Health condition
Adrenal crisis prevention
Adrenal crisis is a life-threatening collapse from cortisol deficiency in people with Addison's disease, pituitary failure or long-term steroid use - almost always preventable with sick-day rules, a steroid card and an emergency injection kit.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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At risk: anyone with Addison's, hypopituitarism, congenital adrenal hyperplasia, or on long-term steroid treatment
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Sick-day rules: double your usual steroid dose for fever or significant illness; inject and seek help if vomiting
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Carry the NHS steroid emergency card and wear medical alert identification
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Keep an in-date hydrocortisone emergency injection kit and make sure family know how to use it
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Crisis symptoms - vomiting, severe weakness, confusion, collapse - mean 100 mg hydrocortisone immediately and a 999 call
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
Cortisol is the hormone of illness: healthy adrenals multiply output several-fold during infection, injury or surgery. If your body cannot do that, an ordinary vomiting bug can tip you into crisis - plummeting blood pressure, dehydration, confusion and, untreated, death. Crises still kill people in the UK every year, usually because doses were not increased during illness, an injection kit was missing, or emergency staff did not recognise the situation quickly.
Diagnosis and treatment routes
Prevention is a system, not a single act: written sick-day rules (double oral dosing for fever or infection), immediate injection when vomiting prevents tablets being kept down, the NHS steroid emergency card presented at every healthcare contact, alert jewellery, and pre-operative planning for any procedure. This is emergency medicine, not a waiting-list problem - suspected crisis means hydrocortisone and 999 now. For structured prevention planning and annual review, a private endocrinologist appointment is typically available within about two weeks if your NHS review is far off.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant endocrinologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Adrenal crisis prevention.
Quick, plain-English answers to what people ask us most.
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What is an adrenal crisis?
An adrenal crisis is a life-threatening emergency occurring when the body has severely insufficient cortisol, causing a dangerous drop in blood pressure, severe weakness, vomiting, and collapse if not treated immediately.
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Who is at risk of adrenal crisis?
People with Addison's disease, other causes of adrenal insufficiency, or those on long-term steroid medication who reduce or stop it abruptly are at risk, particularly during illness, injury, or surgery.
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What triggers an adrenal crisis?
Common triggers include infections, physical trauma, surgery, vomiting or diarrhoea preventing normal medication absorption, and missed or insufficient steroid doses during periods of increased physical stress.
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How can adrenal crisis be prevented?
Prevention involves increasing steroid medication doses ('sick day rules') during illness or stress, carrying emergency injectable hydrocortisone, wearing medical alert identification, and educating those around you about the risk.
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What are the symptoms of an impending adrenal crisis?
Warning symptoms include severe weakness, dizziness, nausea and vomiting, abdominal pain, confusion, and a rapid drop in blood pressure, which can progress quickly to collapse.
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How is an adrenal crisis treated?
Treatment requires immediate injectable hydrocortisone, followed by urgent hospital care with intravenous fluids and steroids, making rapid recognition and emergency treatment essential.
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How quickly does treatment need to happen in an adrenal crisis?
Treatment should be given as soon as a crisis is suspected, ideally with emergency hydrocortisone administered immediately at home before hospital arrival, since delay significantly increases risk of serious harm.
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Adrenal crisis prevention vs treatment — what's the difference?
Prevention involves proactive steps like sick day dose adjustments and emergency kit availability to stop a crisis developing, while treatment refers to the emergency response once a crisis has actually begun, requiring immediate injectable steroids and hospital care.
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Do all patients with adrenal insufficiency need an emergency hydrocortisone kit?
Yes, anyone with confirmed adrenal insufficiency should carry an emergency injectable hydrocortisone kit and know how and when to use it, along with training for family members or close contacts.
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When should I review my adrenal crisis prevention plan, and how quickly can I be seen privately?
Review your plan regularly with your endocrinologist, especially before travel or surgery. NHS endocrinology follow-up intervals are set by your team, while private specialist review is often available within about two weeks if you have concerns.