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

Research output: Contribution to journalResearch articleContributedpeer-review


  • Tina Kienitz - , Endocrinology in Charlottenburg (Author)
  • Nicole Bechmann - , Institute of Clinical Chemistry and Laboratory Medicine (Author)
  • Stefanie Hahner - , TUD Dresden University of Technology (Author)
  • Jürgen Honegger - , NAMS - Romodanov Neurosurgery Institute (Author)
  • Matthias Kroiss - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Marcus Quinkler - , Endocrinology in Charlottenburg (Author)
  • Nada Rayes - , University Hospital Leipzig (Author)
  • Nicole Reisch - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Holger Sven Willenberg - , Rostock University Medical Centre (Author)
  • Gesine Meyer - , University Hospital Münster (Author)


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.


Original languageEnglish
Pages (from-to)10-15
JournalHormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme
Publication statusE-pub ahead of print - 10 Aug 2023

External IDs

Scopus 85168393141
ORCID /0000-0002-6932-333X/work/148144954



  • Adrenal Insufficiency/diagnosis, Endocrinology, Germany/epidemiology, Humans, Surveys and Questionnaires