Key Takeaways
- Understanding acute adrenal crisis seniors is important for seniors and their caregivers.
- Symptoms and signs of adrenal crisis can include any of the following:
- Tests that may be ordered to help diagnose acute adrenal crisis include:
- Adrenal crisis is a medical emergency.
- Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
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Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the
adrenal glands
.
What Are the Common Causes and Risk Factors?
Understanding acute adrenal crisis seniors is important for seniors and their caregivers. the adrenal glands are small hormone-releasing organs located on top of each kidney. They are made up of an outer portion called the cortex, and an inner portion called the medulla.
The cortex produces 3 hormones:
- Glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, blood pressure, decrease (suppress) immune response, and help the body respond to stress.
- Mineralocorticoid hormones (such as aldosterone) regulate sodium, water and potassium balance.
- Sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.
The medulla produces the hormone adrenaline (also called epinephrine). Both cortisol and adrenaline are released in response to
stress
.
Cortisol production is regulated by the pituitary. This is a small gland just underneath the brain. The pituitary releases adrenocorticotropic hormone (ACTH). This is a hormone that causes the adrenal glands to release cortisol.
Adrenaline production is regulated by nerves coming from the brain and spinal cord and by circulating hormones.
Adrenal crisis can occur from any of the following:
-
The adrenal gland is damaged due to, for example,
Addison disease
, other adrenal gland disease, or surgery
-
The pituitary is injured and cannot release ACTH (
hypopituitarism
)
- Adrenal insufficiency is not properly treated
- You’ve been taking glucocorticoid medicines for a long time, and suddenly stop
- Medicines such as ketoconazole or immune checkpoint inhibitors
- You’ve become very dehydrated
- Infection or other physical stress
What Are the Symptoms and Warning Signs?
Symptoms and signs of adrenal crisis can include any of the following:
-
Abdominal pain
or
flank pain
-
Confusion
, loss of consciousness, or
coma
-
Dehydration
- Dizziness or lightheadedness
- Fatigue, severe weakness
- Headache
- High fever
- Loss of appetite
-
Low blood pressure
- Low blood sugar
- Nausea, vomiting
-
Rapid heart rate
-
Rapid respiratory rate
- Slow, sluggish movement
- Unusual and excessive sweating on face or palms
📖 What Are Exams and Tests?
What Are Exams and Tests?
Tests that may be ordered to help diagnose acute adrenal crisis include:
-
ACTH (cosyntropin) stimulation test
-
Cortisol level
-
Blood sugar
-
Blood potassium level
-
Blood sodium level
- Blood pH level
- Thyroid hormone level
📖 How Is It Treated?
How Is It Treated?
Adrenal crisis is a medical emergency. In adrenal crisis, you need to be given the medicine hydrocortisone right away through a vein (
intravenous
) or muscle (intramuscular). You may receive intravenous fluids if you have low blood pressure.
You will need to go to the hospital for treatment and monitoring. If infection or another medical problem caused the crisis, you may need additional treatment.
Many people with primary or secondary adrenal insufficiency have an emergency syringe with hydrocortisone at home that a family member can inject into muscle if they are too sick or too weak to take their hydrocortisone pills.
📖 What Is Outlook (Prognosis)?
📖 When to Contact a Medical Professional?
When to Contact a Medical Professional?
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
Contact your health care provider if you have Addison disease or hypopituitarism and are unable to take your glucocorticoid medicine for any reason.
If you have Addison disease, you will usually be told to temporarily increase the dosage of your glucocorticoid medicine if you are stressed or ill, or before having surgery. This is called stress or sick-day dosing.
📖 How Is It Prevented?
How Is It Prevented?
If you have Addison disease, learn to recognize the signs of potential stress that may cause an acute adrenal crisis. If you have been instructed by your provider, be prepared to give yourself an emergency shot of glucocorticoid or to increase your dosage of oral glucocorticoid medicine in times of stress. Parents should learn to do this for their children who have adrenal insufficiency.
Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.
If you take glucocorticoid medicines for pituitary ACTH deficiency, be sure you know when to take a stress dose of your medicine. Discuss this with your provider.
Never miss taking your medicines.
Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency
-
Endocrine glands
-
Adrenal gland hormone secretion
Auchus RJ, Pandey CEF. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds.
Williams Textbook of Endocrinology
. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 13.
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab
. 2016;101(2):364-389. PMID: 26760044
pubmed.ncbi.nlm.nih.gov/26760044/
.
Nieman LK. Adrenal cortex. In: Goldman L, Cooney KA, eds.
Goldman-Cecil Medicine
. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 208.
Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, ed.
Rosen’s Emergency Medicine: Concepts and Clinical Practice
. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 117.
Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
-
Addison Disease
-
Adrenal Gland Disorders
Frequently Asked Questions
Key Takeaways
Tests that may be ordered to help diagnose acute adrenal crisis include:
Adrenal crisis is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
What Are the Common Causes and Risk Factors?
What Are the Symptoms and Warning Signs?
Abdominal pain
or
flank pain
Confusion
, loss of consciousness, or
coma
Dehydration
Dizziness or lightheadedness
Fatigue, severe weakness
Headache
High fever
Loss of appetite
Low blood pressure
Low blood sugar
Nausea, vomiting
Rapid heart rate
Rapid respiratory rate
Slow, sluggish movement
Unusual and excessive sweating on face or palms
📖 What Are Exams and Tests?
What Are Exams and Tests?
ACTH (cosyntropin) stimulation test
Cortisol level
Blood sugar
Blood potassium level
Blood sodium level
Blood pH level
Thyroid hormone level
📖 How Is It Treated?
How Is It Treated?
intravenous
) or muscle (intramuscular). You may receive intravenous fluids if you have low blood pressure.
About the Author: This article was researched and written by the SilverWell Hub editorial team. It was medically reviewed by Dr. Sarah Mitchell, MD, Geriatrics.
Sources: This article is adapted from MedlinePlus, a service of the National Library of Medicine.
Disclaimer: This information is for educational purposes only. See our full Medical Disclaimer.
Published: July 21, 2026 | Next review: January 2027
