The Emergency Injection for the treatment of Adrenal Crisis

Understanding what an Emergency Injection kit is, how to inject and how important it is to use the injection during an Adrenal Crisis. Here we cover:

Get an emergency injection kit - it may save your life

After diagnosis, as per the NICE Guidelines, you should be issued with a prescription for the medication required for a hydrocortisone emergency injection kit.

What's in an emergency injection kit?

Injection kits include vials of hydrocortisone that either you or someone who is with you, can administer if you are vomiting and unable to absorb oral tablets ('Sick Day Rules'), or showing other signs of severe illness. You injection to prevent adrenal crisis.

You should be given enough medication, needles and syringes for 2 or 3 emergency kits so you have a spare in case one of the medication vials breaks, and also so you can keep them in multiple locations for your safety and for when travelling.

Your GP or endocrinology team can prescribe the hydrocortisone medication required for the kit. There are two types of hydrocortisone available. You will be prescribed either:

  • Hydrocortisone sodium phosphate 100mg (1ml liquid ampoule), or
  • Hydrocortisone sodium succinate 100mg Powder for Solution for Injection or Infusion 1x2ml - vial with diluent (previously known as Solu-Cortef),

You will also need:

The necessary intramuscular needles and syringes needed to inject cannot be added to your repeat prescriptions, so these will be provided by your GP or Endocrinology team upon your request. These are also available from our charity online shop.

More information on the items to be prescribed can be found in the 'Emergency Management Kits' section of the NICE Guidelines for Adrenal Insufficiency, as well as the 'medication management' section of The ADSHG Caring For the Addison's Patient leaflet.

Many people prefer hydrocortisone sodium phosphate (ex-Efcortesol) for their injection kits as this requires no mixing before drawing up into the needle for injection. However there is a current shortage of this medication so it is not available. Supply is expected to resume in May 2026. Read more in our News item.

Therefore Hydrocortisone sodium succinate 100mg Powder for Solution (ex-Solu-Cortef) is to be used. This is a dried form of hydrocortisone that is mixed with a water vial before injection. This type of hydrocortisone is more stable in hot weather (above 25ºC) so it is a prudent choice for those planning a trip abroad.

Our 'How-To' leaflets for your kit and instructions below cover both types of hydrocortisone medication for injection. Regularly check your kit to make sure the medication is in date. Having the expiry date taped to the container is a good way of reminding yourself of the expiry dates of medication. 

When to give an emergency injection

You can read more about the symptoms of adrenal crisis and what you should do in the emergency section of our website.

Learn how to administer an emergency injection - practice makes perfect!

Once you have your kit,  both you and people that you spend a lot of time with, such as family, colleagues or friends, should learn what to do if you have an adrenal crisis and how to give an emergency injection of hydrocortisone. Learning how to do this is very important. It doesn’t take very long and it could save your life. Regularly check your kit to make sure the vials are in date, requesting replacements for any out of date vials.

Any person who recognises someone is in adrenal crisis is permitted to administer the individual's prescribed emergency hydrocortisone injection for the purpose of saving life, whether they are a healthcare professional or not, as Schedule 19 in the Human Medicine Regulations 2012. The law is very clear and simple on this as the emergency injection saves a life and immediate action is required. This is why it is important to train those you spend time with on the emergency injection through the materials discussed on this page, and to always keep your 'how to' injection leaflets with your injection kit.

Check out these short videos :

Print out our emergency injection leaflets to keep in your kit

Download our emergency injection leaflets

How to store your injection kit

Some hospital endocrine units provide ready made injection kits for you. If this is not the case for your hospital, in our online shop, we sell emergency injection boxes (minus the drug preparations which your GP or Endocrinologist needs to prescribe). These come with amp snaps (for the glass vial) along with photo instructions on how to give the injection and allow you to keep all the materials needed to give the injection in the same place.

Alternatively, you can choose a small sturdy box yourself to keep your emergency kit in. Ensure the box is clearly labelled. It is advisable to include the photo instructions on how to give the injection, adrenal crisis guidelines, hospital stickers and NHS steroid emergency card in the box.  See our more detailed advice on preparing your own emergency kit.

Having the expiry date taped to the container is a good way of reminding yourself of the expiry dates of medication.  All items including syringes and needles will have an expiry date. Note the shortest item date on your kit or set a calendar reminder if you use an electronic diary. This allows for items to be checked regularly and to request a new prescription in good time.

