Acute adrenal insufficiency: optimising care

R. Louise Rushworth, Henrik Falhammar, David J. Torpy


© 3d4medical/medical images
© 3d4medical/medical images


Adrenal crises are severe, life-threatening episodes of adrenal insufficiency. Preventing and managing adrenal crises is complex and current strategies have not been successful in achieving a reduction in the incidence of episodes. Treatment with intravenous hydrocortisone is life saving and should be given without delay to patients displaying signs of acute adrenal insufficiency and adrenal crises.


Key Points

  • An adrenal crisis is an acute episode of adrenal insufficiency that is characterised by hypotension and other symptoms and signs, including reduced consciousness, acute abdominal symptoms and electrolyte abnormalities.
  • Treatment with intravenous hydrocortisone should be given urgently and never withheld because of concerns about the side effects of glucocorticoid exposure.
  • All patients with adrenal insufficiency should carry a steroid identification card, belong to the MedicAlert Foundation (or equivalent), have adequate supplies of oral replacement therapy and have their own hydrocortisone intramuscular injection vial and needles.
  • At each review, patients should be reminded about the importance of adrenal crisis prevention and the steps involved in glucocorticoid stress dosing and be assessed for competency with intramuscular self-injection of hydrocortisone. For patients unwilling or unable to inject intramuscularly, subcutaneous injection before clinic presentation should help avoid deterioration and severe shock.