The adrenal glands are located just above the kidneys. The adrenal gland consists of two parts. The outer portion, called the cortex, produces cortisol. This is an important hormone for controlling blood pressure. The inner portion, called the medulla, produces the hormone adrenaline (also called epinephrine). Both cortisol and adrenaline are released in response to stress.
Cortisol production is regulated by the pituitary gland. This is a small gland behind the nose and under the brain. The pituitary gland releases adrenocorticotropic hormone (ACTH). This is a hormone that causes the adrenal glands to release cortisol.
Adrenaline production is regulated by nerves coming from the brain and spinal cord and by circulating hormones.
Adrenal crisis occurs when:
The adrenal gland is damaged due to, for example, Addison disease or other adrenal gland disease, surgery
The pituitary gland is injured and cannot release ACTH
Call your health care provider if you have Addison disease and are unable to take your glucocorticoid medicine for any reason.
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
If you have Addison disease, you may be told to increase the dosage of your glucocorticoid medicine if you are very ill or before having surgery.
If you have Addison disease, learn to recognize signs of potential stress that may cause an acute adrenal crisis. If you have been instructed by your doctor, be prepared to give yourself an emergency shot of glucocorticoid or to increase your dosage of oral glucocorticoid medication in times of stress.
Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 15.
Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.