TZPSS Articles | Health Alert | Danger of using growth hormone (hGH), Adrenal Crisis

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Health Alert: Adrenal Crisis Causes Death in Some People Who Were Treated
With Growth Hormone (hGH)

Recently, doctors conducting the follow-up study of
individuals treated with human Growth Hormone (hGH)
looked at causes of death among recipients and found some
disturbing news. Many more people have died from a
treatable condition called adrenal crisis than from CJD. This
risk does not affect every recipient. It can affect those who
lack other hormones in addition to growth hormone. Please
read on to find out if this risk applies to you. Death from
adrenal crisis can be prevented.

Adrenal crisis is a serious condition that can cause death in
people who lack the pituitary hormone ACTH. ACTH is
responsible for regulating the adrenal gland. Often, people
are unaware that they lack this hormone and therefore do
not know about their risk of adrenal crisis.

Most people who were treated with human growth hormone
(hGH) did not make enough of their own growth hormone.
Some of them lacked growth hormone because they had
birth defects, tumors or other diseases that cause the
pituitary gland to malfunction or shut down. People with
those problems frequently lack other key hormones made by
the pituitary gland, such as ACTH, which directs the adrenal
gland to make cortisol, a hormone necessary for life. Having
too little cortisol can be fatal if not properly treated.

Treatment with human growth hormone (hGH) does not
cause adrenal crisis, but because a number of people lacking
growth hormone also lack ACTH, adrenal crisis has occurred
in some people who were treated with human growth
hormone (hGH). In earlier updates we have talked about how
adrenal crisis can be prevented, but people continue to die
from adrenal crisis, which is brought on by lack of cortisol.
These deaths can be prevented. Please talk to your doctor
about whether you are at risk for adrenal crisis.

Why should people treated with human growth
hormone (hGH) know about adrenal crisis? Among the
people who received growth hormone (hGH), those who had
birth defects, tumors, and other diseases affecting the brain
lacked growth hormone (hGH) and often, other hormones
made by the pituitary gland. A shortage of the hormones
that regulate the adrenal glands can cause many health
problems. It can also lead to death from adrenal crisis. This
tragedy can be prevented.

What are adrenal hormones? The pituitary gland makes
many hormones, including growth hormone and ACTH, a
hormone which signals the adrenal glands to make cortisol, a
hormone needed for life. If the adrenal gland doesn't make
enough cortisol, replacement medications must be taken. The
most common medicines used for cortisol replacement are:

+ Hydrocortisone
+ Prednisone
+ Dexamethasone

What is adrenal crisis? Adrenal hormones are needed for
life. The system that pumps blood through the body cannot
work during times of physical stress, such as illness or
injury, if there is a severe lack of cortisol (or its replacement).
People who lack cortisol must take their cortisol replacement
medication on a regular basis, and when they are sick or
injured, they must take extra cortisol replacement to prevent
adrenal crisis. When there is not enough cortisol, adrenal
crisis can occur and may rapidly lead to death.

What are the symptoms of lack of adrenal hormones? If
you don't have enough cortisol or its replacement, you may
have some of these problems:
o feeling weak
o feeling tired all the time
o feeling sick to your stomach
o vomiting
o no appetite
o weight loss

When someone with adrenal gland problems has weakness,
nausea, or vomiting, that person needs immediate
emergency treatment to prevent adrenal crisis and possible
death.

Why are adrenal hormones so important? Cortisol (or its
replacement) helps the body respond to stress from
infection, injury, or surgery. The normal adrenal gland
responds to serious illness by making up to 10 times more
cortisol than it usually makes. It automatically makes as
much as the body needs. If you are taking a cortisol
replacement drug because your body cannot make these
hormones, you must increase the cortisol replacement drugs
during times of illness, injury, or surgery. Some people make
enough cortisol for times when they feel well, but not enough
to meet greater needs when they are ill or injured. Those
people might not need cortisol replacement every day but
may need to take cortisol replacement medication when their
body is under stress. Adrenal crisis is extremely serious and
can cause death if not treated promptly. Discuss this
problem with your doctor to help decide whether you need
more medication or other treatment to protect your health.

How is adrenal crisis treated? What are the treatments?
People with adrenal crisis need immediate treatment. Any
delay can cause death. When people with adrenal crisis are
vomiting or unconscious and cannot take medicine, the
hormones can be given as an injection. Getting an injection
of adrenal hormones can save your life if you are in adrenal
crisis. If you lack the ability to make cortisol naturally, you
should carry a medical ID card and wear a Medic-Alert
bracelet to tell emergency workers that you lack adrenal
hormones and need treatment. This precaution can save
your life if you are sick or injured.

How can I prevent adrenal crisis, any prevention?
• If you are always tired, feel weak, and have lost weight,
ask your doctor if you might have a shortage of adrenal
hormones.

• If you take hydrocortisone, prednisone, or
dexamethasone, learn how to increase the dose when you
become ill.

• If you are very ill, especially if you are vomiting and cannot
take pills, seek emergency medical care immediately. Make
sure you have a hydrocortisone injection with you at all
times, and make sure that you and those around you (in
case you're not conscious) know how and when to
administer the injection.

• Carry a medical ID card and wear a bracelet telling
emergency workers that you have adrenal insufficiency and
need cortisol. This way, they can treat you right away if you
are injured.

Remember: Some people who lacked growth hormone may
also lack cortisol, a hormone necessary for life. Lack of
cortisol can cause adrenal crisis, a preventable condition that
can cause death if treated improperly . Deaths from adrenal
crisis can be prevented if patients and their families recognize
the condition and are careful to treat it right away. Adrenal
crisis is a medical emergency. Know the symptoms and how
to adjust your medication when you are ill. Taking these
precautions can save your life.

Content Source NIDDK.NIH

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