Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol, a hormone produced by the adrenal glands.

Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the inner portion, called the medulla. The cortex produces three types of hormones, all of which are called corticosteroids.

Cortisol is a glucocorticoid -- a corticosteroid that:

• Helps regulate blood sugar (glucose)
• Holds back the immune response
• Is released as part of the body's response to stress

Cortisol production is regulated by a small gland just below the brain called the pituitary gland. Cortisol is essential for life.

Adrenal crisis occurs when:

• The adrenal gland is damaged (Addison's disease, primary adrenal insufficiency)
• The pituitary gland is injured (secondary adrenal insufficiency)
• Adrenal insufficiency is not properly treated

Risk factors for adrenal crisis include:

• Dehydration
• Infection and other physical stress
• Injury to the adrenal or pituitary gland
• Stopping treatment with steroids such as prednisone or hydrocortisone too early
• Surgery
• Trauma

Stewart PM. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 14.