Sudden shock, dehydration, and even death—How an adrenal crisis can lead to a life-threatening emergency?

When the adrenal glands, which produce essential hormones like cortisol, suddenly stop working properly, it can result in an adrenal crisis, which can be deadly. If you ignore it, this condition can cause severe dehydration, shock, and even death. Although adrenal crises are uncommon, it is important for people who are at risk—especially those who have adrenal insufficiency or other conditions related to the adrenal glands—to be aware of the warning symptoms, causes, and available treatments. What an adrenal crisis is, how it develops, and what to do if you or someone you know has one will all be covered in this article. 

What is an adrenal crisis?

When the hormone cortisol, which is produced by the adrenal glands, is drastically insufficient, a medical emergency known as an adrenal crisis occurs. The body needs cortisol to strengthen the immune system, control blood pressure and blood sugar, and react to stress. 

In individuals with adrenal insufficiency (often due to Addison’s disease or other adrenal disorders), the adrenal glands cannot produce enough cortisol to handle the body’s stress responses. When the body faces a physical stressor such as illness, trauma, surgery, or infection, cortisol levels drop sharply, leading to an adrenal crisis.

Adrenal crises need to be treated right away because they occur unexpectedly and without warning.

Causes of Adrenal Crisis

Adrenal crises can be triggered by various factors, particularly in individuals who already have an underlying adrenal disorder. Some common causes include:

1. Addison’s Disease:

● Addison’s disease is when the adrenal glands are damaged and cannot produce sufficient cortisol and aldosterone. If left untreated or when cortisol medication is suddenly stopped, it can lead to an adrenal crisis.

2. Sudden Withdrawal of Corticosteroids:

● People who have been on long-term corticosteroid therapy (such as prednisone) for conditions like asthma or arthritis may develop adrenal insufficiency. Abruptly stopping these medications without tapering them down gradually can precipitate an adrenal crisis.

3. Infections or illness:

● Infections such as the flu, pneumonia, or gastroenteritis increase the body’s need for cortisol. In individuals with adrenal insufficiency, the body may not produce enough cortisol to respond to the infection, leading to a crisis.

4. Trauma or Surgery:

● Major physical stress, including surgery or significant injury, can overwhelm the body’s ability to produce adequate cortisol in people with adrenal insufficiency.

5. Dehydration and electrolyte imbalance:

● Severe dehydration, which often comes by vomiting, diarrhoea, or heavy sweating, can drop blood pressure and weaken the body’s reaction to stress, which can lead to the start of an adrenal crisis. 

Symptoms of Adrenal Crisis

An adrenal crisis develops rapidly and can lead to severe symptoms, often resembling shock. The hallmark symptoms of adrenal crisis include:

1. Severe Fatigue and Weakness:

● One of the first signs of an adrenal crisis is a sudden, overwhelming feeling of exhaustion that does not improve with rest.

2. Low Blood Pressure (Hypotension):

● As cortisol helps regulate blood pressure, a lack of cortisol can cause a dangerous drop in blood pressure, resulting in dizziness, fainting, and shock.

3. Severe Abdominal Pain:

● Abdominal pain is common and often described as severe and cramp-like. This pain can be followed by nausea and vomiting.

4. Vomiting and Diarrhea:

● Gastrointestinal symptoms such as nausea, vomiting, and diarrhoea are frequent in adrenal crises and can contribute to dehydration.

5. Confusion and Mental Changes:

● Due to low blood pressure and dehydration, confusion, irritability, and even loss of consciousness can occur.

6. Rapid Heart Rate (Tachycardia):

● The body attempts to compensate for low blood pressure by increasing the heart rate, which can become dangerously fast during an adrenal crisis.

7. Hypoglycemia (low blood sugar):

● Because cortisol is important for managing blood sugar levels, a deficiency in this hormone can result in low blood sugar. This may cause symptoms including anger, confusion, and shaking.

8. Electrolyte Imbalances:

● A lack of cortisol can also cause a drop in sodium and an increase in potassium levels, leading to electrolyte imbalances that can worsen the symptoms of adrenal crisis.

Diagnosing Adrenal Crisis

Diagnosing adrenal crisis is primarily based on the patient’s symptoms and medical history. If an adrenal crisis is suspected, doctors may perform several tests to confirm the diagnosis:

1. Blood Tests:

● Blood tests are used to check for low cortisol levels, low sodium, and high potassium levels. These imbalances are indicative of adrenal insufficiency.

2. ACTH Stimulation Test:

● This test measures the adrenal glands’ response to adrenocorticotropic hormone (ACTH), which stimulates cortisol production. In people with adrenal insufficiency, the adrenal glands do not respond appropriately.

3. Electrolyte Levels:

● Blood tests to check for low sodium and high potassium levels are important, as these imbalances are common during an adrenal crisis.

Treatment of Adrenal Crisis:

An adrenal crisis is a medical emergency that requires immediate treatment to prevent complications, including shock and organ failure. The main goals of treatment are to restore cortisol levels, stabilize blood pressure, and correct electrolyte imbalances. Treatment options include:

1. Intravenous (IV) Hydrocortisone:

● IV hydrocortisone, a synthetic cortisol, is quickly administered as the first line of treatment. This is administered in large quantities to stabilize the body’s reaction and raise cortisol levels.

2. IV Fluids:

● to treat dehydration, raise blood pressure, and fix electrolyte imbalances—particularly low sodium and high potassium—IV fluids, like saline, are given.

3. Electrolyte Correction:

● Electrolyte imbalances, including low sodium and high potassium, are corrected through IV fluids and medications to normalize blood pressure and heart function.

4. Treatment of Underlying Cause:

● If an infection, trauma, or other condition has triggered the adrenal crisis, appropriate treatment for the underlying cause (e.g., antibiotics for infection, treatment for dehydration) is crucial.

5. Oral Corticosteroid Therapy:

● Oral corticosteroids will be used after the patient’s condition has stabilized. To avoid these crises, you will need daily hormone replacement therapy for a lifetime. 

6. Emergency Injection Kit:

● People with known adrenal insufficiency should always carry an emergency injection kit with hydrocortisone in case of an acute illness or stress that could trigger an adrenal crisis.

Preventing Adrenal Crisis

While an adrenal crisis is an emergency, there are several steps that individuals with adrenal insufficiency can take to prevent it:

1. Follow Medication Guidelines:

● Take prescribed corticosteroids regularly and never stop or reduce the dosage without consulting a doctor. Always adjust doses when under physical stress, such as during illness or surgery, as advised by your healthcare provider.

2. Wear a Medical Alert Bracelet:

● Wearing a medical alert bracelet that indicates your condition can help doctors provide the right care in an emergency.

3. Monitor for Symptoms:

● Notice early signs of stress or illness if you are feeling extremely tired, dizzy, or have some gastrointestinal distress. If you are experiencing these symptoms, Seek immediate medical attention if these symptoms worsen.

4. Emergency Plan:

● Develop an emergency plan with your doctor that includes what to do if you experience an adrenal crisis. This plan should include how to use your emergency medication and when to seek help.