Adrenal crisis: warning signs and what to do

Call 911 or go to the nearest emergency room now if you have an adrenal condition, take a steroid medicine, or may have an adrenal problem, and you have any of these.

• Vomiting or severe diarrhea, especially if you can’t keep your steroid medicine down.
• Severe weakness, so that you can’t do your usual daily activities.
• Fainting, or feeling faint when you stand.
• A severe infection, or a serious injury or illness, on top of an adrenal condition or steroid use.

Don’t wait for a test, an appointment or a call-back. Tell the crew you have adrenal insufficiency or take steroid medicine, and show your steroid emergency card or medical ID if you have one. Follow the emergency plan your prescriber gave you. These signs fit many other illnesses, and all of them need urgent care. You don’t have to be sure it is adrenal.

An adrenal crisis is a life-threatening shortage of cortisol. It is a complication of adrenal insufficiency, including Addison’s disease, and it can also be the first sign that someone has the condition. This page explains the signs, who is at risk, what happens in hospital and why we give no cortisol number to wait on.

The warning signs

A 2013 paper describes an imminent crisis as nausea and vomiting, a large fall in blood pressure and weakness so severe it stops daily activities. It says these will worsen into a crisis unless hydrocortisone is started immediately. A full crisis is shock caused by cortisol deficiency, with low sodium and high potassium in the blood and sometimes low blood sugar. A 2014 hospital study describes crisis as vomiting and fainting with low blood pressure and abnormal blood salts.

The signs are harder to read in some people. A 2021 European review says symptoms may be more difficult to interpret in older adults and in young children. The 2014 study adds that older adults with adrenal insufficiency may not get typical signs of infection, such as fever, and may become confused, which makes it harder to manage an illness alone.

For this reason, the rule is simple. If someone with an adrenal condition or steroid use is vomiting, has severe diarrhea, is very weak or has fainted, treat it as an emergency.

What to do, step by step

1. Call 911. If you are with someone who is very unwell and has an adrenal condition, make the call for them.
2. Say the words. “Adrenal insufficiency” or “I take steroid medicine” tells the crew what to look for.
3. Show the card or ID. MedlinePlus advises people with Addison disease to carry an emergency ID that says they have the disease, lists their medicines and says how much they need in an emergency. A 2021 paper recommends a steroid emergency card for every patient.
4. Follow your emergency plan. Some people are trained to give themselves or a relative an emergency injection. The 2014 study says a patient or relative may use an injection kit if getting care is delayed. It is meant to bridge a delay, so you still need emergency care.

What happens in hospital

NIDDK says treatment for adrenal crisis is immediate corticosteroids and large amounts of saline, a salt solution with dextrose (a sugar), all given through a vein. A 2023 review says patients with suspected crisis should start treatment as quickly as possible, without being held up by diagnostic tests. Doctors treat first and work out the cause afterwards.

Who is at risk

People with known adrenal insufficiency. A 2021 review, citing earlier work, puts crises at 5 to 10 per 100 patient years in people with adrenal insufficiency. Other studies of primary adrenal insufficiency cited in the 2014 paper found about 10% a year.

People taking steroids for another condition. NIDDK says a severe infection, severe diarrhea or vomiting that stops you keeping steroid pills down needs immediate medical attention, in an emergency room if necessary, because it can lead to crisis. The authors of the 2014 study say that, in their clinical experience, crises are relatively rare in people taking steroids for other conditions, probably because the adrenal glands keep some function. Rare is not never. See steroids and cortisol.

People who don’t know they have it. NIDDK says symptoms sometimes appear for the first time during an adrenal crisis. In a Polish clinic’s group of 60 people with primary adrenal insufficiency, 13 were first diagnosed during a crisis and 13 more just as signs of one appeared. See low cortisol symptoms.

Older adults. In the 2014 study of hospital stays in New South Wales, Australia, crisis admissions rose with age and were highest in people in their 60s, 70s and 80s.

Pregnancy. In a 2025 audit of 79 women with primary adrenal insufficiency in the UK and Ireland, 19 (24%) had a crisis during pregnancy. The authors attributed 9 of the 19 to severe nausea and vomiting. They say a pregnant woman who can’t take her prescribed steroid medicine because of vomiting should seek urgent medical review. See cortisol in pregnancy.

What can set one off

The 2014 hospital study found an infection recorded in 38.5% of crisis admissions, most often pneumonia and urinary tract infection. It found gastroenteritis recorded in 15.2%. The authors point out that nausea and vomiting from a crisis overlap with gastroenteritis, so a stomach bug may be overstated as a trigger in studies that rely on patients’ own reports.

The Polish clinic followed 60 people after diagnosis. Their imminent crises came from illness or injury where the steroid dose was not raised enough or was cut back too quickly, and from stomach problems such as ulcers or gastritis that stopped medicine being absorbed. Your prescriber sets the plan for sick days. Don’t improvise one.

NIDDK says the most common cause of adrenal insufficiency overall is suddenly stopping steroids taken for a long time. Never stop or change a steroid medicine on your own. Ask your prescriber.

Is there a dangerously low cortisol level?

This page deliberately gives no number. Here is why.

• A crisis is recognized by signs, not by a threshold. Treatment starts before results because an untreated crisis can be fatal.
• Cortisol is meant to change through the day, and labs differ. A 2024 review reports one study in which five automated lab methods read 1.08 to 1.36 times higher than a mass spectrometry reference (Endocrine Reviews, 2024). A number printed on one report doesn’t carry over to another.
• In a serious infection the body normally raises its cortisol. The 2014 paper says that in cortisol deficiency this rise doesn’t happen, which leads to an unrestrained inflammatory response. What matters is whether the body can respond to the stress, and one value out of context doesn’t show that.
• Waiting for a result is the risk. Nobody should decide whether to seek care by checking a figure.

How clinicians test for adrenal insufficiency, step by step, is on the low cortisol page. Those steps are for diagnosis. They are not a way to decide whether to seek care.

If you have adrenal insufficiency: the plan to ask your prescriber about

These points come from the 2021 European review, and your prescriber sets the details.

• Carry a steroid emergency card.
• Ask whether you should have an emergency injection kit, and be shown how to use it.
• Keep a supply of medicine that includes a sick-day package, and ask what your sick-day rules are.
• Seek medical care if you have diarrhea or vomiting, because tablets may not be absorbed. The 2014 paper makes the same point.
• Tell the team before surgery, and tell any new clinician you have adrenal insufficiency. NIDDK says doses are raised for illness, surgery and injury, and your doctor decides how.

Common questions

Is an adrenal crisis the same as Addison’s disease?

No. Addison’s disease is one form of adrenal insufficiency, a long-term condition treated with daily hormone medicine. An adrenal crisis is an acute emergency that can happen in anyone with adrenal insufficiency. Hospital records code it as Addisonian crisis. “Adrenal emergency” and “adrenal gland crisis” mean the same thing.

What causes an adrenal crisis?

A lack of cortisol at a time when the body needs a lot of it. The causes above are infection, vomiting or diarrhea that stops medicine working, surgery or injury, and untreated or undiagnosed adrenal insufficiency. See causes of low cortisol for why the adrenal glands may fail in the first place.

Can I tell if I am heading for one?

The early picture is nausea, vomiting, falling blood pressure and severe weakness. If you have adrenal insufficiency and these appear, treat it as urgent rather than waiting to see if it passes.