Adrenal Crisis / Emergencies – Causes, Symptoms, Treatment

Last updated: February 7, 2026Reviewed date: February 7, 2026Reading time: 3 min read

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Adrenal crisis (also known as Addisonian crisis and acute adrenal insufficiency) is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. It is a constellation of symptoms that indicate severe adrenal insufficiency caused by insufficient levels of the hormone cortisol. This may be the result of either previously undiagnosed or untreated Addison's disease, a disease process suddenly affecting adrenal function (such as bleeding from the adrenal glands in Waterhouse-Friderichsen...

Key Takeaways

This article explains Adrenal Emergencies in simple medical language.
This article explains Signs and symptoms in simple medical language.
This article explains Diagnosis in simple medical language.
This article explains Prevention in simple medical language.

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Adrenal crisis (also known as Addisonian crisis and acute adrenal insufficiency) is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. It is a constellation of symptoms that indicate severe adrenal insufficiency caused by insufficient levels of the hormone cortisol. This may be the result of either previously undiagnosed or untreated Addison’s disease, a disease process suddenly affecting adrenal function (such as bleeding from the adrenal glands in Waterhouse-Friderichsen syndrome), suddenly stopping the intake of glucocorticoids or an intercurrent problem (e.g. infection, trauma, in fact, any form of physical or mental stress) in someone known to have Addison’s disease, congenital adrenal hyperplasia (CAH), or another form of primary adrenal insufficiency.

Adrenal Emergencies

Definition

Hormones: aldosterone, cortisol, androgens, catecholamines

Causes of Adrenal insufficiency

Adrenal crisis is caused by a deficiency of cortisol resulting from Addison’s disease, congenital adrenal hyperplasia (CAH), corticosteroid biosynthetic enzyme defects or pituitary disorders (such as Sheehan’s syndrome, pituitary adenoma, hypopituitarism (inactive or underactive pituitary) causing failure to activate the adrenal glands.

Primary

Causes
- Autoimmune (associated with other endocrinopathies, PTH, DM)
- Infection (TB, viral, meningococcemia)
- Infiltration (sarcoidosis, amyloidosis)
- Hemorrhage (trauma, anti-coagulation)
- Malignancy (primary, metastatic)
Secondary
- Causes
  - Iatrogenic (>5mg prednisone/day for > 2 weeks)
  - Pituitary/sellar tumors
  - Hemorrhage (Sheehan)
  - Cranial radiation

Signs and symptoms

Characteristic symptoms are

Sudden penetrating pain in the legs, lower back or abdomen
Confusion, psychosis, slurred speech
Severe lethargy
Convulsions
Fever
Hyperkalemia (elevated potassium level in the blood)
Hypercalcemia (elevated calcium level in the blood): the cause of hypercalcemia is a combination of increased calcium input into the extracellular space and reduced calcium removal by the kidney, this last caused by decreased glomerular filtration and increased tubular calcium reabsorption. Both renal factors are secondary to volume depletion and, in fact, improve rapidly during rehydration with saline infusion.^[rx]
Hypoglycemia (reduced level of blood glucose)
Hyponatremia (low sodium level in the blood)
Hypotension (low blood pressure)
Hypothyroid (low T4 level)
Severe vomiting and diarrhea, resulting in dehydration
Syncope (loss of consciousness and ability to stand)
AIMS
Hypotension (refractory)
GI: anorexia, nausea/vomiting, diarrhea
Hyperpigmentation

Diagnosis

Labs

Hyponatremia
Hyperkalemia
Hypercalcemia
Mild metabolic acidosis
Hypoglycemia
Various investigations aid the diagnosis.
- ACTH (cosyntropin) stimulation test
- Cortisol level (to assess the level of glucocorticoids)
- Fasting blood sugar
- Serum potassium

Signs/Symptoms
- RAAS function maintained, hypotension rare
- Features of pituitary/hypothalamic dysfunction: menstrual disturbances, headache, vision changes, galactorrhea, acromegaly

Adrenal Crisis
- Precipitated by physiologic stressor: sepsis, MI, trauma, surgery
- Diagnosis
  - AM cortisol <3
  - ACTH stimulation peak cortisol <15
  - ACTH level
- Management
  - Glucose management
  - Fluid resuscitation
  - Dexamethasone 10mg IV
  - Identify and treat precipitant

Treatment

Acute adrenal insufficiency is a medical emergency and needs to be treated with injectable hydrocortisone and fluid support.

Prevention

An adrenal crisis is triggered by physiological stress (such as trauma). Activities that have an elevated risk of trauma are best avoided. Treatment must be given within two hours of trauma and consequently, it is advisable to carry injectable hydrocortisone in remote areas.

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Drink safe fluids and monitor temperature.
In dengue-prone areas, discuss CBC and platelet count when fever persists or warning signs appear.
Use tepid sponging for high fever discomfort; avoid ice-cold bathing.

OTC medicine safety

For fever, common fever medicine may be discussed with a clinician or pharmacist.
Avoid aspirin/ibuprofen-like medicines in suspected dengue unless a doctor says it is safe.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Fever with breathing difficulty, confusion, repeated vomiting, bleeding, severe weakness, stiff neck, or dehydration needs urgent care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician

Tests to discuss with doctor

Temperature chart and hydration assessment
CBC with platelet count if fever persists or dengue/other infection is possible
Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Article Summary

Key Takeaways

RX Patient Tools

Adrenal Emergencies

Causes of Adrenal insufficiency

Signs and symptoms