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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Endocrinology · Secondary Adrenal Insufficiency

What Are Adrenal Crisis Symptoms in Pituitary Tumors?

At a Glance

An adrenal crisis is a life-threatening emergency caused by dangerously low cortisol levels during physical stress. Key warning signs include severe nausea, profound dizziness, extreme weakness, and confusion. Immediate treatment with an emergency hydrocortisone injection is required to prevent organ shutdown.

In this answer

3 sections

01

Warning Signs of an Adrenal Crisis

02

Emergency Protocols and “Sick Day Rules”

03

What to Do in an Emergency

An adrenal crisis is a severe, life-threatening medical emergency that occurs when your body does not have enough cortisol to handle physical stress, such as an infection, injury, or surgery [1][2][3]. When a non-functioning pituitary adenoma damages the pituitary gland, it can stop producing the hormone (ACTH) that tells your adrenal glands to make cortisol. This condition is called secondary adrenal insufficiency. Without enough cortisol, your body’s systems can quickly begin to shut down during times of stress. While everyday cortisol levels might be managed with daily pills, an adrenal crisis happens when a sudden stressor drastically increases your body’s need for cortisol, and you cannot produce or supply it quickly enough [1][2][3].

Warning Signs of an Adrenal Crisis

Recognizing the symptoms of an impending crisis early is critical. Unlike a slow decline in energy, an adrenal crisis hits rapidly and requires immediate medical attention. Be on the lookout for these primary warning signs [4][5][6]:

  • Severe Nausea and Vomiting: Sudden, relentless stomach upset, often accompanied by severe abdominal pain [4][7][8].
  • Profound Dizziness and Low Blood Pressure: A sudden drop in blood pressure (hypotension) that makes you feel incredibly lightheaded, dizzy, or even causes you to pass out when standing up [7][9].
  • Sudden, Severe Weakness: A debilitating lack of energy where you may feel too weak to get out of bed or stand [4][5].
  • Confusion or Brain Fog: Mental cloudiness, trouble staying awake, or extreme difficulty concentrating [4][5][6].

Note on Pituitary Tumors: Because a non-functioning pituitary adenoma causes secondary adrenal insufficiency, your adrenal glands usually still produce another hormone called aldosterone, which helps balance salt and potassium [10][11]. This means you might not experience the severe salt cravings or extreme potassium imbalances seen in primary adrenal disease (like Addison’s disease), but your risk for a life-threatening crisis from a lack of cortisol remains just as high [11][12].

Emergency Protocols and “Sick Day Rules”

If your pituitary tumor has caused secondary adrenal insufficiency, you must be prepared to act quickly to prevent a crisis. Studies show that roughly half of patients with adrenal insufficiency will experience a crisis at some point, making preparation essential [3][13].

Your action plan should include:

  • Following “Sick Day Rules”: When you get sick (like having a fever or infection) or undergo a medical procedure, your body needs extra cortisol. You must be trained to increase (often double or triple) your daily oral glucocorticoid dose to mimic what a healthy body would naturally do [14][3][13].
  • Using an Emergency Injection Kit: If you are vomiting and cannot keep your pills down, or if you are unconscious, you or a family member must inject a high dose of emergency steroids (such as intramuscular hydrocortisone, typically 100mg for adults) immediately [14][15][16]. Prompt injection of stress-dose glucocorticoids can save your life [17][18][1]. Regular training on how to use these injectable kits improves confidence and readiness [19][3][20]. It is strongly recommended to teach a family member or close friend how to administer the injection, check expiration dates frequently, and keep multiple kits (e.g., one at home, one in a travel bag, one at work).
  • Carrying Medical Alert Identification: Always carry a steroid emergency card and wear a medical alert bracelet [16][21]. Carrying an emergency letter from your endocrinologist is also incredibly helpful, as it provides ER staff with explicit medical instructions to treat your secondary adrenal insufficiency instantly [14][3][21].

What to Do in an Emergency

If you suspect you are having an adrenal crisis:

  1. Administer your emergency injection of hydrocortisone immediately. Do not wait [14][15][3].
  2. Call 911 or go to the nearest emergency room.
  3. Inform the paramedics or emergency room staff that you have secondary adrenal insufficiency and require an immediate “stress dose” of IV fluids and hydrocortisone [22]. Present your medical alert emergency card or endocrinologist’s letter right away.

