Patient education: Adrenal crisis (The Basics)

What is adrenal crisis? — 

This is a serious medical problem that can make you pass out and can even lead to death. It happens when your adrenal glands are not working right.

The adrenal glands are located on top of the kidneys (figure 1). They make a lot of different hormones, including 2 that are very important for normal body function:

●Cortisol – This helps control how the body uses sugar and how it responds to stress.

●Aldosterone – This helps control the amount of salt and fluid in the body.

Adrenal crisis happens when the adrenal glands do not release 1 or both of these hormones. If this happens, your body can go into shock. This is when your blood pressure drops to a dangerously low level.

Adrenal crisis is a medical emergency.

What are the symptoms of adrenal crisis? — 

Adrenal crisis usually starts suddenly. The symptoms can include:

●Vomiting

●Belly pain

●Weakness

●Fever

●Confusion

●Feeling dizzy or passing out

What causes adrenal crisis? — 

Adrenal crisis usually happens in people who already have a medical condition that affects the adrenal glands. For example, it can happen in people who have:

●Addison disease, also called "adrenal insufficiency"

●Congenital adrenal hyperplasia, or "CAH"

In these conditions, the adrenal glands don't make enough hormones. People must take hormone medicines to replace the adrenal hormones. But if they get sick, get into an accident, or have surgery, the medicine doses they normally take are not always enough. For this reason, people with adrenal problems sometimes have to take extra medicine when they are sick or when they are going to have surgery.

Adrenal crisis can also happen in people who:

●Take "steroid" medicines (such as prednisone) at high doses for a long time, then suddenly stop taking them

●Have bleeding in their adrenal glands because of infection or severe injury, or because they were taking blood thinners

Will I need tests? — 

Yes. If your doctor or nurse suspects that you have adrenal crisis, they will order blood tests to check your blood sugar, electrolytes, and hormone levels.

How is adrenal crisis treated? — 

Treatment is done at the hospital. It involves getting an IV (a thin tube that goes into a vein) with:

●Fluids with salt and sugar to replace what has been lost

●Hormone medicines to replace the hormones that are missing

After doctors have treated the crisis, they will try to find out what caused it. For example, they will check for infection. They will also try to find out why your adrenal glands aren't working normally, if this isn't already known.

Can adrenal crisis be prevented? — 

Yes. If you have a medical condition that keeps your adrenal glands from making enough hormones, your doctor will give you hormone medicines to replace what is missing. These medicines can reduce the chance that you will have adrenal crisis again.

People usually need to take these medicines every day for the rest of their lives. Your doctor or nurse will tell you:

●How to take your medicines

●What dose to take

●How to change your dose when needed – For example, if you get sick and have a fever, you can usually increase your dose for 3 days.

It's important to tell your doctor or nurse if you have any side effects, develop any new symptoms, or have any illness that gets worse while you are taking a higher dose.

Your doctor will also prescribe emergency medicine you should keep with you at all times in case you have adrenal crisis again. This medicine comes as a shot. If you think that you are having adrenal crisis, use this medicine and then call for an ambulance (in the US and Canada, call 9-1-1).

Your doctor might recommend that you also use this emergency medicine if you:

●Get very sick with a high fever

●Have a major injury, for example, if you break a bone or lose a lot of blood

●Pass out

●Can't keep your daily medicine down due to vomiting

If you have a condition that can cause adrenal crisis, it's a good idea to wear a medical alert bracelet and carry an emergency medical card. This way, other people will know about your condition in case of an emergency.

More on this topic

Patient education: Addison disease (The Basics)
Patient education: Congenital adrenal hyperplasia (The Basics)
Patient education: Cortisol test (The Basics)
Patient education: Adrenal crisis – Discharge instructions (The Basics)
Patient education: Aldosterone test (The Basics)

Patient education: Adrenal insufficiency (Beyond the Basics)