Adrenal crisis: What to do in an emergency

An adrenal crisis (also called Addisonian crisis or acute adrenal insufficiency) is a medical emergency that can occur when the cortisol levels in the body are insufficient to support life-essential functioning. This is a time-critical, life-threatening emergency and must be treated immediately. Diagnostic measures should never delay treatment.

• 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

How do you know it is an adrenal crisis?

If you are not sure whether or not it is an adrenal crisis, watch our 4-minute video on YouTube.

Remember, if in doubt, you should inject/be injected. There is no known toxic dose of hydrocortisone in an emergency, but an untreated adrenal crisis is a serious medical emergency.

Hydrocortisone is the same chemical formula as cortisol.  If you, or the person you are supporting is in adrenal crisis, this means they urgently need extra steroid medication (hydrocortisone) to raise their cortisol levels. This is most efficiently given by emergency injection into muscle (usually of the upper arm or thigh).    

This can be self-administered or given by someone close by or by a medical professional.

Learn more about the emergency injection

If you have access to an emergency injection kit, an instruction leaflet is often included. If there is not, view our step-by-step picture instructions.

If you'd prefer to watch a video for instructions, please use our videos below. The video you choose depends on:

What type of hydrocortisone is being injected? In the UK it will either be:

• a 1ml ampoule of liquid called Hydrocortisone Sodium Phosphate.
• a vial of powder (100mg Hydrocortisone Powder for Solution for Injection or Infusion) that needs to be first mixed with an ampoule of water that it is supplied with.

What type of syringe is being used? It will either be:

• A safety syringe (all-in-one needle and syringe).
• A standard syringe (which needs the needle to be attached to it use it).

Liquid Hydrocortisone videos

with Safety Syringe with Standard Syringe

Hydrocortisone Powder & Water videos

with Safety Syringe with Standard Syringe

Going to Hospital

After you have received/administered a hydrocortisone injection, you need to go to hospital (A&E) for monitoring, as you may need additional doses of hydrocortisone and fluids.

There are some things you/your carer can do to prepare for a visit/stay in hospital:

• Check that you have a Steroid Emergency Card (NHS or ADSHG) with you to show to hospital staff
• Check that you are wearing your medical ID jewellery
• Bring information for hospital staff on adrenal insufficiency/Addison's disease (see links below)
• Bring your ADSHG Hospital Folder, if you have one
• Prepare a hospital bag with some basics in case you are