Here we look at the key warning signs of adrenal crisis. Adrenal crisis, and its preceding adrenal insufficiency, may, in some instances, be prevented by taking hydrocortisone tablets.

What is adrenal crisis?

Before looking at the warning signs of adrenal crisis, let’s first explain what adrenal crisis is.

Adrenal crisis is a life-threatening condition which occurs when the body’s levels of cortisol (a hormone) are far too low. Cortisol is one of the hormones which is released by the adrenal glands. The adrenal glands are two glands which sit on top of your kidneys. Normally, the adrenal glands produce enough cortisol as needed by your body. Every organ in your body needs cortisol and it helps to regulate the body’s stress response. This in turn affects your metabolism. It’s a crucial process, which we need to function healthily every day.

Adrenal crisis is rare but occurs when there isn’t enough cortisol being produced.

Adrenal insufficiency is the precursor to adrenal crisis and if treated with hydrocortisone tablets rarely goes on to cause adrenal crisis itself. Adrenal insufficiency has different causes, the most common of which is Addison’s disease. Addison’s disease happens when the adrenal glands aren’t managing to generate enough hormones, including cortisol.

What causes adrenal crisis and adrenal insufficiency?

The outside of the adrenal glands, called the cortex, is responsible for producing various types of corticosteroids – these are types of hormones. A key one of these is cortisol, often dubbed ‘the stress hormone’. Cortisol is a glucocorticoid. This means its core job is to regulate blood sugar. In times of stress, it suppresses the immune response. This is because under times of heightened stress, we needed to fight or flight, so focus was shifted from long term health (immunity) to short-term survival. Cortisol affects so much in the body because of its roles in metabolic function. This is meant to be a short-lived stress response, but it’s dangerous if it goes on too long and too much.

Cortisol is necessary for healthy functioning. Without it, our bodies fail in numerous ways. It is essential for life.

Adrenal crisis is caused when adrenal insufficiency isn’t spotted and treated, or insufficiency isn’t well-managed. It’s a medical emergency and hospital treatment must be sought immediately. It happens when the adrenal gland fails or deteriorates. It may also happen if there is damage to the pituitary gland (found in the brain) as this determines when the adrenal glands should release cortisol.

What actually causes adrenal insufficiency can vary. There may be severe physical stress including trauma, infection, injury, dehydration or coming off steroid treatment too quickly or too soon can also cause adrenal crisis.

Spotting the warning signs of adrenal crisis

It can actually be quite tricky to spot signs of adrenal crisis, unless you are a medical professional, as in the earlier stages, the symptoms mirror those of many other conditions. Therefore, if you have Addison’s disease, or are otherwise at risk of adrenal insufficiency or crisis, then you must seek immediate medical attention. Remember, adrenal crisis can be life-threatening.

The warning signs of adrenal crisis include:

• Extreme weakness and fatigue
• Headache
• Slow movements
• Nausea and/or vomiting
• Dehydration
• Chills (and shaking)
• Fever
• Low blood pressure
• Tachycardia (fast heart rate)
• Tachypnea (rapid breathing)
• Darkening of the skin, skin rashes or lesions
• Joint pain
• Abdominal pain or pain in the flank
• Loss of appetite
• Unintentional weight loss
• Excessive facial or palm sweating
• Confusion
• Coma

These are the symptoms of adrenal crisis, but additional warning signs of adrenal crisis can be spotted following specific medical tests. Adrenocorticotropic Hormone (ACTH) stimulation tests measure the adrenal’s release of hormones and can detect low cortisol. If the baseline cortisol level is low, especially if combined with low fasting blood sugar, this may be an indication that adrenal crisis is happening. Additionally, blood tests can reveal elevated serum potassium and decreased serum sodium, both of which are indications of primary adrenal insufficiency.

Treatment for adrenal crisis and adrenal insufficiency

If the warning signs of adrenal crisis have been spotted, then treatment is next.

In adrenal crisis, hospitalization is required to deliver hydrocortisone rapidly via injection or intravenous methods. Alongside this, supportive treatments such as IV fluids and medication to increase blood pressure, might be used. Additionally, the cause of the adrenal crisis will be addressed, for example, giving antibiotics for an infection. Because of the seriousness of adrenal crisis, patients usually remain in hospital for monitoring.

During adrenal insufficiency, treatment focuses on replacing the missing cortisol which the adrenal glands are failing to produce in sufficient amount. Hydrocortisone tablets are the most common treatment for adrenal insufficiency. It may be necessary to adjust the dose at times, such as if you are having an operation or become pregnant.

Those with Addison’s will need to take replacement cortisol for life, usually with daily tablets. Additionally, most people with Addison’s disease will be given injectable hydrocortisone and be taught how to recognize the signs of adrenal crisis so that they can self-administer a higher dose before seeking urgent medical care.

It’s also important to note that if you take hydrocortisone tablets for adrenal insufficiency, and you are unable to get the full dose because of something like vomiting, you must contact your doctor for advice – your dose may need to be adjusted or administered via injection in the short term. Steps should also be taken, such as phone alarms and dosing pill boxes, to ensure a dose is never forgotten.

Sourcing your hydrocortisone tablets for adrenal insufficiency

At International Pharmacy, we stock hydrocortisone tablets for adrenal insufficiency. We are a reputable supplier and can dispatch hydrocortisone tablets from US manufacturers to patients around the world.

As always, at International Pharmacy, our articles are intended for general information only and they do not constitute medical advice. If you are concerned about adrenal insufficiency and dosing of your hydrocortisone tablets please seek the direction of your endocrinologist or general physician. If you have spotted the warning signs of adrenal crisis in yourself or someone else, this is a medical emergency, and you must get urgent medical attention.