Acute Adrenal Crisis
What is Acute Adrenal Crisis?
Acute adrenal crisis is a life-threatening emergency that happens when your body cannot produce enough cortisol. Cortisol is a hormone made by your adrenal glands, which sit on top of your kidneys. This hormone helps your body respond to stress, regulate blood pressure, and maintain blood sugar levels.
When cortisol levels drop dangerously low, usually below 3 micrograms per deciliter, your body cannot handle physical stress. Blood pressure can drop suddenly. Blood sugar can fall to unsafe levels. Without immediate treatment, acute adrenal crisis can lead to shock, coma, or death within hours.
This condition most often affects people who already have adrenal insufficiency or Addison's disease. It can be triggered by infections, injuries, surgery, or suddenly stopping steroid medications. Recognizing the warning signs and getting emergency care can save your life.
Symptoms
- Severe weakness and fatigue that comes on suddenly
- Extreme confusion or altered mental state
- Severe abdominal pain, nausea, and vomiting
- Very low blood pressure, leading to dizziness or fainting
- Dangerously low blood sugar levels
- High fever or unusually low body temperature
- Rapid heart rate and breathing
- Loss of consciousness or coma in severe cases
- Severe dehydration and electrolyte imbalances
- Pain in the lower back, legs, or abdomen
Acute adrenal crisis develops rapidly, often within hours. People with known adrenal insufficiency may notice their usual symptoms getting much worse. Anyone experiencing these symptoms needs immediate emergency medical attention.
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Causes and risk factors
Acute adrenal crisis occurs when the adrenal glands cannot produce enough cortisol during times of physical stress. The most common cause is a sudden increase in stress on someone who already has adrenal insufficiency or Addison's disease. Physical stressors include infections, injuries, surgery, dehydration, or intense illness. Suddenly stopping corticosteroid medications without proper tapering can also trigger a crisis.
Risk factors include having primary adrenal insufficiency, taking long-term steroid medications for conditions like asthma or arthritis, having autoimmune diseases, having had pituitary gland surgery or damage, and skipping doses of prescribed cortisol replacement medication. People with these conditions need to increase their medication during illness or stress. Not doing so can lead to crisis.
How it's diagnosed
Acute adrenal crisis is diagnosed through emergency cortisol blood testing combined with clinical symptoms. Cortisol levels below 3 micrograms per deciliter during a crisis confirm the diagnosis. Blood tests also check sodium, potassium, and blood sugar levels, which are often abnormal. Because this is a medical emergency, treatment usually starts immediately, even before test results return.
Rite Aid offers cortisol testing as part of our preventive health panel. Testing your cortisol levels when you are healthy establishes a baseline. This helps identify adrenal insufficiency before a crisis occurs. If you have risk factors or symptoms of adrenal problems, regular monitoring can catch issues early. Get tested at any Quest Diagnostics location through your Rite Aid membership.
Treatment options
- Immediate intravenous hydrocortisone injection in the emergency room
- Intravenous fluids with salt to restore blood pressure and hydration
- Glucose infusion if blood sugar is dangerously low
- Treatment of any infection or illness that triggered the crisis
- Ongoing corticosteroid replacement therapy after stabilization
- Emergency injection kit for at-home use during future stress events
- Medical alert bracelet identifying adrenal insufficiency
- Education on stress dosing of medications during illness
- Regular follow-up with an endocrinologist
- Action plan for increasing medication during physical stress
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- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Adrenal insufficiency is a chronic condition where your adrenal glands do not make enough cortisol on an ongoing basis. Acute adrenal crisis is a sudden, life-threatening emergency that happens when cortisol levels drop dangerously low. People with adrenal insufficiency can develop acute adrenal crisis during times of physical stress. Crisis requires immediate emergency treatment, while adrenal insufficiency is managed with daily medication.
Acute adrenal crisis can develop within hours. Symptoms may start gradually but worsen very rapidly. People with known adrenal insufficiency may notice their usual tiredness and weakness becoming severe. Once blood pressure starts dropping and confusion sets in, the situation becomes critical. This is why anyone with adrenal insufficiency needs emergency treatment at the first signs of crisis.
In people already diagnosed with adrenal insufficiency, crisis typically has identifiable triggers like infection or injury. However, some people do not know they have adrenal problems until they experience their first crisis. This is less common but can happen. People on long-term steroid medications who stop suddenly are also at risk without realizing it.
Cortisol levels below 3 micrograms per deciliter during a crisis are diagnostic. Normal cortisol levels during stress should be much higher, typically 18 to 20 micrograms per deciliter or above. During a medical emergency, your body should naturally produce more cortisol. Failure to do so confirms adrenal crisis.
Emergency treatment includes immediate intravenous hydrocortisone, typically 100 milligrams given right away. Patients receive IV fluids with salt to restore blood pressure and hydration. Glucose is given if blood sugar is low. Doctors also treat any infection or illness that triggered the crisis. Treatment starts immediately based on symptoms, without waiting for test results.
Yes, with immediate emergency treatment, most people survive acute adrenal crisis. The key is recognizing symptoms early and getting to a hospital quickly. Delayed treatment significantly increases the risk of serious complications or death. People with known adrenal insufficiency should carry emergency injection kits and medical alert identification to ensure fast treatment.
People with Addison's disease or primary adrenal insufficiency face the highest risk. Those taking long-term corticosteroid medications for conditions like asthma, lupus, or rheumatoid arthritis are also at risk. People who have had pituitary gland surgery or damage can develop secondary adrenal insufficiency. Anyone in these groups needs to be aware of crisis symptoms and have an emergency action plan.
Common triggers include infections like flu or pneumonia, physical injuries, surgery, severe dehydration, and intense emotional stress. Suddenly stopping prescribed corticosteroid medication is a major trigger. Even dental procedures or minor illnesses can trigger crisis in people with adrenal insufficiency. Anything that increases physical stress on the body can precipitate a crisis if cortisol replacement is not increased appropriately.
Take your prescribed cortisol replacement medication every day without missing doses. Increase your medication dose during illness, injury, or stress as directed by your doctor. Carry an emergency injection kit at all times. Wear a medical alert bracelet identifying your condition. Educate family members on when and how to give emergency injections. Have a clear action plan written down.
Testing cortisol when you are healthy provides a valuable baseline. This is especially important if you take steroid medications regularly or have autoimmune conditions. Low cortisol levels on routine testing can identify adrenal insufficiency before a crisis happens. Early detection allows you to start treatment and learn how to prevent emergencies. Rite Aid offers cortisol testing as part of our preventive health panel.