Q: We have had an upset in the family and it has affected me terribly - I have not been able to eat and feel nauseous, is this related to the fact that I have Addison’s? Also many years ago I had an Addisonian crisis and was unconscious for a week with a temperature of 106. No one has ever explained the reason for this, only that I was lucky to he alive. I had a very had throat infection prior to the crisis.

A: Psychological stress does not normally precipitate an exacerbation of Addison's Disease nor an Addisonian crisis. For the patient with Addisonian crisis this was clearly precipitated by her throat infection. I recommend to my patients who have inter current infection that if they have no fever then they should take no increased dose of there corticosteroid. However if they have a fever they should double their hydrocortisone until the fever has gone away. If they are ill with diarrhoea or vomiting or cannot take their tablets they must have their hydrocortisone by injection. With my own patients I teach how to give intramuscular hydrocortisone themselves as well as a member of their close family so that they can be given an emergency injection in an emergency situation. They of course keep a dose of intramuscular hydrocortisone in their refrigerator ready for use if necessary and there is no medical attendant available.