Adrenal Crisis

Adrenal crisis is an acute, life-threatening failure of cortisol production during a period when the body needs more cortisol than it can supply. A patient may arrive with vomiting, profound weakness, abdominal pain, and hypotension that does not correct as expected with fluids. The presentation can resemble sepsis, a gastrointestinal catastrophe, or another form of shock; infection may be the trigger as well as the competing diagnosis. The decisive nursing move is not to wait for laboratory confirmation. Give emergency hydrocortisone and isotonic fluid promptly while assessing perfusion, glucose, electrolytes, and the precipitating illness. The mechanism explains the urgency: without cortisol, vascular tone and responsiveness to catecholamines fail. In primary adrenal insufficiency, aldosterone deficiency adds sodium and water loss and potassium retention. Most crises can be prevented with stress-dose planning, reliable access to medication, and a patient or family member who can give emergency intramuscular hydrocortisone when oral absorption is impossible.