Cortisol is a hormone that helps with a variety of bodily functions. These include maintaining blood sugar, managing the immune system, regulating blood pressure, controlling some of the electrolytes in the body, and controlling stress levels.
Cortisol levels are highest in the early morning and after meals and the lowest at night in the early sleep phases.
Low levels of cortisol can cause weakness, extreme tiredness, and drops in blood pressure. Most of the time, however, the human body is capable of balancing the amount of cortisol it produces.
What is Addisonian crisis?
An Addisonian crisis occurs when the adrenal glands, which are located at the top of each kidney, do not produce enough cortisol. The adrenal glands may struggle to produce cortisol efficiently when the body becomes stressed as a result of certain factors or triggers.
An Addisonian crisis is a dangerous event and can be fatal if a person cannot maintain their cortisol levels. Despite being a highly treatable condition, the death rate associated with an Addisonian crisis is about 6 percent, according to one report published in The Journal of Clinical Endocrinology & Metabolism.
Confusion, dizziness, and nausea are all symptoms of an Addisonian crisis.
Symptoms of an Addisonian crisis include:
- extreme tiredness and weakness
- confusion, psychosis, and slurred speech
- dizziness and feeling faint
- nausea, vomiting, loss of appetite, and stomach pain
- fever, chills, and sweating
- sudden lower back or leg pain
- dangerously low blood pressure
- fast heart rate
- skin reactions, including rashes
- loss of consciousness
Convulsions are another possible symptom of the Addisonian crisis. The body's muscles contract and relax quickly and repeatedly, resulting in uncontrolled shaking.
Causes and risk factors
People with a condition called Addison's disease are at the highest risk of developing Addisonian crisis, especially if their condition is not managed well or has not been diagnosed.
Addison's disease is an endocrine disorder where the adrenal glands do not produce enough of the hormones that the body needs, including cortisol and aldosterone.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Addison's disease affects 110-144 of every 1 million people in developed countries.
The NIDDK also reported that up to 80 percent of Addison's cases are autoimmune diseases, conditions where the body's immune system thinks healthy tissues are diseased and attacks cells, tissues, and organs.
Other potential triggers of an Addisonian crisis are:
- traumatic physical events, such as a car accident or injury leading to physical shock
- severe dehydration
- infections, including stomach viruses and the flu
- surgery, especially when it involves the adrenal glands
- pituitary gland not working properly
- general anesthesia
- severe allergic reactions
- low blood sugar levels in people with diabetes
- long-term steroid use or abruptly stopping steroid medications
- pregnancy complications
- emotional trauma
In a 2015 study, 423 people with adrenal insufficiency were asked to report on factors that triggered their adrenal crisis events.
A total of 20 percent of people said that triggers included gastrointestinal infection, fever, or emotional stress. Around 7 percent of the study participants reported other stressful events.
Those who had a previous adrenal crisis were at the highest risk for another crisis. The study's researchers did not identify any additional risk factors.
Emergency treatment for Addisonian crisis
Emergency treatment will be focused on providing intravenous corticosteroids and rehydrating the person.
An Addisonian crisis usually starts out with a person experiencing symptoms, such as nausea, vomiting, stomach pain, diarrhea, and loss of appetite. As the crisis worsens, the person will experience chills, sweating, and fever.
If the condition remains untreated, severe dehydration eventually follows, leading to symptoms of shock or convulsions. Some people may also experience low blood sugar or low blood pressure.
It is important for people to get to an emergency room right away for an Addisonian crisis, as it requires urgent medical attention.
A doctor can make an initial diagnosis by doing blood tests to check cortisol levels. Making a diagnosis of an Addisonian crisis is not easy, however. People can often go undiagnosed for long periods and remain undiagnosed until an emergency occurs.
Corticosteroids administered into the veins can keep adrenal levels from getting dangerously low. Other important aspects of treating an Addisonian crisis are:
- rehydrating the person
- balancing their electrolyte levels
- getting blood sugar and blood pressure levels back to normal
The length of time that people need to spend in the hospital for a crisis depends on the severity, the underlying causes, and the general health of the individual.
A case of Addisonian crisis in an emergency department setting
The Journal of Clinical Endocrinology & Metabolism reported on a case where a 20-year-old man came into the emergency room with severe weakness and low blood pressure that had progressed over 3 months.
He had visited his doctor 2 months before with symptoms of fever, lack of energy, tiredness, and dizziness. His doctor diagnosed him with a viral infection and symptoms went away after spending several days in the hospital, being treated with saline solution.
Upon going to the emergency room for the crisis, he reported no previous health issues but had lost over 15 pounds in the 3 months since he started experiencing symptoms. He did say, however, that his skin had been darkening over the past 3 years.
Testing revealed the following health problems:
The man improved after treatment with saline infusion and hydrocortisone, a medical form of cortisol.
The doctors determined the potential cause of his Addisonian crisis event was hyperthyroidism, a condition where the thyroid gland makes too much thyroid hormone.
Two years later, the man was doing well and was being treated with hydrocortisone and fludrocortisone. He was living a relatively normal life and had not had another adrenal crisis. He was taking medication for the hyperthyroidism, and he was managing the condition well.
Prevention of a crisis
Taking medication as directed by a doctor can help prevent further crises.
Once someone has had an Addisonian crisis, they should continue to have regular checkups.
People should also take the following steps to help prevent a crisis:
- learn to watch out for the symptoms of adrenal insufficiency
- manage triggering conditions
- take daily oral steroids as directed
- have emergency glucocorticoids on hand
- know how much extra medication to take if they have stressors or become ill
A person should administer an emergency injection as soon as they experience symptoms and not wait until they are too weak, sick, or confused.
Once they have had the injection, it is important that the person calls their doctor right away. The emergency injections are only intended to stabilize symptoms and are not a substitute for medical care.
A person who has had an Addisonian crisis can make a full recovery if diagnosed correctly and treated quickly. With ongoing and regular treatment, anyone who has adrenal insufficiency can live a mostly healthy and active life.
An untreated Addisonian crisis could lead to shock, coma, seizure, and possibly death. People can limit complications and risk of another Addisonian crisis by:
- taking all prescribed treatments
- having a hydrocortisone injection kit on hand at all times
- keeping a medication condition identification bracelet or card for emergency situations