Skip over main navigation
  • Log in
  • Basket: (0 items)
Addison's Disease Self-Help Group
Emergency Help Join Us COVID-19
Menu
  • About Addison's Disease
    • Novel Coronavirus (COVID-19)
      • Novel Coronavirus (COVID-19) Guidance
      • Vaccines and Adrenal Insufficiency
    • What is Addison's Disease?
    • Newly diagnosed?
    • Living With Addison's Disease
    • Information for patients
    • Children and Young Adults
    • Information for employers
    • Downloadable publications
    • Research
      • Research Grants
      • 2020 Research Awards
      • Research Application
    • A-Z of Addison's Resources
  • Medics
    • COVID-19: Clinical Management guidance: Adrenal Insufficiency
    • Information for Paramedics and A&E
      • Emergency Treatment Information
      • ADSHG Paramedic Training in Adrenal Crisis Management
      • JRCALC 2017 guidelines on adrenal crisis
    • Information for clinicians
  • Membership latest
    • Membership help
    • Renew your Membership
    • ADSHG Member Online News Feed
    • Magazine
      • Magazine - Winter 2021
      • Magazine - Summer 2021
      • Magazine - Winter 2020
      • All Magazines
    • Online forums (members-only)
    • Member's Social Meetings
    • Events
  • About us
    • Contact us
    • What we do
    • Our team
    • Meet our Founder, Deana
    • Our history
    • Addison's Ireland
    • Our clinical advisors
    • Useful links to other organisations
    • Our Annual Reports
    • Privacy Policy
  • Get involved
    • Fundraising
      • Fundraising for the ADSHG
      • Fundraising ideas
      • Set up a fundraising page
      • Support one of our fundraisers
    • Become a member
    • Volunteering
    • Research
      • Research Grants
      • 2020 Research Awards
      • Research Application
    • Leave a legacy
  • News
    • News Homepage
    • Blog Homepage
    • Magazine
    • ADSHG on Facebook
    • ADSHG on Twitter
    • ADSHG on Instagram
    • ADSHG Press Releases
    • Events
  • Shop
    • Shop
    • Shop terms & conditions
  • Donate
    • Support one of our fundraisers
    • Donate to the ADSHG
    • Donate while you shop
  • Forum
  • Admin
    • Log in
  • Basket: (0 items)

Adrenal Crisis Can Kill

Healthcare professionals managing a patient with COVID-19 and Adrenal Insufficiency - please view the  latest guidance from the European Society of Endocrinology.

Advice for Non-COVID-19 related Emergencies:

Each year, typically 8% of people with Addison's disease experience adrenal crisis.  This means they need extra steroid medication immediately, in the form of an emergency injection of intra-muscular hydrocortisone. This is a medical emergency and must be treated immediately. Follow the instructions below - foreign language translations are also available.

The danger signs include :

  • Extreme weakness, feeling terrible, vomiting, headache
  • Light-headedness or dizziness on sitting up or standing up
  • Feeling very cold, uncontrollable shaking; back, limb or abdominal pain
  • Confusion, drowsiness, loss of consciousness

If this happens to yourself or someone you are caring for, do not delay :

  • inject yourself (or the person you are caring for) with your hydrocortisone ampoule (100mg)
  • seek immediate medical attention - call 999, stating "Addisonian crisis"
  • Other key phrases to use are: Steroid-dependent, risk of adrenal crisis, adrenal insufficiency crisis, Addison’s/ Addisonian emergency 
  • AND describe symptoms (vomiting, diarrhoea, dehydration, injury/shock).

If you are a paramedic, caring for a patient in adrenal crisis :

The JRCALC guidelines (2019) state "If significantly unwell, the patient should be given hydrocortisone and fluids (normal saline) as soon as practicable" :

  • Stabilise the patient with normal saline (intravenously) and injected hydrocortisone prior to transportation
  • Keep the patient lying down - they may become profoundly hypotensive when sitting upright
  • Where the patient cannot be transported flat on a stretcher they must not be moved until full circulatory volume has been restored with IV fluids and they have received injected hydrocortisone
  • Get them to an emergency medical facility urgently 

* Note : Lower hydrocortisone doses/ saline infusion rates are appropriate for children

A&E management of adrenal crisis: the first 24 hours

These guidelines are provided by our Clinical Advisory Panel, as an aid for A&E emergency teams receiving Addisonian patients following an adrenal crisis :

  • For Adults, administer parenteral hydrocortisone 100mg stat (IM preferable) and repeat 6 hourly until the patient is haemodynamically stable and clinical improvement (alternative 200mg/24hrs by continuous IV infusion).  

