Other symptoms include weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma.

The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous glucocorticoids' typical inhibitory effect on inflammatory cytokines.

A low cortisol level of less than 3 mg/dL, measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency.

[7] Gastrointestinal symptoms such as nausea, vomiting, anorexia and abdominal pain are common in adrenal insufficiency and can lead to misdiagnosis.

Other symptoms of an adrenal crisis include severe fatigue, dizziness, diffuse limb and back pain, malaise, and weakness.

In secondary adrenal insufficiency, hyponatremia results from decreased kidney excretion of electrolyte-free water and the inability to suppress vasopressin.

[5] Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia.

Hypercalcemia is triggered by decreased calcium excretion and accelerated bone resorption throughout an adrenal crisis, which can be exacerbated by volume depletion.

[14] A higher risk of adrenal crisis has been linked to other medical conditions such as diabetes and asthma, though the exact mechanism is unknown.

[13][17] Adrenal crises can also be caused by major surgery, dental operations, pregnancy/labour, extreme weather, serious injury/accidents, intense physical activity, vaccines, and emotional stress.

[18] An absolute or relative lack of cortisol causes adrenal crises since there is not enough tissue glucocorticoid activity to preserve homeostasis.

The physiological effects of low cortisol begin with the loss of the natural inhibitory function of glucocorticoids on inflammatory cytokines.

Low levels of cortisol means that it loses its ability to work with catecholamines to reduce vascular reactivity, which causes vasodilatation and hypotension.

[14] When adrenal insufficiency is suspected a blood sample can be collected to test serum cortisol and ACTH levels, while treatment begins during the wait for results.

[22] Adrenal insufficiency can be diagnosed by testing renin, dehydroepiandrosterone sulfate, aldosterone, serum cortisol, and ACTH levels.

A low cortisol level of less than 3 mg/dL, obtained in the early morning or during a stressful period, strongly suggests the possibility of adrenal insufficiency.

Devices like MedicAlert bracelets and necklaces can alert caregivers to the possibility of adrenal crisis in those who are unable to communicate verbally.

[25] Although the exact dosage has been debated, it is generally agreed upon that anyone with proven adrenal insufficiency receives glucocorticoid replacement during stressful times.

[26] Though there may be variations in specific regimens, most agree that stress doses for simple surgery is quickly tapered and does not last longer than three days.

If there is reason to suspect something, a blood sample could be taken right away for ACTH and serum cortisol testing; however, treatment needs to begin right away, regardless of the results of the assay.

[35] In cases of secondary adrenal insufficiency, cortisol replacement can cause water diuresis and suppress antidiuretic hormone.

[40] All age groups are susceptible to misclassification of an adrenal crisis diagnosis,[39] but older people may be more vulnerable if relative hypotension is not evaluated, given the age-related rise in blood pressure.

[42] The treatment of pituitary tumors and the widespread use of opioids for pain, as well as exogenous glucocorticoid therapy for the numerous conditions that become more common in people over 60, are the main causes of a new diagnosis of adrenal insufficiency in older adults.

Cellulitis is linked to adrenal crises within this age range and may be more prevalent in those with fragile skin who have been exposed to higher doses of glucocorticoids.

Older adults, especially those who have primary adrenal insufficiency, frequently experience falls and fractures, which may be linked to postural hypotension.

[46] Older people have a higher mortality rate from adrenal crisis, at least in part due to the existence of comorbidities that make treatment more difficult.

[49][50] Untreated adrenal crisis can cause severe morbidity in both the mother and the fetus, such as inadequate wound healing, infection, venous thromboembolism, extended hospital stays, preterm birth, fetal intrauterine growth restriction, and an increased risk of cesarean delivery.

[53] Psychosocial factors can alter the baseline adrenal crisis risk, especially as the transition from parental treatment oversight to self-management in adolescence.