Support for Those Living with Adrenal Insufficiency

Research Topics D-M

Welcome to the AIU/AIC research library. The articles and documents here are listed by subject. Beneath the following subject headings you’ll find links to current information on that topic. We check the links periodically, however, if you find one that is no longer working, please contact us.

Thank you for visiting, we hope you find our library useful.

We’ve re-organized the library so please be patient as we are still adding content 9/5/16.

Link to topics A-C: Adrenal crisis, Adrenal fatigue, Adrenal insufficiency, Adrenal suppression, Adrenal Insufficiency in the News, Better living tips, Children with adrenal insufficiency, Circadian rhythm, Coexisting conditions, Cortisol pump

D-M:  Dosing, Electrolytes and hydration, Emergency care, Emotional aspects of AI, Financial/Gifting Organizations, Guidelines and reviews, Hormones, Injection kit, Injuries and Illness, Medication interactions

Link to topics N-Z: Overview of endocrine system, PAI, Pain management, Physiology of AI, Pregnancy, Recent developments, SAI, Sleep, Stress, Steroids used to treat adrenal insufficiency (glucocorticoids and mineralocorticoids), Surgery guidelines, Tapering, Testing


Published in JCEM in 2014, we feel this article may be helpful to patients having difficulty getting their doctor to approve stress dosing. The article states the three most common causes of adrenal crisis are gastrointestinal distress, fever, and coming in at number three, stress.

This randomized double-blind cross-over trial showed that patients experience benefits on various aspects of QOL while on a higher dose (30-40mg) of HC substitution when compared to a lower dose (15-20mg) of HC. These effects included, with a striking congruence, improved sense of general and mental health, improved physical functioning, fewer symptoms of depression, fewer somatic complaints, less pain and less fatigue. These results emphasize that QOL is a clinically relevant aspect of HC treatment that needs to be taken into account when individualizing HC substitution therapy.

Electrolytes and Hydration

This article from the Merck Manual explains the process of dehydration and provides links to more information. It also mentions Addison’s, Diabetes Mellitus, and Diabetes Insipidus as contributing factors.

Recipes for homemade electrolyte drinks

Emergency Care


Adrenal Crisis Pathway:  This graphic flowchart illustrates the events that can occur during an adrenal crisis.  These events can happen in 30 minutes or less.  Factors such as the overall health of the individual, mechanism of injury, and severity of illness all play a part. Sometime a crisis can take longer to develop.  It’s important to have a conversation with your physician about what to do in an emergency situation.

Signs and Symptoms of Adrenal Crisis:  This is a poster of some of the common signs/symptoms associated with adrenal crisis.  Keep in mind this is not meant to be a representation of all of them, you could be experiencing a crisis even if you are not experiencing the signs/symptoms listed on this document.

Illness Flow Chart:  This helpful chart created by Professor Hindmarsh can help parents with children who are ill but is not meant to be used as a diagnostic tool. Parents unsure of what to do during a child’s illness should always contact a physician.

Injection Instructions Video:  This youtube video by the Succeed Clinic in OK walks you through the steps to inject.  Although the video was made for those with Congenital Adrenal Hyperplasia the instructions on how to inject are the same for anyone.  Be sure to ask your physician about the circumstances in which you would need an injection.

Written Injection Instructions :  These instructions are from Sydney Children’s Hospital other instructions can be found with google searches.

Endocrinology Expected Values and S.I. Unit Conversion Tables:  This shows the range of many hormones relating to adrenal insufficiency.

Emotional Aspects of Adrenal Insufficiency

Financial and Gifting Organizations

Disability Benefits:

Not everyone with adrenal insufficiency qualifies, decisions are made on a case by case basis.

Disability Evaluation Under Social Security 9.00 Endocrine Disorders – Adult

Disability Evaluation Under Social Security 109.00 Endocrine Disorders – Childhood

Medicaid and the Affordable Care Act: Eligibility

The Children’s Health Insurance Program (CHIP) serves uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid.

Support and Gifting Programs:
Screen Shot 2015-12-05 at 12.46.02 PM

Matches children unable to participate in sports with college sports teams.


harmony 4 hope: share music. spread hope.

 Wish Programs

Dream Factory

Children’s Wish Foundation International

A Special Wish Foundation

Believe In Tomorrow

Make-A-Wish Foundation

Starlight Children’s Foundation


Jonah (bottom right) and his team.

Do you have some links that would help others? Please let us know.

Guidelines and Reviews


Injection Kit

This was published in The European Journal of Endocrinology in 2014. The author, Dr. Bruno Allilio, discusses the misconception that patients easily return to a good quality of life with hydrocortisone therapy. He also states that all patients with adrenal insufficiency should carry an emergency injection kit. Because this was published in the last few years, and the Doctor who wrote it has impressive credentials, this paper may be useful for patients in the exam room. To use this article, click on full text pdf in the blue area to the right of the text. You can download and print from there.

This 2013 study from the National Institutes of Health recognizes the need for more education on this subject and may be a useful starting point for discussions with your medical provider. Scroll halfway down the page for information on adrenal crisis and the injection kit.

Injuries and Illness

Are Stress-Dose Steroids Indicated in Patients with Adrenal Insufficiency Hospitalized with Noncritical, Nonsurgical Illness?  A study on adults with adrenal insufficiency, you can find the Key Points from this article in the highlighted gray box.

Medication Interactions

A list of drugs that may interact with hydrocortisone and fludrocortisone can be found on the CAHISUS website.

Are adults taking corticosteroids for adrenal insufficiency at risk of osteoporosis? A good topic of discussion with your endocrinologist. Found on the NIHC (National Institute for Health and Care Excellence) website, they have a good search engine for research publications.

This article explains the possible consequence of taking this thyroid medication without proper adrenal support.

Metform warning. Mandatory supplementation with Vitamin B12

Search for drug interactions and possible side effects


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