What is an adrenal crisis?
In simple terms, your body goes into an adrenal crisis when your adrenal glands can’t produce enough steroids when needed under stress. Your body then crashes and you may go into shock.
What causes an adrenal crisis?
To have an adrenal crisis, you need two things:
- Adrenal Insufficiency or the inability of your adrenal glands to make enough steroids (underlying problem)
- Stressful situation for your body (trigger)
To understand what causes an adrenal crisis, you need to understand what causes adrenal insufficiency and what triggers an adrenal crisis. People whose adrenal glands are healthy enough to produce sufficient amounts of steroids when needed don’t get an adrenal crisis.
What causes adrenal insufficiencies?
There are two main causes of adrenal insufficiencies:
- Adrenal glands can’t make the steroids: This is called a primary adrenal deficiency because the problem is in the adrenal glands.
- Your pituitary gland won’t tell your adrenal gland to make steroids: This is called a secondary adrenal insufficiency because the problem is elsewhere.
Why can’t the adrenal gland make steroids in a primary adrenal insufficiency?
Because the steroid-making part is destroyed in these patients.
What destroys the adrenal glands in people with a primary adrenal insufficiency?
Here are the things that can destroy the steroid-making part of your adrenal glands:
- Your own immune system: This is the most common cause of adrenal insufficiency. When your immune system attacks your organs and destroys them, it is called autoimmune disease. The particular autoimmune disease that destroys the steroid-making part of the adrenal gland is called Addison’s disease. That’s why an adrenal crisis is also called Addison’s crisis. However, that is not exactly accurate. All Addison’s crises are adrenal crises, but not all adrenal crises are Addison’s crises. However, the majority of adrenal crises are still Addison’s crises.
- Infection of the adrenal glands: This is very uncommon in the United States, but it still happens in third world countries.
- Bleeding into both adrenal glands: This is an extremely rare event.
- Rare congenital defects: Some people are born with defective adrenal glands, which is also very rare.
How is the pituitary gland involved in a secondary adrenal insufficiency?
The pituitary gland sits in your brain. It is also called the master gland because it tells other glands what to do. The adrenal glands need permission from the pituitary glands to make steroids. When there are problems with the pituitary glands, they can’t give the OK signal to the adrenal glands. This “OK signal” is in the form of a hormone called the Adrenocorticotropic hormone, or simply ACTH. When the pituitary gland can’t make ACTH, the adrenal gland can’t make steroids. There are many diseases and conditions that interfere with the pituitary gland and affect ACTH production. Secondary adrenal insufficiency is less common than primary adrenal insufficiency.
What triggers an adrenal crisis?
Anything and everything that creates significant stress on your body can trigger an adrenal crisis. Your body needs steroids in a time of crisis. When your body is under stress and your adrenal glads can’t produce more steroids, that triggers an adrenal crisis.
Here are examples of stress your body can’t handle without the extra steroids:
- Major trauma: This is physical trauma, as in a car accident, sports accident, being beaten, being shot, etc.
- Infections: These includes many different kinds of infections caused by various organisms. Infections may be caused by bacteria, fungi, parasites, or viruses. Even a common infection such as a urine infection or pneumonia can trigger an adrenal crisis.
- Dehydration
- Surgery
- Pregnancy and childbirth
- Food poisoning
- Very strenuous exercise
- Heat exhaustion
- Major bleeding
- Too much alcohol or drug use
The triggers listed here are simple examples of things that can push you towards an adrenal crisis. This list is not supposed to be exclusive. The particular things that push you towards an adrenal crisis may be unique to you and may not exactly match any list. This list is helpful to people who had an adrenal crisis for the first time and don’t know what to expect.
What does an adrenal crisis feel like?
If you had an adrenal crisis once, you know exactly what it feels like. I have treated hundreds of patients hospitalized for an adrenal crisis, and they know what exactly is happening every time they get one. If you have had an adrenal crisis in the past, trust your instincts. If you feel like you are in an adrenal crisis, you probably are.
I can only describe what my patients have told me when they are having an adrenal crisis because it is an experience unlike anything else. You have to experience it to know exactly how it feels. They tell me it feels like their bodies are literally giving up and crashing down; this sensation of all energy being drained out makes them feel very weak, tired, and lethargic. It all happens quickly, and your energy level goes down from 100% to 5% in just a few hours.
Why is an adrenal crisis an emergency? How does an adrenal crisis cause death?
