What is the main cause of acute adrenal crisis?

The main cause of an acute adrenal crisis is the abrupt withdrawal of corticosteroids. This situation arises primarily in patients who have been on long-term glucocorticoid therapy, as their adrenal glands may become suppressed and significantly reduce their endogenous production of cortisol. When these individuals stop taking steroids suddenly, their bodies may not be able to respond adequately to physical stress due to insufficient cortisol levels, leading to an adrenal crisis.

Acute adrenal crises can manifest as severe fatigue, hypotension, shock, and other adrenal insufficiency symptoms. Recognition and treatment of this condition are critical, typically requiring urgent administration of intravenous hydrocortisone to restore appropriate cortisol levels.

While acute illness or stress can indeed precipitate an adrenal crisis in individuals with known adrenal insufficiency, the most direct cause in the context of the options provided is the sudden cessation of corticosteroid therapy, as this represents a failure of the body's adaptive response to increased physiological demand due to a lack of cortisol.