Common questions in this guide

What are the early warning signs of an adrenal crisis?
Early warning signs include severe nausea and vomiting, profound dizziness or fainting from low blood pressure, sudden and severe weakness, and mental confusion or brain fog. An adrenal crisis hits rapidly and requires immediate emergency medical attention.
Why do non-functioning pituitary adenomas cause adrenal crisis?
These tumors can damage the pituitary gland, stopping it from producing the hormone ACTH. Without ACTH, your adrenal glands stop making cortisol, leaving your body unable to handle physical stress like an infection or injury.
What are 'sick day rules' for adrenal insufficiency?
Sick day rules are guidelines for increasing your daily steroid dose when you are ill, have a fever, or undergo a medical procedure. You typically need to double or triple your oral glucocorticoid dose to give your body the extra cortisol it needs to handle the physical stress.
What should I do if I suspect an adrenal crisis?
Administer your emergency hydrocortisone injection immediately, especially if you are vomiting and cannot keep pills down. Do not wait. After injecting, call 911 or go to the nearest emergency room and present your steroid emergency card to get stress-dose IV fluids and hydrocortisone.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What specific 'sick day rules' should I follow for illnesses like a fever or a stomach bug, and when exactly should I double or triple my dose?
  2. 2.Can you prescribe me an emergency injectable hydrocortisone kit and walk me and a family member through how to use it?
  3. 3.Can you provide me with an emergency letter to carry that explicitly instructs emergency room staff to administer stress-dose steroids immediately without waiting for lab results?
  4. 4.How should I adjust my steroid dosing if I need to undergo dental work, minor surgery, or a medical procedure?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

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References

References (22)
  1. 1

    Daily adjustment of glucocorticoids by patients with adrenal insufficiency.

    Schöfl C, Mayr B, Maison N, et al.

    Clinical endocrinology 2019; (91(2)):256-262 doi:10.1111/cen.14004.

    PMID: 31050815
  2. 2

    Perioperative glucocorticoid management based on current evidence.

    Seo KH

    Anesthesia and pain medicine 2021; (16(1)):8-15 doi:10.17085/apm.20089.

    PMID: 33445232
  3. 3

    Adrenal insufficiency.

    Husebye ES, Pearce SH, Krone NP, Kämpe O

    Lancet (London, England) 2021; (397(10274)):613-629 doi:10.1016/S0140-6736(21)00136-7.

    PMID: 33484633
  4. 4

    Autoimmune Adrenalitis in Systemic Lupus Erythematosus: Identifying a Rare Endocrine Complication.

    Zhalka A, Jabareen R, Foqara M, et al.

    Cureus 2025; (17(11)):e96668 doi:10.7759/cureus.96668.

    PMID: 41399549
  5. 5

    An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage.

    Rodriguez Tebar A, Panza-Nduli J, Gubin B, et al.

    Acta gastro-enterologica Belgica 2023; (86(3)):495-498 doi:10.51821/86.3.11251.

    PMID: 37814568
  6. 6

    Case Report: Hypercalcemia as a manifestation of acute adrenal crisis precipitated by fluconazole use, and a review of the literature.

    Choo KS, Yew J, Tan EJH, Puar THK

    Frontiers in endocrinology 2023; (14()):1168797 doi:10.3389/fendo.2023.1168797.

    PMID: 37274338
  7. 7

    Conduct protocol in emergency: Acute adrenal insufficiency.

    Fares AB, Santos RA

    Revista da Associacao Medica Brasileira (1992) 2016; (62(8)):728-734 doi:10.1590/1806-9282.62.08.728.

    PMID: 27992012
  8. 8

    [Adrenal crisis in a child].

    Holmberg NH, Haagensen AL

    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke 2023; (143(2)) doi:10.4045/tidsskr.22.0354.

    PMID: 36718904
  9. 9

    Acute adrenal insufficiency-induced hypotension following spinal surgery in a pediatric patient with Charcot-Marie-Tooth disease and severe scoliosis: a case report.

