EMS Particular Patient Presentations - Addison's Disease

EMS providers should have a basic understanding of Addison's Disease and its potential implications for prehospital care. 

Addison's disease, also known as primary adrenal insufficiency, is a disorder characterized by insufficient production of adrenal hormones, particularly cortisol and aldosterone, due to damage to the adrenal glands. This damage can result from autoimmune processes, infections, or other underlying conditions.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Addison's disease, which may include:

Weakness & Fatigue: Patients with Addison's disease often experience severe fatigue and weakness due to inadequate cortisol levels, which play a crucial role in energy metabolism.

Hypotension: Low blood pressure (hypotension) is a hallmark feature of Addison's disease, resulting from decreased aldosterone levels and impaired fluid and electrolyte balance.

Hyponatremia & Hyperkalemia: Insufficient aldosterone production can lead to abnormalities in sodium and potassium levels, resulting in hyponatremia (low sodium) and hyperkalemia (high potassium).

Gastrointestinal Symptoms: Patients may experience nausea, vomiting, abdominal pain, and weight loss due to gastrointestinal disturbances associated with adrenal insufficiency.

Skin Changes: Hyperpigmentation of the skin, particularly in sun-exposed areas and creases, is a characteristic feature of Addison's disease, resulting from elevated levels of adrenocorticotropic hormone (ACTH) stimulating melanin production.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Adrenal Crisis: Patients with Addison's disease are at risk of adrenal crisis, a life-threatening condition characterized by severe adrenal insufficiency and systemic decompensation. 

Adrenal crisis can be precipitated by stress, infection, trauma, or abrupt cessation of glucocorticoid therapy. EMS providers should be prepared to recognize and manage adrenal crisis promptly, including administration of intravenous fluids and glucocorticoid replacement therapy.

Hypoglycemia: Patients with Addison's disease may experience hypoglycemia (low blood sugar) during adrenal crisis or as a result of inadequate cortisol production. EMS providers should be prepared to assess and treat hypoglycemia with appropriate interventions, such as administration of intravenous dextrose.

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The discovery of Addison's disease is credited to Dr. Thomas Addison, a British physician. 

Dr. Addison first described the condition in 1855 in a paper titled "On the Constitutional and Local Effects of Disease of the Supra-Renal Capsules." 

In this seminal work, he provided detailed clinical observations of patients with adrenal insufficiency and emphasized the association between adrenal gland pathology and clinical manifestations. 

Dr. Addison's pioneering research laid the foundation for understanding and diagnosing Addison's disease, and he is recognized as a key figure in the history of endocrinology.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Medical Terminology - Cushing's Disease

EMS providers should have a  understanding of Cushing's Disease and its potential implications for prehospital care. 

Cushing's Disease is a condition caused by prolonged exposure to high levels of cortisol, often due to a tumor in the pituitary gland that leads to excessive secretion of adrenocorticotropic hormone (ACTH). This, in turn, stimulates the adrenal glands to produce excess cortisol.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Cushing's disease, which may include:

Hypertension: High blood pressure is a common feature of Cushing's disease due to the effects of excess cortisol on blood vessel function.

Weight Gain and Obesity: Patients may exhibit central obesity, particularly in the abdomen, along with increased fat deposits in the face (moon face) and neck (buffalo hump).

Muscle Weakness & Wasting: Excess cortisol can lead to muscle weakness and atrophy, which may affect the patient's mobility and ability to cooperate during assessment and treatment.

Skin Changes: Patients with Cushing's disease may have thin, fragile skin that bruises easily. They may also develop stretch marks (striae) on the abdomen, thighs, and breasts.

Glucose intolerance & Diabetes: High cortisol levels can impair glucose metabolism, leading to insulin resistance and, ultimately, diabetes mellitus.

Psychological Symptoms: Patients may experience mood swings, irritability, depression, or cognitive disturbances due to the effects of excess cortisol on the brain.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Cardiovascular Complications: Patients with Cushing's disease may be at increased risk of cardiovascular events such as heart failure, myocardial infarction, or stroke due to hypertension and other metabolic disturbances.

Fluid & Electrolyte Imbalances: Excess cortisol can disrupt fluid and electrolyte balance, leading to conditions such as hypokalemia (low potassium levels) or hypernatremia (high sodium levels).

Adrenal Crisis: In some cases, abrupt withdrawal of cortisol due to treatment or other factors can precipitate an adrenal crisis characterized by hypotension, dehydration, and shock. EMS providers should be prepared to recognize and manage adrenal crisis promptly.

Communication Challenges: Patients with Cushing's disease may have physical or cognitive impairments that affect their ability to communicate effectively. EMS providers should employ clear communication techniques and be patient and empathetic when interacting with these patients.

Who Made The Dicovery?

The discovery of Cushing's disease is credited to Dr. Harvey Cushing, an American neurosurgeon. Dr. Cushing first described the condition in 1912 in a detailed report titled "The Pituitary Body and its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri." 

In this seminal work, he provided comprehensive observations of patients with pituitary tumors, including those exhibiting symptoms of hypercortisolism, now recognized as Cushing's disease. 

Dr. Cushing's pioneering research laid the foundation for understanding and diagnosing this disorder, and he is regarded as a key figure in the history of endocrinology and neurosurgery. This is an example of an eponymous medical term.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell