, Volume 55, Issue 2, pp 336–345 | Cite as

Adrenal crises: perspectives and research directions

  • R. Louise RushworthEmail author
  • David J. Torpy
  • Henrik Falhammar


Adrenal crises are life-threatening complications of adrenal insufficiency. These events have an estimated incidence of between 5 and 10  adrenal crises/100 patient years and are responsible for some of the increased morbidity and excess mortality experienced by patients with adrenal insufficiency. Treatment involves urgent administration of IV/IM hydrocortisone and IV fluids. Patient education regarding preventive measures, such as increasing the dose of replacement therapy (“stress dosing”) when sick, using parenteral hydrocortisone as necessary and accessing medical assistance promptly, is still considered the best approach to averting the onset of an adrenal crisis at times of physiological stress, most commonly an infection. However, recent evidence has demonstrated that patient education does not prevent many adrenal crisis events and the reasons for this are not fully understood. Furthermore, there is no widely accepted definition of an adrenal crisis. Without a validated adrenal crisis definition it is difficult to interpret variations in the incidence of adrenal crises and determine the effectiveness of preventive measures. This article aims to review the clinical aspects of adrenal crisis events, to explore the epidemiology, and to offer a definition of an adrenal crisis and to offer a perspective on future directions for research into adrenal crisis prevention.


Adrenal insufficiency Incidence Risk factors Morbidity Mortality 



HF is supported by the Magnus Bergvall Foundation, Karolinska Institutet, and the Stockholm County Council.


No funding was received for this review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.School of Medicine, SydneyThe University of Notre DameSydneyAustralia
  2. 2.Endocrine and Metabolic UnitRoyal Adelaide Hospital and University of AdelaideAdelaideAustralia
  3. 3.Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
  4. 4.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  5. 5.Menzies School of Health Research and Royal Darwin HospitalDarwinAustralia

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