  • Infants and children should receive an initial parenteral injection of 50mg hydrodortisone/m2 (usually 25mg in infants and 50mg in children) followed by 50mg/24h in infants and 100mg/24h in children.
  • Administer 1 litre IV 0.9% saline stat (adjust for infants and children), and continue saline resuscitation at an appropriate rate until haemodynamic stability and correction of any electrolyte disturbance and AKI

  • Monitor U&E at least 12 hourly during initial resuscitation and continue regular monitoring until any hyponatraemia, hyperkalaemia or renal impairment are corrected

  • Identify and treat any precipitating cause for Addisonian crisis:
    • vomiting/diarrhoeal illness
    • infection
    • myocardial infarction

* Note : Lower hydrocortisone doses/ saline infusion rates are appropriate for children

Visit the Society for Endocrinology Adrenal Crisis page for further detail

  • Watch our latest video on management on Addison's with Covid-19
  • How to avoid precipitating an acute adrenal crisis (Article by Professor Wass)
  • Our latest advice for people with Addison's and Coronavirus

What is an adrenal crisis?

In an emergency, people with Addison's Disease (or anyone who is "steroid-dependent") may experience symptoms of extreme weakness, a significant drop in blood pressure, drowsiness or mental confusion. This is known as an "adrenal crisis" (or "Addisonian crisis") and means they need extra steroid medication immediately, in the form of an emergency injection of intra-muscular hydrocortisone.

How do you know it is an adrenal crisis?

How do I give an emergency injection?

Check out these short videos :

  • Video : 1. When to give an emergency injection (4 minutes)
  • Video : 2. Emergency injections: Personal stories (5 minutes)
  • Video : 3.1 How to administer a liquid hydrocortisone emergency injection using a safety syringe (3 minutes)
  • Video : 3.2 How to administer a liquid hydrocortisone emergency injection using a standard syringe (3 minutes)
  • Video : 3.3 How to administer a Solu-Cortef emergency injection using a safety syringe (3 minutes)
  • Video : 3.4 How to administer a Solu-Cortef emergency injection using a standard syringe (3 minutes)
  • Video : 3.5 How to administer a Solu-Cortef emergency injection using an Act-o-Vial Safety Syringe (3 minutes)

View our Emergency Injection Guide

Download and complete the ADSHG adrenal crisis guidelines

These guidelines allow you to keep on you at all times the emergency medical treatment guidance ambulance or hospital staff would need, in the event of an adrenal crisis.

Last updated: 22/04/2020

Published: 22nd February, 2019

Updated: 15th December, 2021

Author:

Share this page
  • Email
  • Facebook
  • Twitter

Latest

  • Adrenal Insufficiency due to Autoimmune Polyglandular Syndrome (APS) type I and type II

    Adrenal Insufficiency due to Autoimmune Polyglandular Syndrome (APS) type I and type II

    For some, their Addison's diagnosis leads on from or to other autoimmune conditions. Those with Addison's together with underactive thyroid, dlabetes insipidus, hepatitis, pernicious anaemia, type 1 diabetes or vitiligo, might have a type of autoimmune polyglandular syndrome. Monitoring to track the onset of related conditions can help people reach earlier diagnosis and work towards a better quality of life.

  • Twitter Chat - Don’t Wait, Educate

    Twitter Chat - Don’t Wait, Educate

    Join our latest #AddisonsQA Twitter Chat on Addison's Disease Day for this year's theme 'Don’t wait, educate'. Our medical experts and others living with Addison's and adrenal insufficiency are ready to share their tips and answer questions.

  • Addison's Disease Day 2022

    Addison's Disease Day 2022

    Join us on Sunday 29th May for Addison's Disease Day 2022! We're asking everyone around the world who is affected by Addison’s disease and adrenal insufficiency to join us in a day of raising awareness.

