Support for Those Living with Adrenal Insufficiency

Emergency Instructions


An adrenal crisis is life threatening and needs prompt treatment. If you think you or your loved one is experiencing crisis symptoms do not wait!  CALL 911. If you have an emergency injectable use it per your endocrinologist’s instructions, and get to the ER! Contact your endo to alert him/her so they can inform the ER staff of your imminent arrival.
Purchase your Adrenal Insufficiency Kit at AIU's Store

Get your emergency kit at AIU’s store.

Signs and Symptoms of Adrenal Crisis
Not all symptoms will be present

  • Shock-like symptoms
  • Nausea or vomiting/diarrhea
  • Lethargy/listlessness
  • Neurological deficits: behavior changes, confusion, difficulty speaking, slurred speech
  • Pale, cold, clammy skin, shivering
  • Rapid pulse and/or breathing
  • Headache/dizziness
  • Fever/infections
  • Low blood sugar
  • Low OR high blood pressure
  • Pain: abdominal, back, flank, legs.
  • Seizures
  • Cardiovascular collapse/stroke

Low sodium levels can lead to delirium and abnormal brain function. As a result patients may seem to be under the influence. This is a sign of adrenal crisis and must be treated immediately.

Without proper and immediate treatment the patient will suffer cardiovascular collapse, stroke and death.

1. Administer/assist with patient provided emergency injection. If not available use one locally approved steroid IM/IV. Hydrocortisone is the preferred emergency glucocorticoid. Be aware, many patients also lack mineralocorticoid coverage.

hydrocortisone              methylprednisolone             dexamethasone

Adult 100 mg                       125 mg                                           4 mg

Pediatric 2 mg/kg              2 mg/kg                                          0.03 – 0.15 mg/kg
(max of 100 mg)                (max of 125 mg)                            (max of 4 mg)

2. Check a capillary blood glucose. If blood glucose is less than 70 mg/dl. refer to local diabetic protocols.
3. Administer NS fluids per local protocol. Refer to local hypotension shock protocol.
4. Refer to local cardiac arrest protocol.

If you’re not sure how to inject or need a refresher, here’s the training from our 2019 Conference.

Injection Training – Heflin

Injection Instructions Video:  This youtube video by the Succeed Clinic in OK walks you through the steps to inject.  Although the video was made for those with Congenital Adrenal Hyperplasia the instructions on how to inject are the same for anyone.  Be sure to ask your physician about the circumstances in which you would need an injection.

Injection Instructions  Download a pdf file from Pfizer and Sydney Children’s Hospital.

Online Injection Instructions :  These online instructions are also from Sydney Children’s Hospital.


Emergency Letter: A letter to take to the emergency room with you written for AIU by Professor Peter Hindmarsh.

Emergency Letter: A letter to take the the emergency room written by the Pediatric Endocrine Society Board of Directors, November 2015.

Emergency Letters Translated into several languages thanks to the Addison’s Disease Self-Help Group. Languages available: Cantonese, French, German, Greek, Italian, Mandarin, Portuguese, Russian, Spanish, and Thai.

Adrenal Crisis Pathway:  This graphic flowchart illustrates the events that can occur during an adrenal crisis.  These events can happen in 30 minutes or less.  Factors such as the overall health of the individual, mechanism of injury, and severity of illness all play a part. Sometime a crisis can take longer to develop.  It’s important to have a conversation with your physician about what to do in an emergency situation.

Illness Flow Chart:  This helpful chart created by Professor Hindmarsh can help parents with children who are ill but is not meant to be used as a diagnostic tool. Parents unsure of what to do during a child’s illness should always contact a physician.

Great Info from the NIH on managing AI. For those having difficulty getting a prescription for Solu-Cortef® the second page clearly states that all with adrenal insufficiency should carry the injection.

Another from the NIH on stress dosing and illness.

Visit our page about How to Prepare for Emergencies!

Backpack Health has created a place for individuals and families to manage and share their health information. Our innovative, multi-tier technology ecosystem enables medical foundations, health advocacy groups and drug and device developers to build and support branded communities based on the needs of their members/patients.
AIU’s exciting new partnership with Backpack Health means that there is now an app for your phone that will soon have features specific to those with Adrenal Insufficiency.

To learn more about Emergency Protocols for adrenal insufficiency visit our State Report Card Page. To learn about protocols for all rare disease visit RareEmergency.Info

Backpack Health App for AI

An app to help improve daily self-management of your health information, while contributing to research, and improving access to AIU support. Join the AIU Backpack Health Group now at:


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