The Addison crisis


The Addison crisis is a dreaded complication of adrenal cortex insufficiency. In general, it is a rare but acute disease characterized by a severe lack of cortisol. The Addison’s crisis, or severe cortisol deficiency, is a life-threatening condition that requires immediate medical treatment.


The cause of the Addison crisis is the deficiency of the hormone cortisol. This hormone is produced in the adrenal cortex. In some people the production of this hormone does not work properly.

The loss of function can be caused by a disorder in the adrenal gland itself or in the pituitary gland. The pituitary gland is part of the human brain and influences the production of cortisol in the adrenal cortex by releasing the hormone ACTH (adrenocorticotropic hormone). If ACTH is not produced, the adrenal cortex lacks the signal for cortisol production.

Addison’s disease is most common in people with this disorder. This means that they have too little cortisol, which has to be compensated by the administration of cortisol in a drug form. Cortisol is also often referred to as the stress hormone.

In states in which the body has a higher demand for cortisol, the amount available is then no longer sufficient. People who have not yet been diagnosed with adrenal insufficiency are particularly susceptible to an Addison crisis. But patients who have already received treatment can also suffer an Addison crisis.

This happens when the amount of cortisol supplied does not really cover the need in stress situations. – a feverish infection,

  • Psychological stress,
  • Heavy physical strain,
  • Vomiting and diarrhea,
  • Strong injuries
  • And operations. The Addison crisis is caused by an acute lack of cortisol, especially in people whose adrenal glands can no longer produce cortisol properly.

This means that Addison’s crisis does not usually occur after cortisol administration. The inconsistent intake of cortisone in cases of adrenal cortex insufficiency or a stress situation that requires a higher amount of cortisol can cause a crisis. The administration of cortisol is then one of the most important treatment measures to avert the life-threatening condition of those affected.


Even the suspicion of an Addison crisis requires an immediate presentation to a doctor or even direct admission to hospital. The typical symptoms such as hypoglycaemia and shock can also be typical symptoms of an Addison crisis. The regular intake of cortisol or the sudden discontinuation of therapy can, in combination with the symptoms mentioned above, also provide an indication of an Addison crisis.

If there is no known adrenal insufficiency, diagnosis may be more difficult. The determination of cortisol and ACTH levels in particular can make a decisive contribution to the diagnosis. Furthermore, a special test, the ACTH test, can be used to measure the function of the adrenal gland.

However, this is a special measure that is only carried out if there is a strong suspicion of an Addison’s crisis. Ultrasound and, if necessary, CT or MRI can also be used as a diagnostic tool. The main focus is on whether the adrenal gland is enlarged or whether a tumour is the cause of the hypofunction. – fever,

  • Clouding of consciousness and
  • A drop in blood pressure associated with a known disease of the adrenal cortex or pituitary gland.