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Addisonian Crisis (Acute Adrenal Crisis): Symptoms, Causes, Risk factors, Diagnosis, Treatments, Outlook

What is Addisonian Crisis (Acute Adrenal Crisis)?

When you’re stressed, your adrenal glands, which sit atop the kidneys, produce a hormone called cortisol. Cortisol helps your body respond effectively to stress. It also plays a role in bone health, immune system response, and the metabolism of food. Your body normally balances the amount of cortisol produced.

An Addisonian crisis is a serious medical condition caused by the body’s inability to produce a sufficient amount of cortisol. An Addisonian crisis is also known as an acute adrenal crisis. People who have a condition called Addison’s disease or who have damaged adrenal glands may not be able to produce enough cortisol.

Low levels of cortisol can cause weakness, fatigue, and low blood pressure. You may have more symptoms if you have untreated Addison’s disease or damaged adrenal glands due to severe stress, such as from a car accident or an infection. These symptoms include sudden dizziness, vomiting, and even loss of consciousness. This is called an Addisonian crisis.

An Addisonian crisis can be extremely dangerous if cortisol levels aren’t replenished. It’s a life-threatening condition that requires immediate medical treatment.

Symptoms of an Addisonian Crisis

The symptoms of an Addisonian crisis include:

  • extreme weakness
  • mental confusion
  • dizziness
  • nausea or abdominal pain
  • vomiting
  • fever
  • a sudden pain in the lower back or legs
  • a loss of appetite
  • extremely low blood pressure
  • chills
  • skin rashes
  • sweating
  • a high heart rate
  • loss of consciousness

Causes of Addisonian Crisis

An Addisonian crisis may happen when someone who doesn’t have properly functioning adrenal glands experiences a highly stressful situation. The adrenal glands sit above the kidneys and are responsible for producing numerous vital hormones, including cortisol. When the adrenal glands are damaged, they can’t produce enough of these hormones. This can trigger an Addisonian crisis.

People with Addison’s disease are at a higher risk of having an Addisonian crisis, especially if their condition isn’t treated. Addison’s disease often occurs when a person’s immune system accidentally attacks their adrenal glands. This is called an autoimmune disease. In an autoimmune disease, your body’s immune system mistakes an organ or part of the body as a harmful invader, such as a virus or bacteria.

Other causes of Addison’s disease include:

  • prolonged use of glucocorticoids, such as prednisone
  • severe infections, including fungal and viral infections
  • tumors
  • bleeding in the adrenal glands due to use of certain blood thinners that help prevent blood clots
  • surgery on the adrenal gland

Your cortisol levels will gradually decrease over time if you have Addison’s disease that isn’t treated. When you don’t have a normal amount of adrenal hormones, stress can overwhelm your body and lead to an Addisonian crisis. An Addisonian crisis may be triggered by certain traumatic events, including:

  • a car accident
  • an injury leading to physical shock
  • severe dehydration
  • severe infection, such as the flu or a stomach virus

Risk Factor for  Addisonian Crisis

Those most at risk for an Addisonian crisis are people who:

  • have been diagnosed with Addison’s disease
  • have recently had surgery on their adrenal glands
  • have damage to their pituitary gland
  • are being treated for adrenal insufficiency but don’t take their medication
  • are experiencing some type of physical trauma or severe stress
  • are severely dehydrated

Diagnosing Addisonian Crisis

Your doctor may make an initial diagnosis by measuring the level of cortisol or adrenocorticotropic hormone (ACTH) in your blood. Once your symptoms are under control, your doctor will perform other tests to confirm the diagnosis and to determine whether your adrenal hormone levels are normal. These tests might include:

  • an ACTH (cosyntropin) stimulation test, in which your doctor will assess your cortisol levels before and after an injection of ACTH
  • a serum potassium test to check potassium levels
  • a serum sodium test to check sodium levels
  • a fasting blood glucose test to determine the amount of sugar in your blood
  • a simple cortisol level test

Treatments for Addisonian Crisis


People who are experiencing an Addisonian crisis typically get an immediate injection of hydrocortisone. The medicine can be injected into a muscle or vein.

Home care

You may already have a kit that includes a hydrocortisone injection if you’ve been diagnosed with Addison’s disease. Your doctor can show you how to give yourself an emergency injection of hydrocortisone. It may also be a good idea to teach your partner or a family member how to give an injection properly. You may want to keep a spare kit in the car if you’re a frequent traveler.

Don’t wait until you’re too weak or confused to give yourself the hydrocortisone injection, especially if you’re already vomiting. Once you’ve given yourself the injection, call your doctor right away. The emergency kit is meant to help stabilize your condition, but it’s not meant to replace medical care.

Treatment for a severe Addisonian crisis

After an Addisonian crisis, your doctor may tell you to go to a hospital for ongoing evaluation. This is usually done to make sure that your condition has been treated effectively.

Long-term outlook for Addisonian Crisis

People who have an Addisonian crisis often recover if the condition is treated quickly. With consistent treatment, those with adrenal insufficiency can live a relatively healthy, active life.

However, an untreated Addisonian crisis can lead to:

  • shock
  • seizures
  • a coma
  • death

You can limit your risk of developing an Addisonian crisis by taking all of your prescribed medications. You should also carry a hydrocortisone injection kit and have an identification card stating your condition in case of an emergency.

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