Adrenal Crisis

If there is a severe shortage of cortisol then an individual’s life can be in danger with an adrenal crisis. This event is very rare is will never happen to most people with CAH who take treatment regularly, make appropriate increases in dose when ill and seek help early if unexpectedly unwell or vomiting. The symptoms are faintness, nausea, vomiting and abdominal pain. An adrenal crisis can be triggered by a stressful illness such as severe flu or gastro-enteritis. An injection of hydrocortisone should be given immediately. Admission to hospital may be needed so that fluids can be given into a vein – a ‘saline drip’. If in doubt – always give an injection of hydrocortisone and go to the nearest accident and emergency department.

Why not take the adrenal glands out?

There is an operation to remove the adrenal glands called adrenalectomy. People who have no adrenal glands, a condition called Addison’s disease, require the same medication as those with CAH, so the question sometimes arises that if treatment is difficult for any reason, why not remove the adrenal gland? Adrenalectomy is not a minor operation and the long-term safety of this option has not been established. For some women in whom all fertility treatments have failed, then adrenalectomy might be the only answer.

©Dr G. S. Conway 1999

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