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Adrenal Crisis — Emergency Management

Life-threatening acute decompensation of adrenal insufficiency.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Adrenal Crisis — Emergency Management?

Adrenal crisis is the life-threatening acute decompensation of cortisol insufficiency. In patients with known adrenal insufficiency it can be triggered by infection, surgery, trauma or failure to increase glucocorticoid dose. It can also develop with bilateral adrenal haemorrhage, pituitary apoplexy and abrupt withdrawal of long-term exogenous steroids.

The clinical picture is characterised by hypotension (resistant to fluid resuscitation), hyponatraemia, hyperkalaemia, hypoglycaemia, dehydration, abdominal pain and altered mental status. Untreated mortality is very high.

Diagnostic tests (cortisol level, ACTH) must not delay treatment. When suspected, an IV hydrocortisone 100 mg bolus should be given, followed by 50 mg IV every 6–8 hours.

Symptoms

Severe hypotension and shock (refractory to fluids)
Dehydration and vomiting
Severe abdominal pain (mimicking acute abdomen)
Hypoglycaemia
Confusion and loss of consciousness
Fever

Risk Factors

Known adrenal insufficiency (failure to increase the stress dose)
Sudden withdrawal of long-term steroids
Bilateral adrenal haemorrhage (on anticoagulation)
Pituitary apoplexy
Sepsis (functional adrenal insufficiency)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If a patient with known adrenal insufficiency develops fever and vomiting (emergency)
  • If unexplained hypotension and shock are present (emergency)
  • If steroids have been stopped suddenly and symptoms have started (emergency)
  • When adrenal crisis is suspected, treatment must be started immediately

Treatment Methods

01
IV hydrocortisone 100 mg bolus (immediately, without awaiting diagnosis)
02
Aggressive IV isotonic saline infusion (dehydration and hypotension)
03
Hydrocortisone 50 mg IV every 6–8 hours (first 24 hours)
04
Correction of hypoglycaemia (IV dextrose)
05
Treatment of the trigger (antibiotics etc.)
06
Switch to oral replacement after stabilisation and patient education

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.