Adrenal Crisis

The adrenal glands, sitting on the kidneys, produce a hormone (cortisol) that helps your body deal with stress (i.e., severe illness or injury). When you are taking steroids, the adrenal glands stop producing cortisol (“adrenal suppression”). Once the steroids are discontinued, it can take weeks or months for your body to begin making cortisol again. Without cortisol, your body is unable to deal with stress, resulting in adrenal crisis which may be life threatening.

Adrenal suppression and crisis are a potentially life-threatening complications of long-term steroid use (See Figure 5). It is important to know that you may be at risk of an adrenal crisis if your steroids are stopped suddenly or if doses are missed because of illness or other reasons for more than 24 hours. All patients taking chronic daily steroids should have a plan in place that outlines what to do in case of missed doses or during times of major illness or severe trauma, when extra doses, or “stress doses” of steroids may be needed. Information about preventing, recognizing, and managing adrenal insufficiency, as well as when and how to use stress doses of steroids, are in included in the PJ Nicholoff Steroid Protocol, which can be found here:


You should should receive information about the signs and symptoms of an adrenal crisis:

  • Severe fatigue
  • Headache
  • Nausea/vomiting
  • Low blood sugar
  • Low blood pressure
  • Passing out
Figure 5. Assessment and Management of Growth and Puberty while taking Corticosteroids