Learn About Acute Adrenal Crisis

What is the definition of Acute Adrenal Crisis?

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.

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What are the alternative names for Acute Adrenal Crisis?

Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

What are the causes of Acute Adrenal Crisis?

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 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, or surgery
  • The pituitary is injured and cannot release ACTH (hypopituitarism)
  • 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
What are the symptoms of Acute Adrenal Crisis?

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

  • Abdominal pain or flank pain
  • Confusion, loss of consciousness, or coma
  • Dehydration
  • Dizziness or lightheadedness
  • Fatigue, severe weakness
  • Headache
  • High fever
  • Loss of appetite
  • Low blood pressure
  • Low blood sugar
  • Nausea, vomiting
  • Rapid heart rate
  • Rapid respiratory rate
  • Slow, sluggish movement
  • Unusual and excessive sweating on face or palms
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What are the current treatments for Acute Adrenal Crisis?

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.

Many people with primary or secondary adrenal insufficiency have an emergency syringe with hydrocortisone at home that a family member can inject into muscle (IM) if they are too sick or too weak to take their hydrocortisone pills.

Who are the top Acute Adrenal Crisis Local Doctors?
Elite
Highly rated in
11
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German Society For Endocrinology

DE 

Stefanie Hahner is in Germany. Hahner is rated as an Elite expert by MediFind in the treatment of Acute Adrenal Crisis. She is also highly rated in 11 other conditions, according to our data. Her top areas of expertise are Acute Adrenal Crisis, Addison's Disease, Adrenocortical Carcinoma, and Adrenal Cancer.

Elite
Highly rated in
20
conditions

Beaumont Hospital

Dublin, L, IE 

Mark Sherlock is in Dublin, Ireland. Sherlock is rated as an Elite expert by MediFind in the treatment of Acute Adrenal Crisis. He is also highly rated in 20 other conditions, according to our data. His top areas of expertise are Addison's Disease, Acute Adrenal Crisis, Isolated ACTH Deficiency, and Secondary Adrenal Insufficiency.

 
 
 
 
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Elite
Highly rated in
14
conditions

Charité University Medicine Berlin

DE 

Marcus Quinkler is in Germany. Quinkler is rated as an Elite expert by MediFind in the treatment of Acute Adrenal Crisis. He is also highly rated in 14 other conditions, according to our data. His top areas of expertise are Addison's Disease, Acute Adrenal Crisis, Adrenal Cancer, and Adrenocortical Carcinoma.

What is the outlook (prognosis) for Acute Adrenal Crisis?

Shock may occur if treatment is not provided early, and it can be life threatening from very low blood pressure and heart problems.

When should I contact a medical professional for Acute Adrenal Crisis?

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 or hypopituitarism 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 stressed or ill, or before having surgery. This is called 'stress' or 'sick-day' dosing.

How do I prevent Acute Adrenal Crisis?

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.

If you take glucocorticoid medicines for pituitary ACTH deficiency, be sure you know when to take a stress dose of your medicine. Discuss this with your provider.

Never miss taking your medicines.

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Who are the sources who wrote this article ?

Published Date : May 13, 2021
Published By : Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Bornstein SR, Alloliu B, Arlt W, et al. Diagnosis and treatment of primary adrenal Insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. PMID: PMC4880116 www.ncbi.nlm.nih.gov/pmc/articles/PMC4880116/.

Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020: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.