The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Adrenal Insufficiency: Acute Crisis

Adrenal crisis is a life-threatening emergency requiring immediate parenteral hydrocortisone, fluid resuscitation, and trigger management.

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 Endokrinoloji department. Book Appointment →

What is Adrenal Insufficiency: Acute Crisis?

Adrenal crisis (acute adrenal insufficiency) is a life-threatening medical emergency caused by absolute or relative cortisol deficiency. Annual incidence: 6-8/100 patient-years; mortality 0.5/100 patient-years. The most common trigger is gastroenteritis (40%), followed by infection, surgery, trauma, and emotional stress.

Pathophysiology: cortisol deficiency → loss of vasoconstrictor response → vasodilatation, decreased preload, hypotension, shock. Mineralocorticoid deficiency → hyponatremia, hyperkalemia, metabolic acidosis. Decreased gluconeogenesis → hypoglycemia.

Diagnosis: clinical suspicion + cortisol <5 µg/dL + ACTH (high in primary, low/normal in secondary). Treatment: hydrocortisone 100 mg IV bolus → 50 mg q6h or 200 mg/24h infusion + 0.9% NaCl 1L in first hour + dextrose if hypoglycemic + trigger management. Patient education: 3-fold dose increase + emergency injector kit.

Symptoms

Severe weakness, fatigue
Nausea, vomiting, abdominal pain
Hypotension, orthostatic dizziness
Confusion, syncope
Hypoglycemic symptoms
Fever, shock signs

Risk Factors

Primary AI (Addison's disease)
Chronic glucocorticoid use (sudden cessation)
Pituitary surgery, hypopituitarism
Bilateral adrenalectomy
Sepsis, surgery, trauma
Gastroenteritis (most common trigger)

When to See a Doctor?

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

  • Severe weakness, fainting (urgent)
  • Persistent vomiting, fluid intake impossible (urgent)
  • Abdominal pain, fever (urgent)
  • Confusion, syncope (urgent)
  • Sick day rules failure
  • After surgery, trauma

Treatment Methods

01
Hydrocortisone 100 mg IV bolus (immediate)
02
Hydrocortisone 50 mg IV q6h or 200 mg/24h infusion
03
0.9% NaCl 1L in first hour (then 2-3L/24h)
04
Glucose 5% if hypoglycemic
05
Trigger management (antibiotics, etc.)
06
Education: sick day rules, IM hydrocortisone kit

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.

Learn About Endokrinoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

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.