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Adrenal crisis: the emergency to know after adrenal surgery | CION Cancer Clinics
An adrenal crisis is a sudden shortage of cortisol that causes vomiting, severe weakness, confusion and falling blood pressure. It needs steroid by injection in hospital the same day. After adrenal surgery the risk sits mainly with people whose tumour made cortisol, who lost both glands, or who take steroid replacement. This page explains the signs, the triggers, what to do and what hospital will do. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is an adrenal crisis, and why is it an emergency?
- What does an adrenal crisis look like?
- What happens when you reach hospital?
- When can you manage at home, and when do you go in?
- What do families believe that delays help?
- How can you lower the chance of a crisis?
- Common questions about adrenal crisis
The short answer
What is an adrenal crisis, and why is it an emergency?
An adrenal crisis is a sudden, dangerous shortage of cortisol, the stress hormone your adrenal glands make. It causes vomiting, severe weakness, confusion and a steep fall in blood pressure, and it needs steroid by injection in hospital the same day.
Why it matters after adrenal surgery
Most people who have one adrenal gland removed never come close to a crisis, because the other gland keeps working. The risk sits with a smaller group: people whose tumour was making too much cortisol, people who have had both glands removed, and people taking steroid replacement for any reason. In these groups the body cannot raise its own cortisol when it is under strain.
What sets it off
A crisis rarely comes out of nowhere. It usually follows a stomach bug with vomiting, a fever, an injury, another operation, or missed steroid tablets. The illness raises the body's need for cortisol at the very moment the tablets are not getting in.
What this page cannot tell you
It cannot tell you whether you personally are at risk, or what dose your sick day rules should use. Your endocrinologist, the hormone specialist, sets both. If nobody has told you whether you are in a higher-risk group, ask before you leave hospital.
This page is for families as much as patients. A person in crisis is often too drowsy to explain what is happening.
!
Go to hospital now if
Someone on steroid replacement, or who has had adrenal surgery, is vomiting repeatedly, cannot keep tablets down, is confused or hard to wake, faints, or has severe pain in the belly, back or legs. Call an ambulance or go to the nearest emergency department. Show the steroid card and say the words "adrenal insufficiency, needs hydrocortisone". Do not wait to see whether the vomiting settles overnight.
Not sure whether this applies to you?
Ask an oncologistKnowing the signs
What does an adrenal crisis look like?
The early signs are easy to mistake for an ordinary stomach upset or tiredness. The later signs are not subtle.
Early warning signs
These can appear over hours or a day or two, often during another illness. On their own they are a reason to follow your sick day rules and call your team.
- Feeling sick and losing appetite
- Unusual weakness or heavy tiredness
- Dizziness on standing up
- Aching muscles and joints
Signs of a crisis
These mean the body is no longer coping. Treat any of them as an emergency, especially in someone who cannot keep tablets down.
- Repeated vomiting or loose motions
- Confusion, slurred speech or drowsiness
- Fainting or collapse
- Cold, clammy, pale skin
Signs families notice first
Relatives often see the change before the patient does. An elderly parent who suddenly seems muddled, stops eating or cannot get out of bed during a fever needs checking the same day, not the next week.
In the emergency department
What happens when you reach hospital?
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Tell the triage nurse straight away
Say that the person has had adrenal surgery or takes steroid replacement, and show the card. In a busy casualty in Hyderabad or a district hospital, this single sentence changes how quickly you are seen.
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Steroid by injection
Hydrocortisone is given into a vein or a muscle. Doctors are taught to give it first and confirm with blood tests afterwards, because waiting for results is more dangerous than the injection.
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Fluids through a drip
Salt water through a drip brings the blood pressure back up and corrects dehydration. Blood sugar and salt levels are checked and corrected too.
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Finding the trigger
The team looks for what set the crisis off, such as an infection, and treats it. Most people improve quickly once steroid and fluids are in.
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Before going home
Your tablet dose is brought back down under supervision, and your sick day rules are reviewed. Ask what should be done differently next time.
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Situation by situation
When can you manage at home, and when do you go in?
What is happening
What to do
A cold, mild fever, but eating, drinking and keeping tablets down
Follow the sick day rules your team gave you and call them for advice
Vomited once, then kept the next tablet down
Watch closely and call your team the same day
Vomiting again, or cannot keep tablets down
Emergency department now, or the emergency injection if you have been trained to give it
Confused, fainting or very drowsy
Call an ambulance. Do not try to give tablets by mouth
Commonly believed
What do families believe that delays help?
