What is an adrenal crisis?
An adrenal crisis is the result of an extreme physical or emotional stress that does not get the necessary steroid coverage to meet that stress. It is a potentially life-threatening medical emergency that requires management in a hospital or emergency department. Typical symptoms are:
• Severe drop in blood pressure, causing dizziness, lightheadedness and possibly loss of consciousness
• Nausea and vomiting
• Confusion and lethargy
• Muscle weakness, cramps, headaches
Hospital or Emergency Department treatment will include IV saline, IV hydrocortisone and close monitoring of blood pressure and electrolytes. The length of hospitalization may be hours to days, and will depend on the severity of the crisis and any underlying precipitating factors, such as infection, as well as the basic health of the individual.
The current recommendation is for all adrenal insufficient patients to carry an emergency injection kit to allow a self-injection in case of symptoms of adrenal crisis. An adrenal crisis is a life-threatening medical emergency that requires immediate treatment with an emergency injection of a glucocorticosteroid. Since it can happen anywhere, anytime and emergency medical help may not always be immediately available, it is recommended that patients carry this kit at all times. Studies have demonstrated that a self-injection in case of an adrenal crisis significantly reduces hospital admission rates and shortens the time it takes for symptoms to improve.
The current recommendations for the emergency injection for adult patients are
- 100mg hydrocortisone – preferred (Solu-Cortef® act-o-vial) OR
- 125mg methylprednisolone (Solu-Medrol® act-o-vial) OR
- 4mg dexamethasone
Ideally, you should have two vials in case of a malfunction or breakage. In addition, your emergency kit should
- Syringes (3ml)
- Needles (typically in the range of 22–25 gauge, 1 to 1.5 inches in length)
- Alcohol swabs