adrenal with fever

Overview

The adrenal glands are two small organs that sit on top of your kidneys. They make hormones that help your body manage stress, blood pressure, and blood sugar. If your adrenal glands do not make enough of these hormones, doctors call this adrenal insufficiency. When you have a fever or an infection, your body needs extra of these stress hormones. If you cannot make more, it can lead to a serious condition called adrenal crisis. This article explains what to look for and how to stay safe.

Adrenal insufficiency itself is rare. Adrenal crisis is even rarer, but it is serious and can happen to anyone whose body cannot make enough stress hormones.

It mainly affects people who have been diagnosed with adrenal insufficiency (including Addison’s disease) or who take certain hormone medicines for a long time. It can also affect people whose pituitary gland does not work properly.

Symptoms

Common symptoms

• Extreme tiredness or weakness
• Dizziness or lightheadedness
• Nausea or vomiting
• Low blood pressure (feeling faint or passing out)
• Confusion or unusual drowsiness
• High fever that does not get better
• Severe abdominal or back pain
• Fast or irregular heartbeat

Symptoms in children

• Lack of energy or unusually sleepy
• Irritable and crying more than usual
• Poor appetite or feeding problems
• Vomiting or diarrhea
• Cool or clammy skin

Symptoms in older adults

• Confusion or sudden change in behavior
• Dizziness and a higher risk of falling
• Low blood pressure, sometimes with fainting
• Rapid breathing or feeling short of breath

Causes

Main causes

• In people with adrenal insufficiency, the glands cannot produce extra stress hormones when the body faces a fever, infection, injury, surgery, or severe stress.
• A fever is the body’s natural reaction to an infection. The infection itself can be the trigger.
• Stopping or lowering hormone replacement medicines too quickly without medical advice can also lead to adrenal crisis.

Risk factors

• Having adrenal insufficiency (including Addison’s disease)
• Taking long-term steroid medicines that suppress the adrenal glands
• Having an underactive pituitary gland
• Having an infection that causes fever, like flu, pneumonia, or COVID-19
• Undergoing surgery, injury, or trauma
• Not having a clear emergency care plan for sick days

When to see a doctor

See a doctor urgently if:

• If you have adrenal insufficiency and a fever, contact your healthcare team the same day. They may tell you to come in or go to the emergency room.
• If you have severe vomiting or diarrhea and cannot keep fluids down, seek urgent medical care.
• If you think your fever is due to an infection and you are feeling very unwell, see a doctor promptly.

Book a routine appointment if:

• Continue regular check-ups with your endocrinologist (a doctor who specializes in hormones).
• Ask your care team for a written 'sick-day action plan' if you do not have one.

Diagnosis

If you already have adrenal insufficiency, your doctor will usually make the diagnosis based on your symptoms and the situation. If you do not have a diagnosis, your doctor will do a physical exam and ask about your medical history. They may order blood tests to check your hormone levels.

Tests that may be done

• Blood tests to measure stress hormone levels and other blood chemicals
• A stimulation test, which checks how your adrenal glands respond to a special hormone
• Blood tests for sodium, potassium, glucose (sugar), and kidney function
• Sometimes a CT scan or MRI of the adrenal glands or pituitary gland

What to expect at your appointment

During an adrenal crisis, treatment is given in a hospital, usually in the emergency room. You will receive fluids, electrolytes, and medicines to replace the missing hormones through an IV (drip). You may need to stay in the hospital until your condition is stable. Once you are stable, your doctor will talk with you about adjusting your daily medicines and sick-day plan.

Treatment

The main goal of treatment is to replace the hormones your body cannot make, especially during times of stress like fever or infection. This prevents an adrenal crisis. If a crisis happens, it is treated as an emergency with IV fluids and medicines.

Self-care at home

• Follow your sick-day plan exactly as given by your care team. This often includes increasing the dose of your usual hormone medicine during illness — but only according to instructions.
• Stay well hydrated, even if you do not feel thirsty.
• Rest as much as possible and keep your body temperature comfortable.
• Do not stop your hormone replacement medicine suddenly, even if you feel unwell.
• Tell a family member or friend about your condition and where your emergency medicines are kept.

Medical treatments

Medical treatment for adrenal insufficiency involves replacing the hormones your body is missing, usually with oral tablets or injections. During an adrenal crisis, the hospital team will give fluids, sugar, and hormone medicine through an IV. Stress doses may be given before surgeries or procedures to prevent a crisis. Your doctor will tell you exactly what you need and when.

When is surgery considered?

If you need surgery or an invasive procedure, you must tell the medical team that you have adrenal insufficiency before the procedure. Your care team will arrange for you to receive extra stress hormones during and after surgery to keep you safe.

Living with this condition

Living with adrenal insufficiency means paying attention to your body and being prepared. Always carry your medical supplies and a medical alert card or bracelet that says you have adrenal insufficiency. Let your close contacts know what to do in an emergency.

Lifestyle tips

• Take your hormone medicines exactly as prescribed, every day.
• Make sure you have enough medicine for travel and for unexpected illness.
• Learn how to give an emergency injection if your doctor has prescribed one for you.
• Wear a medical alert bracelet or necklace and carry a wallet card.

Diet and exercise

Eat a balanced diet with regular meals. Some people need extra salt, especially in hot weather or after exercise. Talk to your dietitian or doctor about how much salt is right for you. Regular gentle exercise is good, but avoid overdoing it when you are unwell. Rest when you need to.

Mental health and emotional wellbeing

Living with a condition that can become serious suddenly may cause anxiety or stress. It is normal to feel worried about fevers or sick days. Talking to a counselor or joining a support group can help you manage these feelings. Your healthcare team is there to support you, not just physically but emotionally.

Prevention

Adrenal crisis can often be prevented by following a good sick-day plan, increasing medicine during illness as prescribed, and seeking medical help early for infections. You cannot prevent every infection, but you can reduce your risk of a crisis by being prepared.

Vaccines

Staying up to date with recommended vaccines, such as the flu vaccine and pneumonia vaccine, is important for people with adrenal insufficiency. Vaccines help prevent infections that could trigger a crisis. Talk to your doctor about which vaccines are right for you.

Screening programmes

People who are at risk for adrenal insufficiency (for example, those who have taken long-term steroids) should discuss screening with their doctor. If you have symptoms that worry you, early testing can identify the problem before a crisis happens.

Complications

If left untreated

• Adrenal crisis can cause life-threatening low blood pressure and shock.
• It can lead to dangerously low blood sugar, seizures, or coma.
• Without prompt treatment, adrenal crisis can be fatal.

Long-term outlook

With the right treatment and a clear plan for sick days, most people with adrenal insufficiency live full and active lives. The key is education, preparation, and getting help early when a fever or illness appears. Your healthcare team can help you build confidence in managing your condition.

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