Adrenal Crisis Onset
A stress trigger overwhelms an already cortisol-deficient body.
- Illness: Trigger Type (infection or surgery common)
- Very Low: Cortisol Level (inadequate stress response)
- Hours: Onset Speed (can escalate rapidly)
- Addison's: Underlying Cause (primary adrenal insufficiency)
Why crisis happens
Cortisol normally surges under stress. Without it, the body cannot compensate.
Common triggers
Infection, surgery, trauma, or missed medication doses often precipitate crisis.
Who is at risk
Patients with Addison's disease or long-term steroid withdrawal are vulnerable.
Emergency Recognition
Rapid vital sign changes signal an unfolding medical emergency.
- <90: Systolic BP (mmHg, hypotensive shock)
- <50: Blood Glucose (mg/dL, hypoglycemic)
- <130: Sodium (mEq/L, hyponatremic)
- Minutes: Time To Act (delay raises mortality)
Warning signs
Weakness, confusion, nausea, and low blood pressure appear together.
Lab picture
Hyponatremia, hyperkalemia, and hypoglycemia point toward adrenal crisis.
Diagnostic urgency
Treatment should never wait for lab confirmation in suspected crisis.
IV Hydrocortisone 100mg
Immediate IV steroid replacement is the life-saving intervention.
- 100 mg: Dose (IV hydrocortisone bolus)
- IV Push: Route (plus saline fluids)
- Normal Saline: Fluid (restores volume, sodium)
- Q6H: Repeat Dosing (until stable)
Why hydrocortisone
It replaces missing cortisol and restores vascular responsiveness quickly.
Fluid resuscitation
Saline corrects volume depletion and helps raise sodium levels.
Speed matters
Earlier treatment strongly improves survival and recovery time.
Physiologic Stabilization
Cortisol gradually restores normal metabolic and vascular function.
- ~30 min: BP Response (begins improving)
- ~30-60 min: Glucose Response (begins rising)
- Hours: Sodium Response (slower correction)
- Continuous: Monitoring (vitals reassessed often)
Vascular tone
Cortisol restores vessel responsiveness to catecholamines, raising pressure.
Glucose recovery
Gluconeogenesis resumes, correcting dangerously low blood sugar.
Electrolyte correction
Sodium retention improves gradually as mineralocorticoid effects return.
Outcome & Recovery
Treated patients stabilize; untreated crisis is often fatal.
- Recovery: Treated Outcome (vitals normalize in hours)
- Fatal: Untreated Outcome (progressive shock, death)
- Oral Steroids: Follow-up (taper to maintenance dose)
- Sick-Day Rules: Prevention (stress dosing education)
Successful recovery
BP, glucose, and sodium trend back to normal ranges.
Without treatment
Shock deepens, organ perfusion fails, and death can follow.
After the crisis
Patients transition to oral steroids and carry emergency injection kits.