adrenal flare ups

Overview

Adrenal flare-ups are episodes when the adrenal glands—two small organs on top of your kidneys—do not make enough of the hormones your body needs. These hormones help control blood pressure, blood sugar, and how your body responds to stress. A flare-up can happen suddenly and may be triggered by illness, infection, injury, or emotional stress. For people who already have adrenal insufficiency (when the adrenal glands are underactive), a flare-up is a serious event that requires prompt treatment.

Adrenal insufficiency is uncommon, affecting around 1 in 10,000 people. However, for those who have it, flare-ups are a well-known risk and require careful management.

People with primary adrenal insufficiency (often called Addison's disease), people with secondary adrenal insufficiency due to a problem with the pituitary gland, and people who have been on long-term steroid treatment that has reduced their adrenal glands' natural production.

Symptoms

Common symptoms

• Extreme fatigue and weakness
• Dizziness or lightheadedness, especially when standing up
• Nausea, vomiting, or diarrhea
• Abdominal pain
• Low blood pressure
• Craving for salty foods
• Darkening of the skin (in primary adrenal insufficiency)

Symptoms in children

• Poor feeding or weight loss
• Irritability or unusual tiredness
• Low blood sugar (feeling shaky, sweaty, or confused)
• Vomiting or dehydration
• Bedwetting after being dry at night (a possible sign)

Symptoms in older adults

• Confusion or memory changes
• Falls or sudden weakness
• Low blood pressure and dehydration
• Less obvious appetite loss or weight loss
• Symptoms may be mistaken for dementia or a urinary infection

Causes

Main causes

• Missing doses of your regular steroid medication
• Physical stress from infection, injury, surgery, or dehydration
• Emotional stress (such as grief, trauma, or major worry)
• Sudden stopping of long-term steroid treatment
• A change in medication that is not properly adjusted for illness

Risk factors

• Having diagnosed adrenal insufficiency (Addison's disease or secondary adrenal insufficiency)
• Taking long-term corticosteroid therapy
• Having a recent illness or infection
• Not having a written sick-day plan or emergency medication kit

When to see a doctor

See a doctor urgently if:

• If you have symptoms of an adrenal crisis (see emergency symptoms above), call your local emergency number right away.
• If you are on steroid medication and cannot keep it down due to vomiting, seek same-day medical help.

Book a routine appointment if:

• If you have adrenal insufficiency and are not feeling well, contact your doctor for advice on adjusting your medication.
• If you need surgery or a major procedure, talk to your specialist about a stress-dose plan.

Diagnosis

Doctors diagnose adrenal insufficiency and flare-ups by taking a detailed history and doing blood tests. They look for low cortisol (a key adrenal hormone), high or low sodium and potassium, and may do a special stimulation test to see how your adrenal glands respond to a stress hormone.

Tests that may be done

• Blood tests for cortisol, sodium, potassium, and other electrolytes
• ACTH stimulation test: a small injection of a hormone to see if your adrenal glands respond correctly
• Imaging scans (such as a CT scan) if the doctor needs to look at the adrenal or pituitary glands

What to expect at your appointment

If a flare-up is suspected, your doctor will act quickly. You may be asked to lie down, have blood drawn, and possibly receive fluids and steroid treatment through a vein. You will be monitored closely until your condition stabilizes. Afterward, your doctor will help you create a plan to prevent future flare-ups.

Treatment

The main treatment for adrenal insufficiency is hormone replacement. A flare-up is treated by giving extra amounts of the prescribed hormone and supporting blood pressure and blood sugar. This may be done at home if caught early, or in a hospital for more serious episodes.

Self-care at home

• Never stop your steroid medication suddenly—this can cause a flare-up.
• Follow your doctor's 'sick-day rules,' such as doubling your dose when you have a fever or infection.
• Keep your emergency injection kit with you and make sure family members know how to use it.
• Stay hydrated and avoid heat exhaustion or heavy physical stress when you are unwell.

Medical treatments

Medical treatment focuses on replacing the missing hormones. In a flare-up, you may need extra steroid medication (given by mouth or by injection), fluids and electrolytes through a vein, and careful monitoring. Your doctor will adjust your long-term hormone doses as needed. The exact approach depends on the cause and severity of the flare-up.

When is surgery considered?

If you need surgery, your medical team will give you extra steroids before and after the procedure to prevent a flare-up. Tell your surgeon and anaesthetist about your adrenal condition in advance.

Living with this condition

Living with adrenal insufficiency means building safety habits. Wear a medical alert bracelet or carry a card that lists your diagnosis and medication. Always have your emergency medicine close by, and teach a close contact how to use it.

Lifestyle tips

• Manage stress with rest, mindfulness, or gentle activities.
• Get enough sleep and avoid overexertion when possible.
• Stay regular with your medication times, including during travel or time-zone changes.

Diet and exercise

Eat a balanced diet with regular meals and snacks. Some people need extra salt, especially during hot weather or exercise—your doctor will advise. Speak to your doctor about safe exercise routines; gentle activities like walking or swimming are often recommended.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful. It's normal to feel anxious or low sometimes. Talk to your doctor about how you're feeling—they can offer support, and there are also counsellors who specialise in helping people with long-term health problems. If you ever feel like hurting yourself, please contact a crisis helpline in your country or go to your nearest emergency department.

Prevention

Not every flare-up can be prevented, but many can be. The key is having an up-to-date sick-day plan, never missing your medication, and seeking early medical advice when you feel an infection or stress coming on.

Vaccines

Staying up to date with recommended vaccines can help prevent infections that might trigger a flare-up. Ask your doctor which vaccines are appropriate for you.

Screening programmes

If you are on long-term steroid therapy, your doctor may periodically check your adrenal function to make sure your dose is still right and to spot any problems early.

Complications

If left untreated

• Adrenal crisis can lead to extremely low blood pressure, shock, coma, and can be life-threatening.
• Severe dehydration and electrolyte imbalances.
• Long-term fatigue, weight loss, and poor quality of life if flare-ups keep recurring.

Long-term outlook

With proper education and treatment, most people with adrenal insufficiency live full, active lives. The key is to take medication exactly as prescribed, follow a sick-day plan, and seek urgent care when needed. Advances in treatment and emergency kits mean that adrenal flare-ups are highly manageable.

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