Understanding Adrenal Crisis Risk in People With Type 1 Diabetes

Researchers in Norway followed 1,040 patients with primary adrenal insufficiency over 24 years to understand when and why adrenal crises occur. Adrenal crises are medical emergencies in which the body suddenly cannot produce enough cortisol, a hormone essential for managing stress and maintaining blood pressure.

The study distinguished between two types of crisis: overt crisis (where patients show obvious signs of acute illness with measurable changes in heart rate, blood pressure, or blood chemistry) and incipient crisis (where patients experience typical warning symptoms but without clear objective abnormalities on tests).

Among the key findings: people with Type 1 diabetes who also had primary adrenal insufficiency were more than twice as likely to experience an overt adrenal crisis as those with adrenal insufficiency alone. This elevated risk applied regardless of how strictly their blood sugar was managed or what their daily corticosteroid dose was.

Having Type 1 diabetes appears to compound the challenges of managing adrenal insufficiency, though the exact reasons for this increased vulnerability require further investigation.

During the study period, about 63% of patients experienced at least one hospitalization related to adrenal crisis, and 25% had at least one overt crisis after their diagnosis. Over the study period, overt crises occurred at a rate of 3.2 per 100 person-years, while early-warning crises occurred at a rate of 6.9 per 100 person-years.

Notably, hospital visits for incipient crisis—those early warning cases—increased significantly over the 24-year period, which researchers suggest may reflect better recognition and earlier intervention by patients and healthcare providers. Out of 1,754 crisis-related hospitalizations, five deaths were attributed to adrenal crisis, representing 0.3% of admissions.

The study found that both very young and older patients faced higher overt crisis risk, suggesting that age-related factors—possibly changes in how the body handles stress or differences in treatment access—play a role.

About half of all crisis admissions occurred in patients who had received stress-dosing instructions (where patients or caregivers increase their corticosteroid dose during acute illness or injury). This suggests that stress dosing is an important tool but does not prevent all crises, and that education and awareness remain essential.

If you have both Type 1 diabetes and primary adrenal insufficiency, this research underscores the importance of close medical monitoring and early recognition of adrenal crisis symptoms. Being aware of warning signs—such as severe fatigue, dizziness, abdominal pain, or unexpected changes in how you feel during illness—allows for faster intervention.

This is not a reason for alarm, but rather a prompt to ensure you and your healthcare team have a clear crisis plan in place. The rarity of deaths in this large cohort suggests that with proper medical attention, adrenal crisis is a manageable, though serious, complication.

Source: Journal of internal medicine. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.