Adrenal crises are severe, life-threatening episodes of adrenal insufficiency. Preventing and managing adrenal crises is complex and current strategies have not been successful in achieving a reduction in the incidence of episodes. Treatment with intravenous hydrocortisone is life saving and should be given without delay to patients displaying signs of acute adrenal insufficiency and adrenal crises.
- An adrenal crisis is an acute episode of adrenal insufficiency that is characterised by hypotension and other symptoms and signs, including reduced consciousness, acute abdominal symptoms and electrolyte abnormalities.
- Treatment with intravenous hydrocortisone should be given urgently and never withheld because of concerns about the side effects of glucocorticoid exposure.
- All patients with adrenal insufficiency should carry a steroid identification card, belong to the MedicAlert Foundation (or equivalent), have adequate supplies of oral replacement therapy and have their own hydrocortisone intramuscular injection vial and needles.
- At each review, patients should be reminded about the importance of adrenal crisis prevention and the steps involved in glucocorticoid stress dosing and be assessed for competency with intramuscular self-injection of hydrocortisone. For patients unwilling or unable to inject intramuscularly, subcutaneous injection before clinic presentation should help avoid deterioration and severe shock.