When your body is in stress, it needs steroids. The particular steroid involved in an adrenal crisis is called cortisol. It is also called the stress hormone. Whenever you have any of the triggers mentioned above, your body has to prepare itself to fight those conditions. Your body has to increase blood flow, raise defenses, redistribute blood flow, increase energy production, and go into protective mode. Cortisol is essential in starting any of those reactions. Without cortisol, your body can’t fight any stress and simply gives up. Your body goes into shock and your blood pressure drops, eventually resulting in death. This is why an adrenal crisis is an emergency. You need to get help before it is too late.
How long does an adrenal crisis last?
Without treatment, an adrenal crisis can last as long as the trigger exists. In practice, this rarely happens. People with adrenal crises get too sick too quickly and seek medical help. An adrenal crisis resolves quickly with treatment as long as the proper dose is used based on severity of the crisis. With the proper treatment, the average adrenal crisis symptom lasts only a few hours. However, the disease that triggered the crisis can last more or less based the nature and severity of the disease.
What are the symptoms of an adrenal crisis?
After reading the answers to the questions above, I hope you understood the basic nature of an adrenal crisis. I hope that will help you understand the symptoms of an adrenal crisis. In essence, it is simply the symptoms of your body giving up the fight.
Here are the symptoms from mild to severe:
- Extreme symptoms of an otherwise mild illness
- Nausea, vomiting, and a decreased appetite
- Extreme loss of energy
- Getting dizzy and lightheaded
- Unable to get up and walk
- Getting sleepy and confused
- Feeling cold and clammy
- Losing consciousness
- Thready, fast pulse
- Heart stopping
If you are in an adrenal crisis for the first time, it is important to recognize these symptoms and think about an adrenal crisis. You may not even think about it if you were never diagnosed with an adrenal insufficiency in the first place. Unfortunately, many patients only learn about adrenal insufficiencies after they have been in an adrenal crisis.
How do you prevent an adrenal crisis?
Fortunately, once you have been properly diagnosed with an adrenal insufficiency, it is relatively simple to prevent an adrenal crisis. Take your time and do your research. You can easily learn everything you need to know about an adrenal insufficiency and an adrenal crisis.
After that, all you need to do is work with your doctor to identify the best steroid replacement medication that works for you, and stick with it. You have to take your steroid everyday without stopping so that you can enjoy a happy and healthy life. You will also have to have a plan for sick days, which we will talk about in the next section.
How do you treat an adrenal crisis at home?
The treatment of an adrenal crisis at home is possible if you carefully plan it before you get sick. Anyone that has been diagnosed with an adrenal insufficiency needs a “sick day plan.” Whenever you feel like you are getting sick, you need to start your sick day plan. It is better to start early when you think you are coming down with something rather than after you are sick. Every individual sick day plan is different, but it essentially involves taking a higher dose of steroids for the duration of the sickness. Two to three times the normal dose is usually recommended unless you have a special dose plan recommended by your doctor.
If you do it early, you may avoid a trip to the emergency department. However, things don’t always go as planned. You will need a second line of defense at home. The second line of defense is an injectable steroid. It is important to learn how to use the injectable steroid when you need it. You can practice with the syringe by filling it up with sterile saline. Keep practicing and keep yourself well prepared to actually do it when you need it.
If you are not feeling better after taking the higher dose pills, you need to give yourself the injectable steroid. If you are having nausea and vomiting, pills are not recommended. Start with the injectable steroid.
When do you go to the hospital with an adrenal crisis? What is the emergency treatment for an adrenal crisis?
When your condition is not improving after implementing your sick day plan at home, it is time to go to the hospital. The emergency treatment for an adrenal crisis in the hospital consists of two things:
- V steroid: It is more potent and more reliable than the one you can use at home
- Proper treatment of the triggering event: This depends on what the event is.
What can I do to help other people just diagnosed with adrenal insufficiency?
Proper education and good planning are very important in patients diagnosed with adrenal insufficiency. Most patients eventually become experts in their own care, but many learn from experience and mistakes. You can share good reading materials with your friends and family so that they don’t have to experience a bad episode of adrenal crisis to learn from it.
The are two main problems with most reading materials available on the internet:
- Reading materials written in plain English are too superficial and don’t give out important details.
- Reading materials with an in-depth analysis are written with lots of medical jargon, making them unreadable for the average reader.
If you like this article, you can help other people by sharing it with your friends and family.
References:
https://www.ncbi.nlm.nih.gov/books/NBK499968/
https://www.amjmed.com/article/S0002-9343(15)00827-X/pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566489/