What Is 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 normally balances the amount of cortisol
An Addisonian crisis is a serious medical condition caused by the
body’s inability to produce a sufficient amount of cortisol. An Addisonian
crisis is also known as an acute adrenal crisis. People who have a condition
disease or who have damaged adrenal glands may not be able to produce enough
Low levels of cortisol can cause weakness, fatigue, and low blood
pressure. You may have more symptoms if you have untreated Addison’s disease or
damaged adrenal glands due to severe stress, such as from a car accident or an
infection. These symptoms include sudden dizziness, vomiting, and even loss of
consciousness. This is called an Addisonian crisis.
An Addisonian crisis can be extremely dangerous if cortisol
levels aren’t replenished. It’s a life-threatening condition that requires
immediate medical treatment.
What Are the Symptoms of an Addisonian Crisis?
The symptoms of an Addisonian crisis include:
- extreme weakness
- mental confusion
- darkening of the skin
- nausea or abdominal pain
- a sudden pain in the lower back or legs
- a loss of appetite
- extremely low blood pressure
- skin rashes
- a high heart rate
- loss of consciousness
Some people may have a craving for salt when experiencing an
Addisonian crisis. Others may feel fatigued, experience a darkening of the
skin, or have unintentional weight loss. Many of these symptoms can also
develop over time as part of Addison’s disease.
What Causes an Addisonian Crisis?
An Addisonian crisis may happen when someone who doesn’t have properly
functioning adrenal glands experiences a highly stressful situation. The
adrenal glands sit above the kidneys and are responsible for producing 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.
Other causes of Addison’s disease include:
- prolonged use of glucocorticoids, such
- severe infections, including fungal and viral
- extensive use of certain blood thinners that help
prevent blood clots
- surgery on the adrenal gland
Your cortisol levels will gradually decrease over time if you
have Addison’s disease that isn’t treated. When you don’t have an appropriate
amount of adrenal hormones, stress can overwhelm your body and lead to an
Addisonian crisis. An Addisonian crisis may be triggered by certain traumatic
- a car accident
- an injury leading to physical shock
- severe dehydration
- severe infection, such as the flu or a stomach
Who Is at Risk for an Addisonian Crisis?
Those most at risk for an Addisonian crisis are people who:
- have been diagnosed with Addison’s disease
- have recently had surgery on the adrenal glands
- have damage to the pituitary gland
- are being treated for adrenal insufficiency but don’t
take their medication
- are experiencing some type of physical trauma or
- are severely dehydrated
How Is an Addisonian Crisis Diagnosed?
Your doctor may make an initial diagnosis by measuring the level
of cortisol or adrenocorticotropic hormone (ACTH) in your blood. Once your
symptoms are under control, your doctor will perform other tests to confirm the
diagnosis and to determine whether your adrenal hormone levels are normal.
These tests might include:
- an ACTH
(cosyntropin) stimulation test, in which your doctor will assess 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 simple cortisol level test
How Is an Addisonian Crisis Treated?
People who are experiencing an Addisonian crisis typically get an
immediate injection of hydrocortisone. The medicine can be injected 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. Your doctor can show
you how to give yourself an emergency injection of hydrocortisone. It may also
be a good idea to teach your partner or a family member how to give an injection
properly. You may want to keep a spare kit in the car if you’re a frequent
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 your doctor right away. The emergency kit is
meant to help stabilize your condition, but it’s not meant to replace medical
Treatment for a Severe Addisonian Crisis
After an Addisonian crisis, your doctor may tell you to go to a
hospital for ongoing evaluation. This is usually done to make sure that your condition
has been treated effectively.
What Is the Long-Term Outlook?
People who have an Addisonian crisis often recover if the
condition is treated quickly. 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