Top 5 Tips To Avoid An Adrenal Crisis…And What To Do If You Are In One

So, you have Adrenal Insufficiency and are completely steroid dependent for the rest of your life. As if that is not scary enough, NOW you have to make sure that your levels of cortisol are always under control so that you avoid an Adrenal Crisis and even worst, coma or death. Since I have unfortunately been there way too many times, I figured I would compile a list of the top 5 tips to avoid an adrenal crisis. Also, because we are all human, it is inevitable that at some point you’ll be in one, so I’ve included what to do at that point….

Top 5 Tips To Avoid An Adrenal Crisis…..

  1. Make sure your daily steroid intake is the correct dose for YOUR body. This may seem like a no brainer, but I see this all of the time. How much do you truly need?? Too little and you’ll have low coritsol symptoms. Too much and you’ll be over replacing. The best way to see how much your body needs is a 24 hourcortisol test. This can be a challenge, however. You really have two options. You can do a “day curve” test, which is highly recommended. Or…you can opt to take a 24 hour test on your own through urine. You then ship it off to the lab and they send you your results.
  2. Make sure your steroids are being delivered when your body needs them. Also seems like a no brainer. If you are on Prednisone, chances are pretty good that you are completely covered and don’t have to worry about it. However, if you are on Hydrocortisone, that is a whole new story. You have to take Hydrocortisone multiple times per day to mimic a body’s natural replication. So, how is this done? First of all, knowing your baseline is a good start. Also knowing how fast you metabolize the Hydcrortisone. Some need it every 4 hours, while other people can get away with going 6 hours. The best way to mimic the body’s “normal” is to do circadian rhythm dosing. That will assure 24 hour coverage and will give you a higher quality of life.
  3. Make sure your labs are up to date. When you first were diagnosed, they performed an 8am blood cortisol test. They hopefully also performed an ACTH test to show whether you are PAI or SAI. If not, you’ll want to find out. Other tests needed are a Comprehensive metabolic Panel, CBC Count, Thyroid-Stimulating Hormone or TSH, Autoaintibody Testing, Prolactin Testing. Imaging studies are also needed. You’ll want a chest radiograph done to show current evidence of TB. You’ll also want an abdominal CT scan. And an MRI done to show what is going on with your pituitary function. Another test I would recommend is a DNA test. You can order these through My Heritage or 23 And Me. This will show you what other health issues you may have.
  4. Stress Dose when needed. In a normal body, the body will create MORE cortisol when needed. When our bodies are under stress, whether it is good or bad, it doesn’t even know the difference, it lowers it. How do you handle this? You add more! How much will totally depend on how you are feeling. Some people need an extra 2.5mg, others need more like 20mg. It just really depends on the situation. Are you sick, do you have an infection, or are you just stressed out? Knowing your low cortisol symptoms are VITAL.
  5. INJECT!!!! NOW! When in doubt, ALWAYS inject 100mg of Soluctortef. If you even have to second guess this, it’s time to inject. Do you need follow-up hospital care afterwards? Not necessarily. It depends on the situation. If you can keep fluids down, you’re probably ok. However, if you have a stomach bug and are puking and have diarrhea, the best place to be is at the hospital being monitored and replenished with IV fluids.

Now, let’s talk about what to do IF you are IN an Adrenal Crisis….

First of all, breathe. You’re going to be ok! What I like to do is to ask myself “What do I need RIGHT NOW to take care of myself?” And I just keep asking myself that over and over again until I’m in the clear. Questions you may ask yourself are….

  1. How am I feeling? What are my symptoms? Do I need to stress dose or do I need to inject??
  2. How are my fluids? How about my supplements?
  3.  I need to call 911 or can I handle this myself? Is someone home that can help me through this?
  4. If you need to dial 911, make sure they know you have AI, are steroid dependent and need 100mg of Soluctortef when paramedics arrive.
  5. What if you’re not home? You need to start carrying a “to go bag.” The bag should include things such as your medications, your emergency injection, fluids, and lots of snacks, both salty and sugary. Also, you’ll want to include a letter to the ER from your doctor with correct protocol along with emergency contact info and a list of all medications and supplements taken.

Disclaimer: This is not intended to replace medical advice given from your doctor. Please consult with them prior to adjusting any and all medications.

Author: Jen Hudnall

After over 8 years of being incredibly sick, being told it was all in my head, dragging my kids to the hospital over and over again, I was finally diagnosed with Adrenal Insufficiency, also known as Addison's Disease. I've started this blog to share my journey and to help educate and bring awareness about not only Addison's Disease, but every other rare disease in which case patients are fighting to find a diagnoses to their symptoms.

21 thoughts on “Top 5 Tips To Avoid An Adrenal Crisis…And What To Do If You Are In One”

  1. I was diagnosed May, 2000. Oh how I wish I had information like this available. Now its so much easier to learn about, and especially from one another through trial and error. For instance…why would an endocrinologist have me take hydrocortisone just 2 times a day. No wonder I had a hard time sleeping and had anxiety issues at night. I not take 3 times a day, and it solved that issue. Anyway, lots of trial an error. I also added DHEA, and pregnenolone, and that helped too. Exercise and lots of bone building veggies. Thanks for your blog and info!


    1. CeCe, you’re welcome. I wrote a blog on 10 Things I Wish My Endo Would Have Told Me. Anxiety is normally a sign of low cortisol. And two times a day on HC is just silly. Not like a normal body at all!! 🦋


      1. You’re so right…I called the endocrinologist, and he argued with me that anxiety was another issue, not from the addisons! And he wonders why I only go into see him every 3 years ago or so, when he forces me to, to give me another years prescriptions.


      2. Yes….my anxiety is almost non existent when I’m on the right dosage amount. I still get it, but it’s normally always when I’m low in cortisol. It’s one of my first “symptoms.”


      3. Hi Jen, I was diagnosed with AI two years ago, at age 30. I see an Endocrinologist and had all the tests done etc. but I have been told to and so am currently taking HC twice a day as that’s what she has prescribed. I have never heard any different even in the research I’ve done and I’m an RN… well, used to be… I also have chronic daily migraines and am waiting for back surgery so at age 32 I have a totally non existent life with a lot of suicidal thoughts! I guess she tells everyone to take it twice a day, sounds like yours was as well. Should I be taking it three times a day? I know that normal Cortisol levels are supposed to be highest in the morning and then fade as the day goes on, I take 25mg at 8am and 15mg at 2-3pm. I have had anxiety since I was a teenager though so never attributed any of it to the AI.
        I do have to stress dose at times and carry the injection with me, and have a MedicAlert bracelet.
        And I have gained 40lbs from the steroids and other 9 medications I’m on including high doses of nerve and pain meds.


  2. I was just told I have AI but we don’t have an endocrinologist nearby so it will be a while before I can get in to see one. I had my first crisis a week ago and spent 4 days in the hospital, a typically healthy 30 year old then out of no where, super sick. I’m researching everything I can about AI and looking for others who are enduring it when I can across your blog. Your info is very helpful! Thank you!


    1. Alizbeth, welcome to the club. I was healthy one day and then I was not at age 30 so I know the feeling. Feel free to contact me anytime with any questions. There are other blog posts you may find very helpful. 🦋


    2. Alizbeth, so sorry for the really super long delay. I really hope you found a good Endo and have been able to educate yourself!! 💕


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