Patient education: Adrenal crisis (The Basics)

What is adrenal crisis? — Adrenal crisis is a serious medical problem that can cause you to 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 hormone helps control how the body uses sugar and how it responds to stress.

●Aldosterone – This hormone 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's disease, also called "adrenal insufficiency"

●Congenital adrenal hyperplasia, also called "CAH"

People who have these conditions must take hormones to replace the hormones that they don't have enough of. But if they get sick, get into an accident, or have surgery, the hormones they normally take are not always enough. That's why people with adrenal problems sometimes have to take extra medicine when they are sick or when they know they are going to have surgery.

Adrenal crisis can also happen in people who:

●Take "steroid" medicines 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

Should I see a doctor or nurse? — Yes, if you have symptoms of adrenal crisis, call for an ambulance (in the US and Canada, call 9-1-1). This is especially important if you have a medical condition that affects your adrenal glands, such as Addison's disease.

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 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 or for signs of adrenal gland problems.

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 life. 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 with a cold or another minor illness, you can usually increase your dose for 3 days.

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

Your doctor might also prescribe emergency medicine that you should keep with you at all times in case you have adrenal crisis again. This medicine comes as a shot. If you think 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

●Vomit up your daily medicine

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's disease (The Basics)
Patient education: Congenital adrenal hyperplasia (The Basics)

Patient education: Adrenal insufficiency (Addison's disease) (Beyond the Basics)