Save any unused vials so you can then use these for injection practise with friends, family or colleagues. Remember to also check your kit regularly, especially before travelling, to make sure none of the vials have broken and need replacing - always carry spares!

For guidance on taking your injection kit into gigs or venues, read our 'Sharps into Venues' article.

#ShareYourKit 

Help normalise this potentially scary situation by using #ShareYourKit when posting a picture of your kit on Instagram or X/Twitter, or send your examples direct to the ADSHG! We love to see how you store your injection kit and raise awareness, just like Craig below.

You can also search the hashtag to see other people's kits or take a look on our #ShareYourKit blog. Hear from Hannah the police officer, Stuart the racing car driver and Shona the busy Mum, to name just a few! You can also read personal experiences of using injection kits from Dan and Philippa, or watch our video on our YouTube channel.

Visit our #ShareYourKit blog

What to do if you are refused an injection kit

People with Addison's and adrenal insufficiency require an emergency injection kit (100mg hydrocortisone) for at home, when travelling and on holiday, for use in an emergency to avoid precipitating an acute adrenal crisis. This is so either you or a friend or family member can immediately administer if you are vomiting and unable to absorb oral tablets, or showing other signs of severe illness.

Therefore if there is a delay in getting an ambulance to you or in a busy hospital A&E department, the hydrocortisone injection means that you will be safe from the adrenal point of view until you receive further medical attention.

Provision of a hydrocortisone emergency injection kit is standard practice for the prevention of an acute adrenal crisis. It is the advice given in the NICE Guidance: Adrenal insufficiency: identification and management, by the ADSHG Clinical Advisory Panel, Society for Endocrinology, and on the NHS page for Addison's disease, 

Note: The NICE guidance includes that a minimum of two emergency injection kits should be prescribed, so spares available for travel or in case a vial shatters and becomes unusable in an adrenal crisis.

Here is some guidance on the next steps you can take:

Write or Email: If your GP or Endocrinologist does not wish to provide additional prescriptions to provide the above cover, please direct them to our "Why should I give my Adrenal Insufficiency Patient an Emergency Injection Kit?" page. This provides them with the latest Clinical Guidance and advice that a kit is necessary. Ask them to read the page and then politely request again that an injection kit is prescribed. 

Include medical evidence: It is helpful to include copies of Clinical Guidance and research which confirms that prescribing an emergency injection kit is standard practice for your GP or Endocrinologist, along with your letter/email/request.

Further research with quotes highlighted are included on our "Why should I give my adrenal insufficiency patient an emergency injection kit?" page. Please scroll to the 'Clinical Guidance' section.

Clinical Guidance for Healthcare Professionals regarding Injection Kits 

Due to Addison's and adrenal insufficiency being a rare disease, medical professionals don't always have the information they need to make certain decisions. With over 7,000 rare diseases, it isn't possible for your GP to be an expert on your condition. Providing them with this information and working with them, means they have the medical evidence they need to prescribe an injection kit.

Elements to include in kit: If they are unsure about the elements to prescribe, we list these in our The ADSHG Caring For the Addison's Patient leaflet. Please provide your GP with a copy.

Injection Training: If they are unable to provide injection training, you can reassure them you will learn via the print out injection instruction leaflets available on the ADSHG charity website along with training videos demonstrated by an endocrine specialist nurse.

Next steps inc PALs: After sending this email/letter, if your endocrinologist or GP still refuse - ask them to answer why they are going against the expert advice and guidance of the Addison's Clinical Advisory Panel (CAP). This is so you have their response in writing and helps provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about their unsafe management of your Addison’s or adrenal insufficiency. 

Practice Makes Perfect: Be Prepared

Studies show that you need more than just knowledge of how to give an emergency injection: it helps you to feel more confident if you practice regularly.   Read our page on Injection Training for more information.

The Future of Emergency Injections - and why there isn't a more sophisticated system

One of the most frequently asked questions we get from our members and the wider adrenal insufficiency community, is;

"Why isn't there something like an 'epi-pen' for us to use to give ourselves a quick and easy emergency injection'?

It is a very good and valid question, and we share the various considerations, as well as our thoughts on the answer, in our article on The Future of Emergency Injections 

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Author: Vick Smith

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