"It is only a stomach bug. Let us see how she is in the morning."
In someone who needs steroid replacement, vomiting means the tablets are not getting in. A crisis can develop within hours. Waiting overnight is the most common delay, and the most dangerous one.
"The doctors will know what is wrong without being told."
An adrenal crisis looks like many other illnesses: infection, dehydration, a stroke. Casualty doctors can only act quickly if someone tells them about the adrenal surgery and the steroids. Carry the card, and say it out loud.
"A steroid injection is risky, so we should wait for the blood test."
A single emergency dose of hydrocortisone is very unlikely to cause harm, even if it turns out not to have been needed. Not giving it to someone in crisis can be life-threatening. That is why it is given first.
"Only one gland was removed, so this cannot happen to us."
Usually true, but not if the tumour was making cortisol and the other gland is still recovering. Ask your team which group you are in rather than assuming.
Before it happens
How can you lower the chance of a crisis?
Most crises can be prevented by planning for illness before it arrives. The work is done on a calm day, not at midnight with someone vomiting.
Get your sick day rules in writing
Ask your endocrinologist to write down what you should do with your tablets during a fever, a stomach upset or an injury, and at what point you must go to hospital. Keep a photo of it on the phones of the people who live with you.
Ask about an emergency injection kit
Some people are given a hydrocortisone injection to keep at home, and a family member is taught to give it into the thigh. Ask whether this suits you, and where to buy it. It does not replace going to hospital afterwards.
Plan around other procedures
Dental work, scopes, another operation and even a hard labour can all need extra steroid cover. Tell every doctor, well in advance, that you take replacement or have had adrenal surgery.
Keep a spare supply
Running out of tablets during a festival holiday or a journey home to a district is a common, avoidable trigger. Keep spares in more than one place.
Questions we are asked
Common questions about adrenal crisis
Can an adrenal crisis happen after removal of just one adrenal gland?
It can, but it is uncommon. The main risk is when the removed tumour was making too much cortisol, because the other gland has been switched off and takes time to recover. If both glands were removed, or you take steroid replacement, the risk is real and lifelong planning matters.
How fast does an adrenal crisis develop?
Sometimes over a day or two of feeling unwell, sometimes within hours of a vomiting illness starting. Because it can move quickly, the safe rule is to act on the early signs rather than wait for the serious ones. Early treatment is simple and works well.
Is an adrenal crisis the same as low blood pressure?
Low blood pressure is one part of it, but not the whole picture. A crisis also brings vomiting, weakness, confusion, low sugar and upset salt levels. Ordinary blood pressure medicines or a drip alone will not fix it. The missing cortisol has to be replaced.
Can I give the emergency injection myself?
Many patients and family members learn to, once a nurse or doctor has shown them how. It goes into the outer thigh muscle. Only do it if you have been trained and prescribed a kit. Then go to hospital anyway, because the cause of the crisis still needs treating.
What should I say in a hospital that does not know me?
Say that the patient has adrenal insufficiency after adrenal surgery and needs hydrocortisone now. Show the steroid card and the discharge summary. If the team seems unsure, ask them politely to call the endocrinologist on duty or the treating hospital.
Does a crisis mean the steroid dose was wrong?
Not necessarily. Most crises follow an illness that raised the body's need suddenly, not a wrong everyday dose. After recovery your endocrinologist will review what happened, check your usual dose, and go over your sick day rules with you and your family.
Can heat and dehydration in a Hyderabad summer trigger it?
Heavy sweating and loose motions in hot weather can tip someone into trouble, particularly if they also lose salt. Drink plenty, carry water when travelling, and treat heat exhaustion with vomiting as a reason to follow sick day rules or seek care the same day.
Will I always be at risk?
If your remaining gland recovers fully and your tablets are stopped, the risk usually fades, though your team may advise caution for a while. If both glands are gone, the risk stays for life. Blood tests and your endocrinologist will tell you which applies to you.
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Sources
- NHS — Addison's disease
- NHS — Hydrocortisone tablets
- NHS — Cushing's syndrome
- Cancer.Net — Adrenal Gland Tumor
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Steroid Replacement After Adrenal SurgeryWho needs tablets afterwards and how they are stoppedCarrying a Steroid Emergency CardThe card that tells a casualty doctor what to doComplications and Red FlagsOther warning signs after cancer surgeryCaretaker and Family Guide to SurgeryFor the family member who will spot the signs first
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