For a better experience, click the Compatibility Mode icon above to turn off Compatibility Mode, which is only for viewing older websites.

Health Library

Browse A-Z
Search
    test
    test
    test
Print-Friendly
Bookmarks
bookmarks-menu

Acute adrenal crisis

Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

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.

Causes

The adrenal glands are located just above the kidneys. The adrenal gland consists of two 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. This is a small gland just underneath under the brain. The pituitary 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 can occur from any of the following:

  • The adrenal gland is damaged due to, for example, Addison disease or other adrenal gland disease, and surgery
  • The pituitary is injured and cannot release ACTH
  • Adrenal insufficiency is not properly treated
  • You've been taking glucocorticoid medicines for a long time, and suddenly stop
  • You've become very dehydrated
  • Infection or other physical stress

Symptoms

Symptoms and signs of adrenal crisis can include any of the following:

Exams and Tests

Tests that may be ordered to help diagnose acute adrenal crisis include:

Treatment

In adrenal crisis, you need to be given the drug hydrocortisone right away 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.

Outlook (Prognosis)

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.

Prevention

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.

References

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; 2016:chap 15.

Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 120.

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Adrenal gland hormone secretion

      Adrenal gland hormone secretion - illustration

      The adrenal gland secretes steroid hormones such as cortisol and aldosterone. It also makes precursors that can be converted to sex steroids (androgen, estrogen). A different part of the adrenal gland makes adrenaline (epinephrine). When the glands produce more or less hormones than required by the body, disease conditions may occur.

      Adrenal gland hormone secretion

      illustration

      • Endocrine glands

        Endocrine glands - illustration

        Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

        Endocrine glands

        illustration

      • Adrenal gland hormone secretion

        Adrenal gland hormone secretion - illustration

        The adrenal gland secretes steroid hormones such as cortisol and aldosterone. It also makes precursors that can be converted to sex steroids (androgen, estrogen). A different part of the adrenal gland makes adrenaline (epinephrine). When the glands produce more or less hormones than required by the body, disease conditions may occur.

        Adrenal gland hormone secretion

        illustration

      Tests for Acute adrenal crisis

       

      Review Date: 5/7/2017

      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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
      adam.com

       
       
       

       

       

      A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.
      Content is best viewed in IE9 or above, Firefox and Google Chrome browser.