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
,
Nicole Bechmann 
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
,
Marcus Quinkler 
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
,
Holger Sven Willenberg 
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).
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Correction: Adrenal Crisis – Definition, Prevention and Treatment: Results from a Delphi SurveyHorm Metab Res eFirst
DOI: 10.1055/a-2157-2308

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


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

 

  • References

  • 1 Hahner S, Loeffler M, Bleicken B. et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: The need for new prevention strategies. Eur J Endocrinol 2010; 162: 597-602
    CrossrefPubMedSearch in Google Scholar
  • 2 Hahner S, Spinnler C, Fassnacht M. et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: A prospective study. J Clin Endocrinol Metab 2015; 100: 407-416
    CrossrefPubMedSearch in Google Scholar
  • 3 White K, Arlt W. Adrenal crisis in treated Addison’s disease: A predictable but under-managed event. Eur J Endocrinol 2010; 162: 115-120
    CrossrefPubMedSearch in Google Scholar
  • 4 Meyer G, Badenhoop K, Linder R. Addison’s disease with polyglandular autoimmunity carries a more than 2·5-fold risk for adrenal crises: German Health insurance data 2010-2013. Clin Endocrinol (Oxf) 2016; 85: 347-353
    CrossrefPubMedSearch in Google Scholar
  • 5 Bergthorsdottir R, Leonsson-Zachrisson M, Odén A. et al. Premature mortality in patients with Addison’s disease: a population-based study. J Clin Endocrinol Metab 2006; 91: 4849-4853
    CrossrefPubMedSearch in Google Scholar
  • 6 Bensing S, Brandt L, Tabaroj F. et al. Increased death risk and altered cancer incidence pattern in patients with isolated or combined autoimmune primary adrenocortical insufficiency. Clin Endocrinol (Oxf) 2008; 69: 697-704
    CrossrefPubMedSearch in Google Scholar
  • 7 Burman P, Mattsson AF, Johannsson G. et al. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality. J Clin Endocrinol Metab 2013; 98: 1466-1475
    CrossrefPubMedSearch in Google Scholar
  • 8 Puar THK, Stikkelbroeck NMML, Smans LCCJ. et al. Adrenal crisis: still a deadly event in the 21st century. Am J Med 2016; 129: 339e1-339e9
    CrossrefPubMedSearch in Google Scholar
  • 9 Falhammar H, Frisén L, Norrby C. et al. Increased mortality in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 2014; 99: E2715-E2721
    CrossrefPubMedSearch in Google Scholar
  • 10 Dahlqvist P, Bensing S, Ekwall O. et al. Nationellt kort vid binjurebarkssvikt. Lakartidningen 2011; 108: 2226-2227
    PubMedSearch in Google Scholar
  • 11 Grossman A, Johannsson G, Quinkler M. et al. Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe. Eur J Endocrinol 2013; 169: R165-R175
    CrossrefPubMedSearch in Google Scholar
  • 12 Quinkler M, Hahner S, Johannsson G. et al. Saving lives of patients with adrenal insufficiency: a pan-European initiative?. Clin Endocrinol (Oxf) 2014; 80: 319-321
    CrossrefPubMedSearch in Google Scholar
  • 13 Burger-Stritt S, Eff A, Quinkler M. et al. Standardised patient education in adrenal insufficiency – a prospective multi-centre evaluation. Eur J Endocrinol 2020; 183: 119-127
    CrossrefPubMedSearch in Google Scholar
  • 14 Hahner S, Hemmelmann N, Quinkler M. et al. Timelines in the management of adrenal crisis – Targets, limits and reality. Clin Endocrinol (Oxf) 2015; 82: 497-502
    CrossrefPubMedSearch in Google Scholar
  • 15 Hsu C-C, Sandford B The Delphi technique: making sense of consensus. Practical assessment, research, and evaluation 2019; Vol. 12: Article 10; Available at: https://scholarworks.umass.edu/pare/vol12/iss1/10
    PubMed
  • 16 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381
    CrossrefPubMedSearch in Google Scholar
  • 17 Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol 2015; 172: R115-R124
    CrossrefPubMedSearch in Google Scholar
  • 18 Bornstein SR, Allolio B, Arlt W. et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101: 364-389
    CrossrefPubMedSearch in Google Scholar
  • 19 Husebye ES, Allolio B, Arlt W. et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med 2014; 275: 104-115
    CrossrefPubMedSearch in Google Scholar
  • 20 Simpson H, Tomlinson J, Wass J. et al. Guidance for the prevention and emergency management of adult patients with adrenal insufficiency. Clin Med 2020; 20: 371-378
    CrossrefPubMedSearch in Google Scholar
  • 21 Burger-Stritt S, Kardonski P, Pulzer A. et al. Management of adrenal emergencies in educated patients with adrenal insufficiency – a prospective study. Clin Endocrinol (Oxf) 2018; 89: 22-29
    CrossrefPubMedSearch in Google Scholar
  • 22 Repping-Wuts HJWJ, Stikkelbroeck NMML, Noordzij A. et al. A glucocorticoid education group meeting: an effective strategy for improving self-management to prevent adrenal crisis. Eur J Endocrinol 2013; 169: 17-22
    CrossrefPubMedSearch in Google Scholar
  • 23 Kienitz T, Hahner S, Burger-Stritt S. et al. Therapeutic patient education for adrenal insufficiency under COVID-19 pandemic conditions. Exp Clin Endocrinol Diabetes 2021; 129: 241-249
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Quinkler M, Beuschlein F, Hahner S. et al. Adrenal cortical insufficiency – A life threatening illness with multiple etiologies. Dtsch Arztebl Int 2013; 110: 882-888
    CrossrefPubMedSearch in Google Scholar
  • 25 Kienitz T, Meyer G. New aspects of glucocorticoid substitution in adrenal insufficiency. Internist 2022; 63: 12-17
    PubMedSearch in Google Scholar