Adrenal Crisis – Definition, Prevention and Treatment:
                Results from a Delphi Survey

Tina Kienitz; Nicole Bechmann; Timo Deutschbein; Stefanie Hahner; Jürgen Honegger; Matthias Kroiss; Marcus Quinkler; Nada Rayes; Nicole Reisch; Holger Sven Willenberg; Gesine Meyer

doi:10.1055/a-2130-1938

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2024; 56(01): 10-15
DOI: 10.1055/a-2130-1938

Original Article: Endocrine Care

Adrenal Crisis – Definition, Prevention and Treatment: Results from a Delphi Survey

Authors

Tina Kienitz

¹Endocrinology in Charlottenburg, Berlin, Germany
Nicole Bechmann

²Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
Timo Deutschbein

³Medicover Oldenburg MVZ, Oldenburg, Germany

⁴Division of Endocrinology and Diabetes, University Hospital Wurzburg, Department of Internal Medicine I, Wurzburg, Germany
Stefanie Hahner

⁴Division of Endocrinology and Diabetes, University Hospital Wurzburg, Department of Internal Medicine I, Wurzburg, Germany
Jürgen Honegger

⁵Neurosurgery, Eberhard-Karls-Universitat Tubingen, Medizinische Fakultat, Tübingen, Germany
Matthias Kroiss

⁶Department of Internal Medicine IV, University Hospital Munich, Munich, Germany
Marcus Quinkler

¹Endocrinology in Charlottenburg, Berlin, Germany
Nada Rayes

⁷Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
Nicole Reisch

⁶Department of Internal Medicine IV, University Hospital Munich, Munich, Germany
Holger Sven Willenberg

⁸Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
Gesine Meyer

⁹Goethe University Frankfurt, University Hospital, Medical Clinic 1, Division of Endocrinology, Frankfurt am Main, Germany

Abstract

Based on recent data, a total number of about 29 000 patients with adrenal insufficiency can be calculated for Germany, and about 1500 fatalities due to adrenal crises have to be expected within the next decade. Management of adrenal crises is still unsatisfactory. The objectives of this study were to establish consensus for diagnostic criteria, prevention strategies, and treatment recommendations for adrenal crises. The study was conducted from January 2022 to April 2023, using Delphi technique. Four rounds of questionnaires were sent to 45 experts, selected by a coordinating group on behalf of the adrenal section of the German Society of Endocrinology. The survey was implemented online using the REDCap web application. Responses were captured anonymously. During the Delphi process the expert panel developed diagnostic criteria to identify patients likely to have an adrenal crisis. Education about adrenal insufficiency among patients as well as non-endocrine medical personnel were regarded as highly important. It was suggested that recommendations for the management of adrenal insufficiency have to be simplified and made widely available. This study provides pragmatic strategies to identify and treat patients prone to adrenal crisis, thereby highlighting the need for an improved management of patients with adrenal insufficiency.

Key words

adrenal insufficiency - glucocorticoid replacement - adrenal crisis - emergency card - diagnostic criteria

Full Text

References

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