take the largest dose in the mornin=
g
when they rise (or before) and take several doses at tapering levels. I =
do
15 and 5 because I can’t remember to take 10, 2.5, 2.5. Some even spread
that over 5-6 doses totaling anywhere from 20-30. Those with higher dose=
s
seem to have a higher demand with chronic pain or other health conditions=
=2E=0D
=0D
Renee=0D
=0D
She is 65 years old and takes 30 mg hydrocortisone and 0.1 mg (i think?)
fludrocortisone in the morning and 12.5 mg hydrocortisone in the late
afternoon. She is pretty regular about taking it but sometimes needs
reminding. She doubled her hydrocortisone about one month after the
symptons started and tapered down over a period of 10 days; was on normal
dosage again but with the same symptoms for=0D
Another couple weeks until she had an outburst and was transferred to the=
ER
by the local mental health paramedics, where, not surprisingly, she was
uncooperative and placed in the local psychiatric hospital on a 72-hour h=
old
Once in the psyciatric ward, she increased her dosage again by 1/2, but
unfortunately they were not equipped to handle an Addisonian and botched =
the
whole thing. It was a constant struggle from the outside to get them to
give her the proper dose of cortisone and at the proper time. They
diagnosed her as bipolar, which my family fought, until she was re-evalua=
ted
by a second psychiatrist and released. She is now back on her normal dos=
e
but the symptoms persist, though to a lesser degree now.=0D
=0D
Renee - how did you overcome your disturbances? Did you take any
anti-psychotics or do it just through regulation of hydrocortisone? We h=
ave
purchased some over-the-counter DHEA to see if that helps. She is unwill=
ing
to see an endocrinologist or have a blood test of any sort.=0D
=0D
__=0D
To control the emails you receive from CarePlace, go to http://www.carepl=
ace.com/account-notifications
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That is a BIG dose of HC. The average replacement dose is 20-2=
5mg so she has a lot of extra stuff in there and unless she has a conditi=
on(s) that cause significant stress to her body that is WAY too much in m=
y opinion. I have no adrenal glands (surgically removed) and take 1=
5/5 only adding extra in the case of illness, severe injury or severe emo=
tional trauma. (like watching a child get hit and killed by a car) =
I will bet you lunch that she is over medicated and is having Cushingnoid=
behavior. I had Cushing's due to a pituitary tumor and ultim=
ately had to have the adrenals pulled because we haven't been able to qui=
et the tumors. I was a maniac with Cushing's that is why I asked th=
e questions I did because your mom sounds a lot l like me at that stage.&=
nbsp; I overcame by regulating the cortisol levels. To try to be br=
ief, back when my personality literally changed I was evaluated by an end=
ocrinologist and told I was fine. I was referred to a psychiatrist =
who asked about hormone imbalance (and excess cortisol or low cortisol ar=
e both imbalances) and I told him the endo said I was fine. He dx'd=
me bipolar and started me on heavy duty psychiatric meds. Nothing =
worked so the dose kept rising. Ultimately I went toxic on one of t=
hem and now have significant kidney damage that cannot be repaired. =
I would highly recommend working with dosages before making decisions th=
at could have horrible outcome for the future.
DHEA is strongly recommended by endocrinologists and I take a total =
of 25 mg split in 2 doses. DHEA contains the building blocks for th=
e body to convert to several different hormones and assuming your mom is =
post menopause these things tend to really drop.
This is just a suggestion from a patient not medical =
advice!
If she were my mom I'd start to wean her down on HC and talk to an e=
ndocrinologist on the side. Cortisol withdrawal is hell. I wo=
n't kid you. It may get worse before it gets better. I would =
start reducing her dosage by 2.5 mg and if you do not notice changes in h=
er physical or mental condition keep going slowly. You can drop fai=
rly quickly to a point and then it's much harder. The fludro should=
remain the same unless otherwise directed by a physician. This man=
ages fluid levels and electrolytes.
I would take her doses of 30 and reduce every other day by 2.5 mg un=
til she reaches 20 OR she develops serious physical problems like vomitin=
g, diarrhea confusion etc that is one of the signs it's too much too fast=
=2E I'd do the same with her afternoon dose until you reach 5. =
; That much HC WILL keep you up all night. I don't take any after 4=
pm.
I would target 20mg spread out over the day. Many people take =
3-6 doses because it better mimics a normal day. Cortisol starts hi=
gh in the morning and slides a pretty steep slope into the evening and sh=
ould be no higher than 2 at midnight. Unless I'm sick less is better.
Get her to the lowest possible dose she can take. Any excess s=
teriods causes severe problems with hypertension, diabetes (almost imposs=
ible to manage glucose), cholesterol out of control (mine was 525 with 70=
0ish triglycerides on maximum medication to manage it) and one of the wor=
st is bone loss. I was diagnosed with osteoperosis at age 30. =
I'm still fighting with it to this day. Getting to that dose may b=
e a royal pain but it's worth it in the long run. That much I can p=
romise. If I hadn't gotten my cortisol under control I wouldn't be =
here to type this message.
People with well controlled Addison's take the largest dose in the m=
orning when they rise (or before) and take several doses at tapering leve=
ls. I do 15 and 5 because I can't remember to take 10, 2.5, 2.5.&nb=
sp; Some even spread that over 5-6 doses totaling anywhere from 20-30.&nb=
sp; Those with higher doses seem to have a higher demand with chronic pai=
n or other health conditions.
Renee
She is 65 years old and takes 30 mg hydrocortisone and 0.1 mg (i thi=
nk?) fludrocortisone in the morning and 12.5 mg hydrocortisone in the lat=
e afternoon. She is pretty regular about taking it but sometim=
es needs reminding. She doubled her hydrocortisone about one m=
onth after the symptons started and tapered down over a period of 10 days=
; was on normal dosage again but with the same symptoms for
Another couple weeks until she had an outburst and was transferred t=
o the ER by the local mental health paramedics, where, not surprisingly, =
she was uncooperative and placed in the local psychiatric hospital on a 7=
2-hour hold. Once in the psyciatric ward, she increased her do=
sage again by 1/2, but unfortunately they were not equipped to handle an =
Addisonian and botched the whole thing. It was a constant stru=
ggle from the outside to get them to give her the proper dose of cortison=
e and at the proper time. They diagnosed her as bipolar, which=
my family fought, until she was re-evaluated by a second psychiatrist an=
d released. She is now back on her normal dose but the symptom=
s persist, though to a lesser degree now.
Renee - how did you overcome your disturbances? Did you t=
ake any anti-psychotics or do it just through regulation of hydrocortison=
e? We have purchased some over-the-counter DHEA to see if that=
helps. She is unwilling to see an endocrinologist or have a b=
lood test of any sort.
__
To control the emails you receive from CarePlace, go to http://www.careplace.com/a=
ccount-notifications
|
||
|
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Your mom is on a lot of cortisone. Perhaps it is not related to the steroid at all. Perhaps something else is happening. When you take steroids for Addison’s disease, you are just replacing what you don’t have and that’s normal. However, if you’re on a higher dose than you need, perhaps the steroids will start affecting you (i.e. moon face, mood swings, bitchiness, etc.). Taking steroid for an addisonian is like a diabetic taking insulin - you’re just giving yourself what you would normally need if your body made it. Go to her endocrinologist with her and let him/her know what is happening. The doctor may have some insight into what’s going on.