An abrupt, life-threatening emergency called an adrenal crisis is one of the main causes of the higher than expected death rates seen in people with adrenal insufficiency. Patients with adrenal insufficiency are thought to experience adrenal crises 8 times per 100 patient years. Adrenal crisis patients typically have nonspecific signs and symptoms that result in delayed identification and treatment. These patients report as systemically ill and sick. A patient may experience an adrenal crisis even after being on glucocorticoid replacement medication for some time or it may be the initial sign of adrenal insufficiency. The main triggering reason is infection, but there are other factors as well, such as physical stress after surgery or trauma, forgetting to take glucocorticoid medication, intense physical exercise, and psychological stress. Parenteral hydrocortisone, rehydration, and timely recognition are all c- -omponents of the emergency therapy. Rapid diagnosis, parenteral hydrocortisone delivery, rehydration, and control of electrolyte imbalances are all components of emergency care. Patient education is the key to prevention. Parenteral glucocorticoid therapy and stress dosage should be explained to all patients. They should wear a medical alert bracelet or other form of identification and carry a card alerting others to their steroid dependency. Despite many improvements in the management of patients with adrenal insufficiency, adrenal crisis continues to occur and represents a major source of morbidity, mortality and distress for patients. Improved patient and clinician education and measures to facilitate parenteral hydrocortisone self-administration in impending crisis are central to the management of this life-threatening event.
