Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the
Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency
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 diseaseor other adrenal gland disease, 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 medications such as prednisone or hydrocortisone
Symptoms of adrenal crisis can include any of the following:
Abdominal pain Confusionor coma Dehydration
- Dizziness or light-headedness
Fatigue Flank pain
fever Loss of appetite
- Loss of consciousness
Low blood pressure Nausea
weakness Rapid heart rate
respiratoryrate (see tachypnea)
- 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, patients need an immediate injection of hydrocortisone through a vein (
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.
When to Contact a Medical Professional
Call your health care provider if you have
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
If you have Addison disease, you may be told to increase the dosage of your glucocorticoid medicine if you are very ill or before having surgery.
If you have Addison disease, learn to recognize 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 medication in times of stress.
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.