  • My fundraiser for the Addison's Disease Self Help Group

    I'm raising money for the Addison's Disease Self Help Group so that they can continue to support people with Addison's and adrenal insufficiency. Addison’s is a rare endocrine condition where the adrenal glands do not produce enough steroid hormones and can be life threatening. It affects approximately 1 in 10,000 people, meaning an estimated 300 - 350 new cases are diagnosed each year across the UK, this makes it roughly 300 times rarer than diabetes.

Most read

  • Sick Day Rules

    Minor ailments can affect anyone with a steroid-dependent adrenal condition very differently. Things like vomiting, diarrhoea, colds and flu could cause an adrenal crisis. It’s important that you spot the early symptoms of a bug or cold and adjust your steroid replacement medication.

  • Coronavirus Vaccines and Adrenal Insufficiency

    Coronavirus Vaccines and Adrenal Insufficiency

    Everyone with a steroid-dependent adrenal condition should get the coronavirus vaccine to reduce their risk of getting coronavirus. This is because people who are steroid-dependent are at increased risk of needing hospital care if they get coronavirus, due to the risk of adrenal crisis.

  • Novel Coronavirus (COVID-19) - 24/02/2021

    Novel Coronavirus (COVID-19) - 24/02/2021

    Our medics have been keeping an eye on pandemic developments. This page is up to date but we will continue updating it regularly as we find out more information from the government.

  • The Emergency Injection for the treatment of Adrenal Crisis

    The Emergency Injection for the treatment of Adrenal Crisis

    Understanding what an Emergency Injection kit is, how to inject and how important it is to use the injection during an Adrenal Crisis.

  • Adrenal Crisis Can Kill

    Adrenal Crisis Can Kill

  • What is Addison's Disease?

    What is Addison's Disease?

    Find out more about Addison's disease and adrenal insufficiency and and how they are treated.

  • Why Salt?

    Why Salt?

    Why do people with Addison’s and adrenal insufficiency crave salty, acidic and sour foods at diagnosis, and then salt remains our “pick me up” when diagnosed? Professor Simon Pearce explains the connection between aldosterone, fludrocortisone and why you should always listen to your salt cravings.

  • Updated NHS Steroid Card Released

    Updated NHS Steroid Card Released

    Following the early release of the new NHS Steroid Emergency Card back in March to keep patients with Addison's or adrenal insufficiency safe during the COVID-19 crisis, the NHS steroid card has been updated and physical copies will be available to order from Tuesday 18th August 2020 for hospital teams!

  • Receiving the COVID-19 Vaccine - Personal Stories

    Receiving the COVID-19 Vaccine - Personal Stories

    The COVID-19 vaccination campaign has kicked off - but what does it feel like to receive the COVID-19 vaccine? People with Addison's and adrenal insufficiency share their experiences of receiving the vaccine.

  • Surgical Guidelines

    Surgical Guidelines

    The ADSHG surgical guidelines are intended for the information of your medical team or your dentist and have been developed by our Clinical Advisory Panel.

Tag cloud

AGM Conference Ireland sidebar
Research Grants

Research Grants

Our charity is at the forefront of medical research into Addison's Disease. Help us fund medical researchers working in this important field of endocrine research. Read more

Published: 22nd February, 2019

Updated: 10th November, 2021

Author:

Find us

Our Registered Office 
Starling House
1600 Bristol Parkway North
Bristol
BS34 8YU

Links

  • Contact us
  • Media Centre
  • Sitemap
  • Accessibility
  • Shop terms & Conditions
  • Privacy policy
  • Our policies

Follow us

  • Search
  • Facebook
  • Twitter
  • Youtube
  • Instagram
  • LinkedIn

Genetic Alliance logo Rare Disease logoESE Affiliated

Copyright © Addison's Disease Self-Help Group Registered as Charity number 1179825

The information contained within this website is not intended to provide clinical diagnosis and/or personalised medical advice. It should not be treated as such. Always seek the advice of your doctor or a health care professional before starting any new treatment for your underlying condition. While we have taken every care to compile accurate information to reflect the current state of knowledge, we cannot guarantee its correctness and completeness. The information provided in this website does not constitute business, medical or other professional advice, and is subject to change. In no event will the Addison’s Disease Self-Help Group or any of the contributors be responsible or liable directly or indirectly, for damages or liabilities relating in any way to the use (or misuse) of information contained within or referred to in this website.

Manage Cookie Preferences