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Kids Health Info

Adrenal crisis

  • Key points to remember

    • An adrenal crisis is a life-threatening emergency that happens when the body does not have enough cortisol.
    • Physical stresses like vomiting, diarrhoea, fever, injuries or surgery can cause adrenal crisis.
    • Children with adrenal problems such as congenital adrenal hyperplasia (CAH), hypopituitarism or Addison’s disease are at risk of adrenal crisis.
    • Follow your child's emergency management plan to prevent adrenal crises. Ask your child's doctor to make one if they do not have one.
    • An adrenal crisis can make your child sick very quickly; it can be life-threatening.
    • Call an ambulance (000) immediately in an adrenal crisis emergency.

    What are adrenal glands and what do they do?

    The adrenal (ah-dree-nal) glands are two small glands above the kidneys that make several hormones, including cortisol. They are controlled by the pituitary gland – a pea-sized gland at the base of the brain.

    When the body is under physical stress, such as during an illness or injury, the adrenal gland releases extra cortisol. This extra cortisol helps balance blood sugar levels, maintain blood pressure, balance electrolytes, and boost the immune system. If a child has problems with their pituitary or adrenal glands, they may not make enough cortisol. A doctor may diagnose them with a condition called ‘adrenal insufficiency.’

    What is adrenal crisis?

    When a child is sick or injured and cannot make enough cortisol, they will need steroid medicine like hydrocortisone to replace the missing cortisol. If they do not take enough steroid medicine, they may have an ‘adrenal crisis.’

    An adrenal crisis can be life-threatening if left untreated.

    What causes adrenal crisis in children?

    Children at risk of an adrenal crisis:

    Physical stresses that may cause an adrenal crisis in some children include:

    • Vomiting
    • Diarrhoea
    • Illness with a fever
    • Injuries such as broken bones
    • Cuts that need stitches
    • Surgery and/or general anaesthetic.

    Signs and symptoms of adrenal crisis in children

    The most common signs of an adrenal crisis in children are:

    • feeling weak
    • feeling very tired or sleepy
    • low blood pressure
    • low blood sugar
    • fainting
    • vomiting
    • feeling nauseous, dizzy or confused
    • abdominal pain.

    What to do during adrenal crisis

    Your child should have an emergency management plan if they have adrenal insufficiency or another adrenal condition that increases their chance of an adrenal crisis. Ask your child's doctor to make a plan if they do not have one.

    The emergency management plan explains what to do when your child shows signs of an adrenal crisis. Call an ambulance (000) immediately if you do not have an emergency management plan, cannot follow the instructions in the plan for any reason or are worried about your child’s health.

    How to stop an adrenal crisis

    Steroid medicine can usually stop an adrenal crisis in times of physical stress. If your child has adrenal insufficiency or another adrenal condition, their emergency management plan will detail what to do.

    Follow the emergency management plan immediately when your child is unwell.

    Mild illnesses

    For example, if your child has flu symptoms, feels sick or has a low-grade fever (below 38 degrees Celsius).

    • Start the ‘mild illnesses’ dose of their steroid medicine as noted in their emergency management plan. This dose is usually double the normal dose but can differ between patients.
    • Do this for two days or until symptoms stop, then start the usual dose again.

    Moderate illnesses

    For example, if your child has diarrhoea, a fever above 38 degrees Celsius or vomits one or more times.

    • Start the ‘moderate illnesses’ dose of their steroid medicine as noted in their emergency management plan. This dose is usually triple the normal dose but can differ between patients.
    • Do this for two days or until symptoms stop. Then, start the ‘mild illnesses’ dose for two days before returning to their usual dose.
    • If symptoms continue after you have followed these steps, or they get sicker, give an emergency hydrocortisone injection into their outer thigh and call an ambulance (000) immediately or take your child to the nearest emergency department.

    Serious illnesses

    For example, if your child is extremely tired or sleepy, lethargic, dizzy, confused, pale and sweaty, shows signs of dehydration, has a broken bone or other major injury, has diarrhoea twice or more or vomits twice or more.

    • Give an emergency hydrocortisone injection into their outer thigh and call an ambulance (000) or take your child to the nearest emergency department.

    Surgery or major dental work

    For example, if your child needs major dental work or surgery with a general anaesthetic.

    • Make sure the surgeon or dentist, and anaesthetist know your child has adrenal insufficiency or another adrenal condition.
    • Your child will need more of their steroid medicine before and after surgery.
    • If possible, ask your child’s doctor to discuss a suitable dose of steroid medicine for you to give before and after the surgery with the surgeon or dentist and the anaesthetist.

    Common questions about adrenal crisis

    How quickly does adrenal crisis happen?

    An adrenal crisis can develop quickly if a person at risk is under physical stress and does not take enough steroid medicine. If your child has adrenal insufficiency or another adrenal condition and becomes unwell or gets injured, you must follow their emergency management plan and watch for symptoms of an adrenal crisis. Adrenal crises can be life-threatening if not treated.

    How long will it take my child to recover from adrenal crisis?

    If your child is going through an adrenal crisis, they usually start to feel better within 30 minutes of a hydrocortisone injection. However, full recovery can take about 2–3 days, depending on the seriousness of the illness or injury that caused the crisis. It is also very important to gradually reduce your child’s steroid medicine dose once they start getting better.

    Is adrenal crisis linked to adrenal fatigue?

    The term ‘adrenal fatigue’ is controversial because it is not a recognised medical condition. Some people with general tiredness are told they may have adrenal fatigue, but there is usually a clear medical explanation. If your child is very lethargic, speak with their doctor.

    My child has adrenal insufficiency. Should they wear a medical alert bracelet?

    Any child with a life-threatening disease should wear a medical alert bracelet. It is also a good idea to give copies of your child’s emergency management plan to all their caregivers and teachers.

    For more information

    Developed by The Royal Children’s Endocrinology and Diabetes department. We acknowledge the input of RCH consumers and carers.

    Reviewed December 2024

    Please always seek the most recent advice from a registered and practising clinician.



Disclaimer

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.