What is an Adrenal Crisis?

Signs and Symptoms of Adrenal Crisis

The danger signs can be different for everyone, but common symptoms include:

• Extreme weakness, feeling terrible
• Vomiting
• Headache
• Light-headedness or dizziness on sitting up or standing up
• Feeling very cold, uncontrollable shaking
• Back, limb or abdominal pain
• Confusion, drowsiness, loss of consciousness

It is really important to listen to your body, and if you are in doubt, you should act to prevent/treat adrenal crisis with an emergency hydrocortisone injection. 

Be aware that an adrenal crisis can develop very quickly in some cases: immediate treatment is essential to prevent serious health outcomes.

Read our blog articles and watch our YouTube video for firsthand experiences from some of our members who have had an adrenal crisis.

Triggers/causes of adrenal crisis

There are many potential causes of adrenal crisis, but the most common ones are shown below.

Vomiting and diarrhoea are the most common causes of adrenal crisis.  This is because they prevent you from keeping your replacement steroid medication in your stomach for long enough to absorb it.  It is also physically stressful for you to be unwell with vomiting or diarrhoea, which usually means that your body will need a higher level of cortisol than usual.

Other common causes are physical illnesses such as flu, physical stressors such as trauma, and psychological stressors such as grief. 

Preventing adrenal crisis

The way to avoid adrenal crisis is to ensure that your body always has enough cortisol.  This is not always straightforward.

Your daily replacement steroid medication gives your body the cortisol it needs, but when your body is under physical or extreme emotional stress, it requires more cortisol.  If you have not fully absorbed your usual replacement medication, it will also not have what it needs.

To lower your risk of having an adrenal crisis;

• Take your replacement steroid medication at the right times, every day
• Understand the Sick Day Rules, and when to increase your medication dose
• Stay hydrated
• Avoid infection and illness where possible
• Look after your emotional wellbeing
• Have regular (ideally annual) reviews with your endocrine team to check your treatment routine is still the best one for you. 

The hydrocortisone injection should be made as soon as possible, into the muscle of the outer thigh (or upper arm if necessary).  

If you are not able to self-inject, and there is no one who can administer the injection for you, you should call 999 for a paramedic to come and inject you. An adrenal crisis is a Category 2 ambulance call which is classed as an emergency or a potentially serious condition that may require rapid assessment, urgent 'on-scene' intervention and/or urgent transport.

Emergency Injection Kits

After diagnosis, you should be issued with an emergency injection kit that consists of:

• a needle
• a syringe
• a disposable ampoule snapper (to help open glass 2ml vials of water)
• a set of printed instructions on how to administer an emergency injection

Your GP or endocrinologist will also give you a prescription of hydrocortisone sodium succinate 100mg powder for solution for injection or infusion 1x2ml - vial with diluent (a medicine with a long name!). It comes in a box with a small bottle with powder in, and also a small glass vial of water to mix with the powder before it is injected. Sometimes people are prescribed the powder separately to the water, which may be given to them in a 5ml plastic vial.

Lots of people put these items together themselves in a rigid box of some kind to protect them, and this is known as an emergency injection kit. 

More information on emergency injection kits

Purchase an injection kit

If you are struggling to put your own kit together, you can purchase one in a secure box, clearly labelled, from our online shop. Please note that the injection kits sold from the shop do not contain prescription medication.

Purchase an injection kit from the ADSHG shop

You may also be interested in: