Adrenal Crisis

What is an adrenal crisis?

An adrenal crisis is a condition in which your adrenal glands don’t make enough of the hormone cortisol. It’s a life-threatening complication of adrenal insufficiency (Addison’s disease). If you suspect that you have an adrenal crisis, reach out to your healthcare provider immediately.

Your adrenal glands are just above each kidney. They’re small and shaped like triangles. They make hormones, including cortisol. Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.

Cortisol affects almost every organ and tissue in your body. Some of its functions include:

• Regulating your body’s stress response.
• Helping control your metabolism.
• Suppressing inflammation.
• Regulating blood pressure.
• Regulating blood sugar.
• Helping control your sleep-wake cycle.

Other names for an adrenal crisis include Addisonian crisis and acute adrenal crisis.

Why is an adrenal crisis an emergency?

An adrenal crisis may cause a lack of blood flow (shock). Shock progresses quickly and may damage your organs. Without treatment, up to 20% of people in shock may die from an adrenal crisis.

An adrenal crisis may also cause seizures or a coma.

Who do adrenal crises affect?

An adrenal crisis can affect anyone. However, it most commonly affects people between the ages of 30 and 50.

How common are adrenal crises?

Adrenal crises aren’t common. Studies estimate that 42% of people with an adrenal insufficiency will have an adrenal crisis. In the United States, adrenal insufficiencies affect 1 in 100,000 people.

Some studies suggest that up to 25% of people who have an adrenal crisis die from it.

What are the symptoms of an adrenal crisis?

The most common symptoms of an adrenal crisis include:

• Abdominal pain or pain in your side (flank).
• Long-lasting fatigue.
• Loss of appetite.
• Darker patches of skin (hyperpigmentation).
• Weakness.
• Unexplained weight loss.

Other warning signs of adrenal crisis may include:

• Dehydration.
• Diarrhea.
• Dizziness, confusion, light-headedness, fainting or coma.
• Fever.
• Headache.
• Joint pain.
• Low blood glucose.
• Low blood pressure.
• Nausea and vomiting.
• Rapid breathing (respiratory rate).
• Rapid heart rate.

What can trigger an adrenal crisis?

The following stressors may trigger an adrenal crisis:

• Not receiving treatment for an adrenal insufficiency such as Addison’s disease.
• Damage to your adrenal gland, including adrenal gland diseases or surgery.
• Dehydration.
• Hypopituitarism.
• Infection.
• No longer taking glucocorticoid medications (prednisone) after taking them for a long time.
• Mental or emotional stress.

How is an adrenal crisis diagnosed?

An adrenal crisis may be difficult to diagnose because it shares many symptoms with other common conditions. However, the following tests can help your healthcare provider properly diagnose an adrenal crisis:

• Adrenocorticotropic hormone (ACTH) blood test.
• Blood sugar tests.
• Cortisol test.
• pH blood test.
• Potassium blood test.
• Sodium blood test.

How is an adrenal crisis treated?

Your healthcare provider will immediately use a small needle and tube to deliver a hydrocortisone injection (hydrocortisone phosphate or hydrocortisone sodium succinate) and a saline solution into your vein in your arm or hand (intravenously). The hydrocortisone injection replaces cortisol.

If a bacterial infection causes your adrenal crisis, your healthcare provider might give you antibiotics.

Your provider may also treat any other symptoms related to your adrenal crisis. For dehydration or an electrolyte imbalance, treatments may include water, sports drinks or coconut water. For hypoglycemia, treatment may including consuming carbohydrates.

If you’ve never had an adrenal crisis before, your healthcare provider will conduct ACTH stimulation tests to determine its cause.

Do hydrocortisone injections have any side effects?

Hydrocortisone injection side effects may include:

• Allergic reaction.
• Bloody or black stool (poop).
• Fever.
• Sore throat.
• Cough.
• Mood swings.
• Pain in your hips, back, ribs, arms, shoulders or legs.

Is it OK to receive a hydrocortisone injection if I am pregnant?

Yes, it’s OK to receive a hydrocortisone injection if you’re pregnant and have an adrenal crisis. You can’t transfer hydrocortisone to a developing fetus through your placenta.

If you don’t treat your adrenal crisis, you may die and your pregnancy would end.

How soon after treatment will I feel better?

It may take 24 hours or longer to feel better after receiving treatment for an adrenal crisis.

How can I prevent an adrenal crisis?

If you have an adrenal insufficiency, learn what stressors may trigger an adrenal crisis. These may include mental or emotional stress, dehydration, infection or not taking your glucocorticoid medications as prescribed by your healthcare provider.

Surgery and pregnancy may trigger an adrenal insufficiency. Tell your healthcare provider that you have an adrenal insufficiency before any surgery. Talk to your provider if you’re planning to become pregnant.

Carry a medical identification card, necklace or bracelet that indicates you have an adrenal insufficiency. Your identification materials should also include what type of medication you need and the exact dosage. This information can help your healthcare providers administer timely treatment.

Regularly weigh yourself and check your blood pressure. Let your healthcare provider know if you lose weight or if your blood pressure gets too high or too low.

Your provider may give you an emergency shot of cortisol. They’ll teach you when and how to give yourself cortisol. Keep this medication and directions on how to use it handy at all times. Teach a family member or close friend how to give you the cortisol shot in case you’re too weak to administer it yourself.

It’s also a good idea for you and your healthcare provider to create a plan in the event you can’t take your hydrocortisone pills because of nausea or vomiting.

What can I expect if I have an adrenal crisis?

If you suspect you’re having an adrenal crisis, seek treatment immediately. High doses of glucocorticoids aren’t harmful over a short period. Death may result if you don’t seek immediate treatment.

Most people who’ve had an adrenal crisis must take hydrocortisone pills for the rest of their lives. Always have extra medicine available in case you become ill and need more.

When should I see my healthcare provider?

Contact your healthcare provider immediately if you have symptoms of an adrenal crisis.

See your healthcare provider if you experience major stress — such as an injury, illness or mental or emotional stress. You may need to adjust your medication.

What questions should I ask my healthcare provider?

• How can you tell that I’m having an adrenal crisis?
• If I’m not having an adrenal crisis, what other condition might I have?
• What stressors triggered my adrenal crisis?
• How long will it take me to recover?
• What medications do you recommend?
• How should I properly store my medications?
• Do the medications have any side effects?

What is the difference between a thyroid storm and an adrenal crisis?

A thyroid storm is a severe case of thyrotoxicosis. Thyrotoxicosis is a condition in which you have too much thyroid hormone in your body.

Your thyroid is a gland in your neck. It makes and releases the hormones triiodothyronine (T3) and thyroxine (T4). Your thyroid gland and thyroid hormones help control your body temperature, heart rate and metabolism.

A note from Cleveland Clinic

An adrenal crisis is a life-threatening condition in which your adrenal glands don’t make enough cortisol. If you have an adrenal insufficiency or show any signs of an adrenal crisis, talk to your healthcare provider right away. Immediate treatment is necessary to prevent death.

If you’ve had an adrenal crisis, you’ll likely have to take medication for the rest of your life. Work with your healthcare provider to identify stressors that may trigger an adrenal crisis and learn how to avoid them.