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Endocrine - Addison's Disease

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hi,

I am not sure if you can help. I am trying to find the right Doctor to speak to regarding diving with Addison's disease. I am very happy to join e-med (probably will anyway now I have found it) and pay for appropriate consultation, medicals etc.

I was recently sent to hospital due to climbing potassium levels and a strong feeling of fatigue, weakness and shortness of breath, completely out of character since I usually run five miles every evening after work, after four days I was sent home with a diagnosis from an endocrinologist of Addison's Disease. (I have vitiligo, another auto immune disease which should have helped the GP diagnose it, although it seems Addison's is relatively rare.)

I have to take Fludrocortisone (100mcg) once daily and Hydrocortisone three times a day (breakfast 10mg, lunch 10mg and dinner 5mg) to account for the lack of cortisone my body is producing.

I am aware that Addison's severely affects my body's reactions to illnesses and infections and due to the nature of the disease my reactions to 'fight' or 'flight' situations.

I have read that people still sky-dive and rock climb however my interest lies in scuba diving. I have been diving for the last three years, completed around 60 dives, mostly on several holidays in the Caribbean, I have completed the advanced dive course, penetrated wrecks and dived comfortably to 40m on various occasions.

So my question is, with Addison's can I continue to dive, given the various underlying stresses on the body and potential for something to happen creating a stressful situation, assuming (among other things?) that I have taken extra doses of cortisone and continue to manage my medication well?

If you can help in terms of diving with Addison's, then I would be grateful to know which medicals or appointments I need to make.

Thanks for your time.

A - The thing about these endocrine problems, like underactive thyroid as well is that the medication you take are there to replace what is missing. If this is done well, and titrated to full effect then you should be normo-hormonal. The lack of steroid from your underactive adrenal glands, and the consequent electrolyte imbalance, should be corrected by the synthetic steroids you are on. If the balance is right, then you should not suffer any effects of over-steroiding.

So diving should be fine. I would say that it is worth having a blood test to check all your levels before doing a long series of dives. As you know the fatigue and fluid balance and low blood pressure caused by this disease can affect diving and increase risk, so plan ahead and get in to your GP early so they can do the tests twice. Twice? They always lose the first one.

(other dive medical questions)



   


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