Acute adrenal crisis
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands.
Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency
The adrenal glands are located just above the kidneys. The adrenal gland consists of 2 parts. The outer portion, called the cortex, produces cortisol. This is an important hormone for controlling blood pressure. The inner portion, called the medulla, produces the hormone adrenaline (also called epinephrine). Both cortisol and adrenaline are released in response to stress.
Cortisol production is regulated by the pituitary gland. This is a small gland behind the nose and under the brain. The pituitary gland releases adrenocorticotropic hormone (ACTH). This is a hormone that causes the adrenal glands to release cortisol.
Adrenaline production is regulated by nerves coming from the brain and spinal cord and by circulating hormones.
Adrenal crisis occurs when:
- The adrenal gland is damaged due to, for example, Addison disease or other adrenal gland disease, and surgery
- The pituitary gland is injured and cannot release ACTH
- Adrenal insufficiency is not properly treated
Risk factors for adrenal crisis include:
- Infection and other physical stress
- Injury to the adrenal or pituitary gland
- Stopping treatment too suddenly with glucocorticoid medicines such as prednisone or hydrocortisone
Symptoms and signs of adrenal crisis can include any of the following:
- Abdominal pain or flank pain
- Confusion, loss of consciousness, or coma
- Dizziness or light-headedness
- Fatigue, severe weakness
- High fever
- Loss of appetite
- Low blood pressure
- Nausea, vomiting
- Rapid heart rate
- Rapid respiratory rate
- Slow, sluggish movement
- Unusual and excessive sweating on face or palms
Exams and Tests
Tests that may be ordered to help diagnose acute adrenal crisis include:
- ACTH (cosyntropin) stimulation test
- Cortisol level
- Blood sugar
- Serum potassium
- Serum sodium
- Serum pH
In adrenal crisis, a person needs an immediate injection of hydrocortisone through a vein (intravenous) or muscle (intramuscular). You may receive intravenous fluids if you have low blood pressure.
You will need to go to the hospital for treatment and monitoring. If infection or another medical problem caused the crisis, you may need additional treatment.
Shock may occur if treatment is not provided early, and it can be life threatening.
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
Call your health care provider if you have Addison disease and are unable to take your glucocorticoid medicine for any reason.
If you have Addison disease, you will usually be told to temporarily increase the dosage of your glucocorticoid medicine if you are very ill, or before having surgery.
If you have Addison disease, learn to recognize the signs of potential stress that may cause an acute adrenal crisis. If you have been instructed by your doctor, be prepared to give yourself an emergency shot of glucocorticoid or to increase your dosage of oral glucocorticoid medicine in times of stress. Parents should learn to do this for their children who have adrenal insufficiency.
Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.
Never miss taking your medicines.
Nelson BK. Adrenal crisis. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 168.
Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.