Adrenal Crisis Prevention: Signs, Triggers, and How to Stay Safe

When your body can’t make enough cortisol, even a small infection or injury can trigger a life-threatening adrenal crisis, a sudden, severe drop in cortisol levels that can cause shock, coma, or death if untreated. This isn’t rare—it happens to about 8% of people with adrenal insufficiency, a condition where the adrenal glands don’t produce enough steroid hormones each year. Most cases are preventable. You don’t need to live in fear, but you do need to know what to do before it’s too late.

People with Addison’s disease, a form of chronic adrenal insufficiency where the adrenal cortex is damaged or those who’ve been on long-term steroids know the drill: stress means more medication. But it’s not just about illness. Surgery, car accidents, even intense emotional stress can spike your need for cortisol. That’s where stress dosing, the temporary increase of corticosteroid medication during physical or emotional stress comes in. It’s not optional. Skipping it because you feel "okay" is how people end up in the ER. And if you’re on corticosteroid tapering, the process of slowly reducing steroid doses after long-term use, your body may still be struggling to wake up its own adrenal glands. That’s when you’re most vulnerable.

Adrenal crisis doesn’t always start with nausea or dizziness. Sometimes it’s just a feeling that something’s "off." You might feel unusually weak, your skin might turn pale or blotchy, your blood pressure drops, and you get confused. If you’ve been told you have adrenal insufficiency, keep emergency hydrocortisone injections at home—and make sure someone close to you knows how to use them. Wear a medical alert bracelet. Keep a written plan on your phone and in your wallet. No one should have to guess what to do when you’re collapsing.

What you’ll find below are real, practical guides from people who’ve been there. How to recognize the early warning signs before it’s an emergency. When to double your dose—and when to go straight to the hospital. How to talk to your doctor about stress dosing without sounding paranoid. What to pack in your travel kit if you’re flying or hiking. And why some people survive adrenal crisis while others don’t—it’s not luck, it’s preparation.