An Addisonian crisis happens when the body cannot produce enough cortisol during a sudden stress event. It typically occurs in people with Addison’s disease and requires immediate medical treatment.
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 stress 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 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 typically balances the amount of cortisol produced.
Low cortisol levels can cause symptoms that include:
- 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:
- extreme weakness
- nausea or abdominal pain
- sudden pain in the lower back or legs
- a loss of appetite
- extremely low blood pressure
- skin rashes
- a high heart rate
- fainting or loss of consciousness
- mental confusion
An Addisonian crisis may happen when someone who doesn’t have properly functioning adrenal glands experiences an acute stress event, including an illness or accident.
The adrenal glands sit above the kidneys and produce 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. 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:
- prolonged use of glucocorticoids, such as prednisone and dexamethasone
- severe infections, including fungal and viral infections
- tumors that affect hormone production
- bleeding in the adrenal glands from certain blood thinners that help prevent blood clots
- surgery on the adrenal gland
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:
- an ACTH (cosyntropin) stimulation test, in which a doctor assesses 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 cortisol serum test to assess the amount of cortisol in your blood
People experiencing an Addisonian crisis typically get an immediate injection of hydrocortisone. You can inject this medication into a muscle or vein.
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. They may also recommend teaching your 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 the car.
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, a doctor may tell you to go to a hospital for ongoing evaluation. This is usually done to monitor the management of your condition effectively.
Treatment for a severe Addisonian crisis
Treatment for an Addisonian crisis typically involves fluids and glucocorticoid medication, typically given through an IV. Steroid medications can include dexamethasone or hydrocortisone. You may receive a large dose of steroid medication followed by steroid replacement therapy in smaller doses.
You may also need treatment for the underlying cause of the Addisonian crisis. This treatment depends on the cause.
If you do not have a diagnosis of Addison’s disease or adrenal insufficiency, doctors may order additional testing to determine your 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.