Adrenal Crisis

Source: ADSHG patient booklet (June 2025) — see The Condition for details. Agree your own treatment plan with your endocrinologist.

People with Addison’s disease and adrenal insufficiency are steroid dependent. Without adequate steroid hormone replacement, all patients with adrenal insufficiency are at risk of a life-threatening emergency called an adrenal crisis. They must follow a strict medication routine, taking glucocorticoid treatment at carefully spaced intervals every day to replace what their body cannot make.

An adrenal crisis happens when the body’s need for cortisol exceeds what the adrenal glands can produce. It requires time-critical, life-saving medical treatment: an emergency hydrocortisone injection given by the patient, someone with them, or a healthcare professional — followed by hospital treatment with intravenous fluids.

Danger signs of an adrenal crisis

• Extreme weakness, feeling very unwell, vomiting, headache
• Light-headedness or dizziness when sitting or standing
• Feeling extremely cold, uncontrollable shivering
• Back, limb or abdominal pain
• Confusion, drowsiness, loss of consciousness

These symptoms may resemble the illness symptoms you had before diagnosis.

Treatment of an adrenal crisis

If you feel seriously unwell you need an emergency hydrocortisone injection (use your emergency injection kit) followed by urgent hospital treatment. Call 112 and tell the team that you have Addison’s disease, may be having an Addisonian / adrenal crisis, and must take steroids regularly. You may need intravenous fluids and further hydrocortisone until you recover.

When you or someone with you calls a doctor or ambulance, it is important to tell the 112 team that you have Addison’s disease, may be having an Addisonian / adrenal crisis, and must take steroids regularly, so the urgency of the situation is understood.

Emergency injection kit

According to the guidance cited in the booklet, people with Addison’s disease and secondary adrenal insufficiency should be prescribed 2 or 3 emergency injection kits to use when an adrenal crisis is perceived to be at risk or actually occurs. An emergency injection kit should also be considered for people with tertiary adrenal insufficiency who have previously had an adrenal crisis.

Kits are prescribed as 3–5 vials of either:

• Hydrocortisone sodium phosphate (100 mg) — 1 ml liquid ampoule or
• Hydrocortisone sodium succinate 100 mg powder / hydrocortisone 100 mg powder for injection or infusion — one 2 ml vial with diluent (5 ml or 10 ml water)

Kit(s) should also include 2 intramuscular (IM) needles (blue) and 2 × 2 ml syringes, with easy-to-follow written instructions on how to prepare and give the injection and how to dispose of needles and syringes. Best practice is to include a steroid emergency card in the kit.

Learning to inject

1. Ask your endocrine team for training for you and the people who care for or support you.
2. Watch online training videos specific to your type of medication and needle.
3. Attend hands-on injection training sessions.
4. Repeat the training regularly to build your confidence.

Going to the emergency department

If you go to the emergency department with an actual or suspected adrenal crisis, the booklet recommends:

1. Follow the emergency plan agreed with your endocrinologist and use your prescribed emergency injection kit immediately (booklet example: 100 mg hydrocortisone; not an absolute rule — the dose in your plan applies).
2. If possible, take a relative or friend with you; they can help explain the urgency of your condition even if you are confused or very unwell.
3. Take your steroid emergency card and medical alert jewellery showing that you take steroids regularly.
4. Take a medical summary showing your diagnosis, your medication and your latest prescription.
5. Take your own emergency injection kit too; if you are still very unwell after the first injection and are not assessed in time, the booklet says a second injection (e.g. 100 mg hydrocortisone) may be needed; assess this with the emergency team and according to your plan.

For dose increases during illness/stress, see Be Prepared → Sick day rules.

Coming soon: information on obtaining an emergency injection kit in Türkiye.

Medical disclaimer: The information on this site is prepared by a patient community for general information only. Always consult your own doctor (endocrinologist) about diagnosis, treatment or any dose change. In an emergency in Türkiye, call 112.