Adrenal crisis symptoms can develop when your body needs more cortisol than your usual prescribed glucocorticoid dose provides, or when illness stops you absorbing tablets. If you have adrenal insufficiency, use the sick-day plan made for your diagnosis and prescription. Guidance commonly advises increasing oral steroids during significant illness, but the dose and when to switch to an injection depend on your situation.
When To Adjust Your Oral Steroid
The Society for Endocrinology’s adult emergency guidance advises doubling the usual daily oral glucocorticoid dose during an illness with fever that requires bed rest and/or antibiotics. This is often called a sick-day rule. It is a guide for people with established adrenal insufficiency—not a one-size-fits-all instruction for every person taking steroids.
Your plan should say which medicine to adjust, the exact dose and schedule, and when to return to your usual dose. Hydrocortisone is commonly used for replacement, but some people take another glucocorticoid, such as prednisolone. Do not assume that doubling the number of tablets works the same way for every drug or prescription. If you have a fever or illness and do not have clear instructions, contact your endocrine team or urgent medical service for advice.
There is also a related but distinct situation: adrenal insufficiency caused by current or recent glucocorticoid treatment for another condition. In a 2024 joint guideline, the European Society of Endocrinology and the Endocrine Society recommend stress-dose coverage for people with current or recent glucocorticoid use who have not had testing to rule out adrenal insufficiency. It advises oral steroids for minor stress when there is no instability or prolonged vomiting or diarrhoea, and injected or intravenous steroids for more serious stress, inability to take medicine by mouth, or signs of instability. This guidance does not set a universal home dose for everyone; your clinician should tailor your instructions to your medication and medical history.
Vomiting, Injury And The Emergency Injection
If vomiting or diarrhoea means you cannot keep tablets down, oral medicine may not be absorbed reliably. The Society for Endocrinology guidance calls for injectable or intravenous glucocorticoids during prolonged vomiting or diarrhoea. The 2024 joint guideline also recommends parenteral treatment when vomiting is prolonged or oral intake is not possible. Follow your personal emergency plan rather than waiting to see whether repeated tablets stay down.
For an adult emergency plan, the Society for Endocrinology guidance describes an immediate 100 mg hydrocortisone injection into a muscle or vein for adrenal crisis. An emergency hydrocortisone injection kit may be prescribed for use outside hospital, but you and anyone likely to help should be shown how to use your specific kit. The hospital treatment also includes fluids and ongoing steroid treatment; an injection at home is not a substitute for urgent assessment.
Serious injury, surgery and procedures involving general or regional anaesthesia can also require injected or intravenous steroid cover. The amount and route depend on the situation and your plan. If an injury is severe or you are unsure whether it counts as significant stress, seek urgent medical advice and tell responders you have adrenal insufficiency.
Recognise Possible Adrenal Crisis Symptoms
Warning signs can include severe weakness, dizziness or collapse, abdominal pain, nausea or vomiting, fever, and confusion or unusual drowsiness. These symptoms are not unique to adrenal crisis, but in someone at risk they need prompt attention—especially if symptoms are worsening or you cannot take oral medication.
If you suspect a crisis, use your prescribed emergency injection plan and seek emergency care immediately. Call your local emergency number; do not wait for a routine appointment or for symptoms to become more severe. Tell the medical team about your diagnosis, usual steroid and any injection already given. An emergency card or medical-alert identification can help communicate this quickly.
Make Your Plan Usable Before You Get Sick
Ask your clinician to write down what to do for fever, vomiting, diarrhoea, injury and planned procedures, including when to inject and who to contact. Check that you have enough tablets and that your injection kit is current; practise the steps with someone who may need to help. Keep emergency information with you.
Guidance differs in scope: the Society for Endocrinology document focuses on emergency care for adults with adrenal insufficiency, while the 2024 joint guideline addresses glucocorticoid-induced adrenal insufficiency and stress coverage for people whose adrenal function has not been tested. Neither makes one dose appropriate for every diagnosis, age or prescription. Children need their own clinician-directed plan. If you are unsure what applies to you, ask your treating clinician to clarify it before an illness occurs.