    Cao J, Lv X, Chen L, et al.

    BMC pediatrics 2025; (25(1)):549 doi:10.1186/s12887-025-05905-0.

    PMID: 40646561
  10. 10

    A rare cause of chronic hyponatremia in an infant: Answers.

    Mutlu GY, Taşdemir M, Kızılkan NU, et al.

    Pediatric nephrology (Berlin, Germany) 2020; (35(2)):243-245 doi:10.1007/s00467-019-04337-0.

    PMID: 31428928
  11. 11

    SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients.

    Arlt W,

    Endocrine connections 2016; (5(5)):G1-G3 doi:10.1530/EC-16-0054.

    PMID: 27935813
  12. 12

    Glucocorticoid-induced adrenal insufficiency and glucocorticoid withdrawal syndrome: Two sides of the same coin.

    Nachawi N, Li D, Lansang MC

    Cleveland Clinic journal of medicine 2024; (91(4)):245-255 doi:10.3949/ccjm.91a.23039.

    PMID: 38561211
  13. 13

    Adrenal crisis and mortality rate in adrenal insufficiency and congenital adrenal hyperplasia.

    Lousada LM, Mendonca BB, Bachega TASS

    Archives of endocrinology and metabolism 2021; (65(4)):488-494.

    PMID: 34283908
  14. 14

    Adrenal Insufficiency in Adults: A Review.

    Vaidya A, Findling J, Bancos I

    JAMA 2025; (334(8)):714-725 doi:10.1001/jama.2025.5485.

    PMID: 40522647
  15. 15

    Treatment and Prevention of Adrenal Crisis and Family Education

    Çamtosun E, Sangün Ö

    Journal of clinical research in pediatric endocrinology 2025; (17(Suppl 1)):80-92 doi:10.4274/jcrpe.galenos.2024.2024-6-12-S.

    PMID: 39713905
  16. 16

    Steroid emergency cards: action needed.

    Drug and therapeutics bulletin 2020; (58(11)):163 doi:10.1136/dtb.2020.000063.

    PMID: 33082160
  17. 17

    Unmasking Addison's Disease: A Case of Acute Adrenal Crisis.

    Mufeeth M, Neethu E, Muraleedharan D, et al.

    The Journal of the Association of Physicians of India 2025; (73(9S)):40-42 doi:10.59556/japi.73.1131.

    PMID: 40955985
  18. 18

    Increased mortality in primary adrenal insufficiency: a systematic review and meta-analysis.

    Dalakas K, Allosso F, Basile C, et al.

    European journal of endocrinology 2025; (193(4)):S53-S60 doi:10.1093/ejendo/lvaf186.

    PMID: 40966723
  19. 19

    The Key to Adrenal Insufficiency Education: Repetition, Repetition, Repetition.

    Keil MF, Van Ryzin C

    Pediatric endocrinology reviews : PER 2017; (14(Suppl 2)):448-453 doi:10.17458/per.vol14.2017.kr.keyadrenalinsufficiency.

    PMID: 28647949
  20. 20

    COVID-19 Infection in Adrenal Tuberculosis Patients with Adrenal Insufficiency Who Complicated with Adrenal Crisis.

    Aisyah MR, Fitri IC, Ahani AR, Wafa S

    Acta medica Indonesiana 2024; (56(3)):356-362.

    PMID: 39463101
  21. 21

    Guidance for the prevention and emergency management of adult patients with adrenal insufficiency.

    Simpson H, Tomlinson J, Wass J, et al.

    Clinical medicine (London, England) 2020; (20(4)):371-378 doi:10.7861/clinmed.2019-0324.

    PMID: 32675141
  22. 22

    Prevention of Adrenal Crisis: Cortisol Responses to Major Stress Compared to Stress Dose Hydrocortisone Delivery.

    Prete A, Taylor AE, Bancos I, et al.

    The Journal of clinical endocrinology and metabolism 2020; (105(7)) doi:10.1210/clinem/dgaa133.

    PMID: 32170323

This page provides educational information about adrenal crisis symptoms and emergency planning. It does not replace professional medical advice. Always consult your endocrinologist to establish your personal 'sick day rules' and emergency action plan.

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