Scared to Death

When Fight or Flight becomes an Adrenal Crisis

When Derek was first diagnosed with adrenal insufficiency we went searching on line to see what it meant.

One of the first things we found, and one of the common things still found, is an article about a young 10 yr old that said she could be “scared to death” if she watched a scary movie, because of Adrenal Insufficiency.

Most say “No” it’s not true, and the story is sensationalized by cheap media needing a story.

Although many of the facts are exaggerated, (and in one instance, wrong), the question still remains.

Can you be Scared to Death?

One article I found in HowStuffWorks (Not sure how good it is but they cite evidence from Harvard).

Take the day of Jan. 17, 1994. That was the day the Northridge earthquake struck Los Angeles. On a normal day in Los Angeles, about five sudden deaths occur; a sudden death is generally defined as a natural death (usually attributable to heart disease) that occurs unexpectedly in someone who hasn’t previously exhibited life-threatening symptoms or conditions. On the day of the earthquake, there were 24 sudden deaths [source: Harvard]. A few were linked to physical exertion, but most were attributed to the frightful earthquake. While the average age of the people that died that day was fairly high — 68 years — only 42 percent of those people had previously exhibited symptoms of heart disease [source: Harvard].

While investigating this, I also stumbled across this piece of information.  It was questions asked of Martin A. Samuels, Chairman of the Neurology Department at Brigham and Women’s Hospital in Boston.

He had this to say:

How can the fight-or-flight response lead to death?
The autonomic nervous system uses the hormone adrenaline, a neurotransmitter, or chemical messenger, to send signals to various parts of the body to activate the fight-or-flight response. This chemical is toxic in large amounts; it damages the visceral (internal) organs such as the heart, lungs, liver and kidneys. It is believed that almost all sudden deaths are caused by damage to the heart. There is almost no other organ that would fail so fast as to cause sudden death. Kidney failure, liver failure, those things don’t kill you suddenly.

What exactly happens in the heart when it’s flooded with too much adrenaline?

Adrenaline from the nervous system lands on receptors of cardiac myocytes (heart-muscle cells), and this causes calcium channels in the membranes of those cells to open. Calcium ions rush into the heart cells and this causes the heart muscle to contract. If it’s a massive overwhelming storm of adrenaline, calcium keeps pouring into the cells and the muscle just can’t relax.

There is this specially adapted system of muscle and nerve tissue in the heart—the sinoatrial (SA) node, the atrioventricular node, and the Purkinje fibers—which sets the rhythm of the heart. If this system is overwhelmed with adrenaline, the heart can go into abnormal rhythms that are not compatible with life. If one of those is triggered, you will drop dead.

What other emotional states besides fear could lead to these fatal heart rhythms?
Any strong positive or negative emotions such as happiness or sadness. There are people who have died in intercourse or in religious passion. There was a case of a golfer who hit a hole in one, turned to his partner and said, “I can die now”—and then he dropped dead. A study in Germany found an increase of sudden cardiac deaths on the days that the German soccer team was playing in the World Cup. For about seven days after the 9/11 terrorists attacks on the World Trade Center and Pentagon there was an increase of sudden cardiac death among New Yorkers.

So I guess the answer is probably YES, you can die of fright, or be scared to death.   Especially if you have, or are prone to, heart disease.

But I have Adrenal Insufficiency!

Are you more susceptible to death by fear because you have Adrenal Insufficiency?

What I found was that it would depend on how well you understand your condition and how willing you are to stress dose, or use your emergency injection.  Or whether you are wearing your medical alert identification.

Derek has, ever since he lost his adrenal glands, had what we considered a strange reaction to frights/shocks.

Let me give you an example. 

I will be driving along the road.  A car will come out of a drive without warning.  I will break hard or swerve (or both) to try and avoid a collision.  I will feel all the signs of an adrenaline rush.  If it’s bad enough I will have to stop until my body has calmed down.

Three things have happened to me.

  1. My autonomic nervous system kicked into action
  2. I get an adrenaline rush.
  3. I get a flood of cortisol, to bring my body back to “normal”.

It’s autonomic.  You don’t think about it.  You don’t have to do anything.  It just happens.

If you have Adrenal Insufficiency (Addison’s disease, PAI or SAI) this doesn’t happen.  The natural process doesn’t work.

Many people with AI (whether Primary or Secondary) still produce adrenaline.  Derek is rare in that his adrenals infarcted, dying from the inside (medulla) out.  He gets the initial signals from the brain, so he knows there is danger but he suffers mild autonomic dysfunction, so he doesn’t get the rapid heart rate increase or any of the other immediate response.  He also doesn’t have an adrenal medulla so he doesn’t get the full blown adrenaline rush to enable him to keep up the fight or flight.

However, his body doesn’t know that, so it thinks it still needs to mop up the adrenaline that should have been rushing through his body.  So he uses up his cortisol.  His reaction to the fright is delayed.  It can take up to 5 minutes for him to begin to suffer from the signs of low cortisol.

Other’s with AI, who do get the adrenaline rush, also suddenly find a call on their cortisol.  The one thing they all need to do is increase their intake of cortisol.

Either way, the Fright or scare, makes you use your cortisol reserves.  As someone with normal functioning Adrenal Glands I would then make more.  If you are taking your cortisol by exogenous replacement (by external form) you MUST replace it yourself.

A good example of being scared to death is from Nicole.  ( )

She explains what happened in a very slight fender bender.  Although she didn’t use the term “Scared to death” she does suffer sudden unexpected stress, a shock.

“I was in a small car accident this afternoon. Once I got out of the car to exchange insurance details, I lasted all of 45 seconds. I tried to ring my boyfriend and my voice was so shaken I got out the words car accident and then collapsed. Out COLD on the gravel ground and I don’t remember nearly an hour of the missing time that followed.”

She went on to explain that she was given her emergency steroid injection, and is here to tell the story.    Nicole tells her story to remind people how important it is to wear our medical alert bracelet, and to have an app on your phone, or any other way possible, to tell bystanders what to do when she can’t.

If she didn’t have those things then yes, technically she would have been “Scared to Death”.

What must be remembered is that those with no cortisol production MUST carry an emergency injection kit.

This is because sudden stress such as an accident, can put you into an adrenal crisis.

Why?  Because a sudden fright, be it the announcement of an unexpected death, a car accident (even a non injury accident), or even an exciting surprise, can cause a sudden and severe reduction in cortisol, causing an adrenal crisis and, if not treated with exogenous corticosteroids quickly, can lead to death.

Professor Hindmarsh of Great Ormand Street Hospital in the UK has produced a great chart of how you can go into crisis.

Adrenal Crisis Pathway by Professor Peter Hindmarsh

Can you be scared to death?

Yes.  Whether or not you have Adrenal Insufficiency, you can be scared to death.  It is rare but it can happen.  And with AI are you more at risk?  Yes, if you don’t carry your Emergency Kit, Medical Alert Bracelet (or tattoo etc), and don’t carry a steroid card telling medical staff what to do, there is a higher risk of death.

That doesn’t mean you have to panic or live life terrified of what could happen.  It means you need to know your condition, and be prepared.

Derek carries his emergency kit with him everywhere.  It’s in his “man bag”.  It doesn’t matter if he is going to the shops down the road, or going out in the car with a professional driver driving him.  He doesn’t worry about what could happen, but he is prepared “just in case”.


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