Abby
Introduction
This is the third of a series of vignettes about young people with adrenal insufficiency (AI) who experience unrecognized or unacknowledged symptoms of low cortisol and the results of ignoring them. Our goal is to help you identify your signs of low cortisol—and to recognize situations that may deplete your cortisol levels—so you may adjust your routine and avoid serious health risks.
In the rush of daily life, especially when we’re off our usual schedule, it’s easy to lose track of time, and miss an all-important dose of our medication. The consequences and risk of missing a dose, however, can be serious. At best, we feel really, really lousy, and it takes a day or several to get back to our baseline. At worst, we could end up in a life-threatening adrenal crisis and be unable to advocate for ourselves.
To prevent serious ramifications from missing a dose, it is important to be attuned to what our particular low cortisol symptoms are, be they fatigue, brain fog, muscle and joint pain, clumsiness, or some combination. If symptoms start to appear, it’s time to ask: did I miss a dose, or might I need a small booster dose?
Abby's Story
After studying for her physics test until 1:30 in the morning, Abby snoozed her alarm three times after it went off at 6:30. Realizing that she now risked missing the school bus, she jumped out of bed, threw on her clothes, and took her cortisol and fludrocortisone. She did not have time for breakfast, but she ate a protein bar on the bus.
The teacher scored the physics tests immediately, and Abby was delighted to learn that she has scored the highest grade, which would help her GPA and college applications. All the talk at school that day, though, was on the prom, which was that evening. Abby had been working overtime at her fast-food job and had bought a beautiful designer dress. She was so excited to wear it when she went to prom with her boyfriend, Josh. During lunch, Abby skipped eating and instead helped decorate the gym for the dance that evening. By her last period class, she felt very tired and nauseated. She then realized that she had forgotten to take her midday cortisol, so she took it after class.
Early that evening, Abby’s mom helped her into the dress, and they both had to admit it looked gorgeous. With her loosely braided hair and elegant heels, Abby felt a glow of excitement. Then she received a text from Josh, which merely said, “I think we’re done, and I can’t do prom. Sorry.” She immediately tried to call him, but the phone went directly to voice mail. He did not answer texts, so she frantically called Josh’s mom, who coldly told her that Josh was away camping for the weekend and indeed would not be going to prom.
Abby laid across her bed crying, but quickly had to go to the bathroom to throw up. As her mom held her head and held a towel across her dress to protect it, Abby got cold sweats and felt faint.
Questions
How many cortisol-consuming stress events can you recognize in this scenario?
[ANSWER: staying up late, not getting enough sleep, rushing to not be late for the bus, taking the test, getting a really good grade on the test, excitement over prom, skipping lunch, taking a dose late, getting ready for prom, getting dumped by text, disappointment over missing prom, vomiting.]
How many symptoms of low cortisol can you identify in this scenario?
[ANSWER: nausea and fatigue in last period when she had missed her midday dose, and vomiting, cold sweats, lightheadedness after Josh’s email.]
What actions might Abby or her mother taken when she was throwing up
[ANSWER: If she was able to keep medication down, she should have double dosed her cortisol. If she couldn’t keep her medication down, she should have injected solu-cortef and gone to the ER.]
What could Abby have done to prevent some of these cortisol sapping events?
[ANSWER: Maintaining a regular sleep schedule, not skipping meals, taking medications on time.]