Adrenal Crisis Clinical Presentation

Updated: Jan 13, 2022
  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: George T Griffing, MD  more...
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History can include the following:

  • Prior steroid use: Use involves at least 20 mg daily of prednisone or its equivalent for at least 5 days within the past 12 months. Patients receiving doses close to normal physiologic levels require only 1 month to recover normal adrenal function.

  • Organisms associated with adrenal crisis (eg, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumonia, fungi)

  • Meningococcemia

  • Severe physiologic stress [14] (eg, sepsis, trauma, burns, surgery): In a retrospective review of patients from a level 1 trauma center, Guillamondegui et al found that trauma patients with acute adrenal insufficiency who were treated for the condition had shorter hospital stays and required fewer days in the intensive care unit and on a ventilator than did untreated patients. [15] In addition, the authors concluded that recognition and treatment of the condition can reduce trauma patient mortality by almost 50%.

  • Anticoagulants, hemorrhagic diathesis

  • Newborn, complicated pregnancy

  • Adrenocorticotropin therapy, known primary or secondary adrenocortical insufficiency

  • Invasive or infiltrative disorders

  • Topical steroids: Risk of adrenal crisis occurs when used over a large surface area for a prolonged duration, using occlusive dressings and a highly potent drug.

  • Inhaled steroids: Use of a high dose (>0.8mg/d) over a prolonged duration increases risk; fluticasone may cause suppression at lower dose.

  • Congenital adrenal hyperplasia (CAH): A retrospective study by Rushworth et al indicated that in pediatric patients with CAH, adrenal crises occur mostly in the younger ones. The study, which evaluated 573 admissions for medical problems in children with CAH, found that 21 of 37 adrenal crises occurred in patients aged 1-5 years, with another six in children aged up to 1 year. [16]



See the list below:

  • Unexplained shock, usually refractory to fluid and pressor resuscitation

  • Nausea, vomiting, abdominal or flank pain



See the list below:

  • Rapid withdrawal of long-term steroid therapy
  • Ketoconazole
  • Phenytoin
  • Rifampin
  • Mitotane
  • Septic shock

A study by Maguire et al indicated that in patients with adrenal insufficiency, the AstraZeneca vaccine ChAdOx1, for coronavirus disease 2019 (COVID-19), can lead to adrenal crisis. The report described five cases in which patients with adrenal insufficiency apparently suffered actual or incipient adrenal crisis from adverse reactions to the first dose of the vaccine. According to the investigators, the fact that the adrenal crises occurred within 24 hours post vaccination strongly suggests that the vaccine can precipitate these events. However, the researchers were unable to determine the incidence of adrenal crises that arise following administration of the vaccine or whether other vaccines may be associated with adrenal crisis. [17]