👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: Addisonian crisis · acute adrenal insufficiency · acute cortisol deficiency
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Use this quick-reference guide to spot, treat, and prevent Adrenal Crisis on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🩺 Signs
Severe hypotension → shock
↓Na, ↑K, ↓glucose
N/V, weakness, fever, confusion
⚠️ Causes
Stopped steroids abruptly
Stress, infection, surgery
✅ Do
IV hydrocortisone STAT
IV NS + D5 fluids, fix K+
🎓 Teach
NEVER stop steroids suddenly
Stress dose, med-alert bracelet
📚 Adrenal Crisis — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Adrenal crisis is a life-threatening acute deficiency of cortisol (and often aldosterone), most often triggered by stress, infection, trauma, or abrupt withdrawal of corticosteroids in a patient with adrenal insufficiency. It causes profound hypotension and shock. It is a medical emergency requiring immediate IV hydrocortisone and fluids.
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Key points
Understand these first
Common triggers: infection, trauma, surgery, dehydration, and sudden stopping of long-term steroids.
Hallmarks are severe hypotension and vascular collapse (shock), along with hyponatremia, hyperkalemia, hypoglycemia, and dehydration.
Other signs include profound weakness, nausea/vomiting, abdominal and flank pain, fever, and altered mental status.
Immediate treatment is IV hydrocortisone (e.g., 100 mg) and rapid IV fluids with 0.9% normal saline (often with dextrose for hypoglycemia).
Hyperkalemia and hyponatremia result from aldosterone deficiency; cortisol deficiency causes hypoglycemia and inability to tolerate stress.
Patients on chronic steroids need stress-dose increases during illness, surgery, or trauma to prevent crisis.
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Nursing priorities
What to do, in order
Administer IV hydrocortisone immediately as the priority intervention.
Give rapid IV fluid resuscitation with normal saline to correct hypotension and dehydration.
Monitor blood pressure, heart rate, blood glucose, and continuous cardiac rhythm for hyperkalemia-induced dysrhythmias.
Monitor serum sodium, potassium, and glucose, and treat hypoglycemia with IV dextrose.
Minimize physical and emotional stress and provide a quiet environment until stabilized.
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Red flags — report now
Escalate immediately
Profound hypotension/shock unresponsive to fluids — give hydrocortisone without delay; do not wait.
Peaked T waves or dysrhythmias from hyperkalemia — treat and notify provider immediately.
Never abruptly discontinue corticosteroids in steroid-dependent patients — can precipitate crisis.
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Labs & values
Numbers to know
Sodium <135 mEq/L (hyponatremia)
Potassium >5.0 mEq/L (hyperkalemia)
Glucose <70 mg/dL (hypoglycemia)
Low serum cortisol
Elevated ACTH in primary adrenal insufficiency
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Patient teaching
What patients must know
Never stop steroids abruptly; doses must be tapered and increased ('stress dosing') during illness, infection, or surgery.
Wear a medical alert bracelet and carry an emergency injectable hydrocortisone kit.
Report fever, vomiting, diarrhea, or injury promptly, as these can trigger crisis and require extra steroids.
Recognize early warning signs: weakness, dizziness, nausea, and salt craving.
❓ Adrenal Crisis: NCLEX FAQs
What are the priority nursing interventions for Adrenal Crisis?
Administer IV hydrocortisone immediately as the priority intervention. Give rapid IV fluid resuscitation with normal saline to correct hypotension and dehydration. Monitor blood pressure, heart rate, blood glucose, and continuous cardiac rhythm for hyperkalemia-induced dysrhythmias. Monitor serum sodium, potassium, and glucose, and treat hypoglycemia with IV dextrose.
What are the warning signs of Adrenal Crisis a nurse must report?
Profound hypotension/shock unresponsive to fluids — give hydrocortisone without delay; do not wait. Peaked T waves or dysrhythmias from hyperkalemia — treat and notify provider immediately. Never abruptly discontinue corticosteroids in steroid-dependent patients — can precipitate crisis.
What do I need to know about Adrenal Crisis for the NCLEX?
Common triggers: infection, trauma, surgery, dehydration, and sudden stopping of long-term steroids. Hallmarks are severe hypotension and vascular collapse (shock), along with hyponatremia, hyperkalemia, hypoglycemia, and dehydration. Other signs include profound weakness, nausea/vomiting, abdominal and flank pain, fever, and altered mental status. Immediate treatment is IV hydrocortisone (e.g., 100 mg) and rapid IV fluids with 0.9% normal saline (often with dextrose for hypoglycemia).
What patient teaching is important for Adrenal Crisis?
Never stop steroids abruptly; doses must be tapered and increased ('stress dosing') during illness, infection, or surgery. Wear a medical alert bracelet and carry an emergency injectable hydrocortisone kit. Report fever, vomiting, diarrhea, or injury promptly, as these can trigger crisis and require extra steroids. Recognize early warning signs: weakness, dizziness, nausea, and salt craving.
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Quick Tip
Common triggers: infection, trauma, surgery, dehydration, and sudden stopping of long-term steroids.