Key takeaways

• An Addisonian crisis is a life threatening medical emergency that happens when your body can’t produce enough cortisol during acute stress events like illness, infection, injury, or surgery.

• Symptoms may include extreme weakness, dizziness, nausea, vomiting, very low blood pressure, confusion, and loss of consciousness. Some people may not know they have Addison’s disease or adrenal insufficiency until they experience a crisis.

• Treatment involves immediate hydrocortisone injections, either given by emergency medical professionals or self-administered from a prescribed emergency kit. If you receive a diagnosis of Addison’s disease, talk with a healthcare professional about emergency preparedness and always seek medical care after using your emergency kit.

An Addisonian crisis is a serious medical condition caused by the body’s inability to produce a sufficient amount of cortisol in response to a sudden stressful event, such as an illness or infection.

People who have a condition called Addison’s disease or who have damaged adrenal glands may not be able to produce enough cortisol. Sometimes, you may not know you have Addison’s disease or adrenal insufficiency until you experience an Addisonian crisis.

When you’re stressed, your adrenal glands, which sit on top of each kidney, 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 typically balances the amount of cortisol produced.

Low cortisol levels can cause symptoms that include:

  • weakness
  • fatigue
  • low blood pressure

You may have additional symptoms of untreated Addison’s disease or damaged adrenal glands due to severe stress.

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

Some people who experience an Addisonian crisis may already have a diagnosis of Addison’s disease. But others may not know they have Addison’s disease or adrenal insufficiency until they have an Addisonian crisis.

The symptoms of an Addisonian crisis can include:

An Addisonian crisis may happen when someone who doesn’t have properly functioning adrenal glands experiences an physical stress, such as an illness, infection, injury, dehydration, or surgery.

The adrenal glands sit above the kidneys and produce numerous vital hormones, including cortisol, which helps the body respond to stress. In people with adrenal insufficiency, the body cannot produce enough cortisol to meet increased demands during periods of stress. This can cause cortisol levels to drop dangerously low and may 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

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. This is known as primary Addison’s disease.

Addison’s disease can also develop as a result of another condition. Secondary causes of Addison’s disease can include:

  • long-term corticosteroid use or suddenly stopping corticosteroid medications
  • severe infections, including fungal and viral infections
  • tumors affecting hormone production
  • bleeding into the adrenal glands
  • surgery involving the adrenal glands
  • potentially, COVID-19 infection

Your cortisol levels will gradually decrease over time if you have Addison’s disease that isn’t treated. When you don’t have the necessary amount of adrenal hormones, stress can overwhelm your body and lead to an Addisonian crisis. Certain traumatic events may trigger an Addisonian crisis. These may include:

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

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 physical trauma or severe stress
  • are severely dehydrated

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

Medications

People experiencing an Addisonian crisis typically get an immediate injection of hydrocortisone. You can inject this medication 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. A doctor can show you how to give yourself an emergency injection of hydrocortisone. Your medical team may also recommend teaching a partner or a family member how to give an injection properly. If you’re a frequent traveler, you may want to keep a spare kit in your carry-on baggage.

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 a doctor right away. The emergency kit can help stabilize your condition, but it cannot replace medical care.

After an Addisonian crisis, you may be advised to seek a full evaluation at your local hospital to monitor your condition.

Treatment for a severe Addisonian crisis

Treatment for an Addisonian crisis typically involves fluids and glucocorticoid medication, usually given through an IV. Healthcare professionals sometimes refer to the “5 S’s” of adrenal crisis treatment:

  • Salt: IV saline helps restore fluid levels and treat low blood pressure.
  • Sugar: Glucose may be given to treat or prevent low blood sugar.
  • Steroids: Glucocorticoids, such as hydrocortisone or dexamethasone, replace the cortisol the body is lacking.
  • Support: Supportive care may include monitoring vital signs and managing complications.
  • Search: Doctors identify and treat the underlying cause of the crisis, such as an infection, injury, or other source of physical stress.

A person may receive a large initial dose of steroid medication followed by smaller replacement doses.

Additional treatment depends on the underlying cause of the Addisonian crisis.

If a person does not have a diagnosis of Addison’s disease or adrenal insufficiency, doctors may order additional testing to assess adrenal function.

People who have an Addisonian crisis often recover if they receive prompt treatment. With consistent treatment, those with adrenal insufficiency can live a relatively healthy, active life.

However, an untreated Addisonian crisis can lead to:

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.

An Addisonian crisis occurs when your body cannot produce the cortisol it needs during an acute stress event.

If you are diagnosed with Addison’s disease, you may have a kit containing an injection to administer if you experience symptoms of Addisonian crisis. You typically need medical attention after administration.

If left untreated, an Addisonian crisis can lead to shock and death.