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

Tina Kienitz
1   Endocrinology in Charlottenburg, Berlin, Germany
2   Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
Timo Deutschbein
3   Medicover Oldenburg MVZ, Oldenburg, Germany
4   Division of Endocrinology and Diabetes, University Hospital Wurzburg, Department of Internal Medicine I, Wurzburg, Germany
Stefanie Hahner
4   Division of Endocrinology and Diabetes, University Hospital Wurzburg, Department of Internal Medicine I, Wurzburg, Germany
Jürgen Honegger
5   Neurosurgery, Eberhard-Karls-Universitat Tubingen, Medizinische Fakultat, Tübingen, Germany
Matthias Kroiss
6   Department of Internal Medicine IV, University Hospital Munich, Munich, Germany
1   Endocrinology in Charlottenburg, Berlin, Germany
Nada Rayes
7   Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
Nicole Reisch
6   Department of Internal Medicine IV, University Hospital Munich, Munich, Germany
8   Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
Gesine Meyer
9   Goethe University Frankfurt, University Hospital, Medical Clinic 1, Division of Endocrinology, Frankfurt am Main, Germany
› Author Affiliations
Fundings The survey is conducted on behalf of the section „Adrenal, Steroids, and Hypertension“ of the DGE in co-operation with the working group on „Pituitary and pituitary tumors“ of the DGE. Supported by the German Research Foundation (DFG) as part of the collaborative research center 205 „The adrenal: central relay in health and disease“ (project number 314061271).


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.

Publication History

Received: 25 May 2023

Accepted after revision: 09 July 2023

Article published online:
10 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

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