Addisonian Crisis (Acute Adrenal Crisis)

Written by Seth Stoltzfus
Medically Reviewed by George Krucik, MD

What Is Addisonian Crisis?

When we’re stressed out, our adrenal glands produce a hormone called cortisol. Cortisol helps our bodies respond effectively to stress. It also plays a role in bone health, immune response, and the metabolism of food. People who have Addison’s disease don’t make enough cortisol or aldosterone. Low levels of cortisol may cause weakness, fatgue and low blood pressure. Aldosterone regulates sodium and potassium levels. When levels of cortisol fall rapidly, you develop Addisonian crisis. Addisonian crisis, also called acute adrenal insufficiency, is a serious emergency condition.

Addisonian crisis can be a life-threatening condition. The patient can go into shock. An Addisonian crisis can be extremely dangerous if cortisol levels are not replaced.

What Causes an Addisonian Crisis?

The underlying cause of Addisonian crisis—the lack of cortisol—is caused by damage to the adrenal glands. The adrenal glands sit above the kidneys. If your adrenal glands do not produce glucocorticoid hormones like cortisol, it compromises the body’s ability to develop effective immune responses.

Stress can overwhelm someone who doesn’t have the necessary adrenal hormones. Medical experts believe that traumatic events like a car accident may trigger an Addisonian crisis. Even the flu or a stomach virus can stress out the body.

Who Is at Risk for an Addisonian Crisis?

Those most at risk for Addisonian crisis are:

  • individuals suffering from Addison’s disease
  • people who have damage to the pituitary gland, where adrenal insufficiency may be a result
  • patients being treated for any kind of adrenal insufficiency and who do not take their medication
  • people who are experiencing some kinds of physical trauma and stress
  • surgical patients
  • individuals who are experiencing dehydration

Symptoms of Addisonian Crisis

If you are experiencing an Addisonian crisis, you may experience a range of symptoms. Some symptoms resemble those of other conditions. They are:

  • nausea or abdominal pain
  • vomiting
  • fever
  • joint pain
  • loss of appetite
  • dramatic changes in blood pressure
  • weakness
  • chills
  • rashes of the skin
  • an irregularly high heart rate

Some patients may experience a craving for salt, for example. Others may feel fatigued, experience darkening of the skin, or have unintentional weight loss.Many of these symptoms can develop over time as part of Addison’s disease.

Diagnosing Addisonian Crisis

Your doctor may use various blood tests to determine if your adrenal hormone levels are normal. These might include:

  • an ACTH or Cosyntropin (Cortrosyn) Stimulation Test, where a doctor will assess your cortisol levels relative to an ACTH injection
  • a fasting blood sugar test
  • a serum potassium or serum sodium test
  • a simple cortisol test

How Do You Treat Addisonian Crisis?

Medications

People who are experiencing an Addisonian crisis typically get an immediate injection of hydrocortisone. If you visit an emergency room or doctor’s office, you may be given an injection through a vein, or in your muscles.

Home Care

If you have already been diagnosed with Addison’s disease, you may have a kit that includes a hydrocortisone injection available.

Treatment for Severe Addisonian Crisis

After an Addisonian crisis, your doctor may also recommend going to a hospital for ongoing evaluation. You’ll want to make sure that your adrenal insufficiency has been effectively treated.

What Is the Long-Term Outlook for Addisonian Crisis?

If an Addisonian crisis is treated quickly, the patient can often return to normal. With consistent drug treatments, those with adrenal insufficiency can function well. However, an untreated Addisonian crisis can lead to:

  • shock
  • seizures
  • coma

You can limit your chance of developing Addisonian crisis by taking all prescribed medications. You should also carry an emergency hydrocortisone kit.

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