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Cited by 45Adrenal Hormones and DisordersStress Responses and CortisolThyroid Disorders and Treatments

Management of adrenal emergencies in educated patients with adrenal insufficiency—A prospective study

Burger‐Stritt, Stephanie, Kardonski, Pavel, Pulzer, Alina, Meyer, Gesine, Quinkler, Marcus, Hahner, Stefanie·2018·Clinical Endocrinology
DOI 10.1111/cen.13608
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Abstract

Summary: Objective: To evaluate the management of adrenal emergencies ( AE ) requiring parenteral glucocorticoid ( GC ) treatment in patients with chronic adrenal insufficiency ( AI ). Design: Prospective, multicentre, questionnaire‐based study. Patients and measurements: Participating patients (n = 150) with chronic AI were provided with a questionnaire on the management of emergency situations, which had to be completed and sent back in case of an AE . In addition, patients were contacted by phone on a regular basis. Results: Fifty‐nine AE in 39 patients were documented. The time interval from contact to arrival of a medical professional was 20 minutes (1‐240). In total, in 43 AE , patients received parenteral GC by a medical professional. The time interval between showing the emergency card and GC injection by a medical professional was 60 minutes (5‐360). A total of 26 patients administered GC by self‐injection. The time from the beginning of symptoms to GC injection was significantly shorter in case of self‐injection (self‐injection vs injection by medical professional; 85 minutes [20‐280] vs 232.5 minutes [1‐3135]; P < .001). After self‐injection, 62% of the patients were treated outpatient, compared to 27% of the patients after exclusive injection by a medical professional ( P = .008). To improve the emergency management, most of the patients (84%) indicated a need for an easier way of self‐injection. Conclusion: While management of AE by both patients and medical professionals still shows high variability, patients profit from the option of self‐injection. Patient care, including education of patients and health‐professionals, as well as the way of GC administration, needs further optimization.

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  • Primary adrenal insufficiency patients are often at a higher risk of adrenal crisis compared with patients with secondary adrenal insufficiency and may develop more severe adrenal crisis.

    “As PAI patients are also deficient in mineralocorticoids, which are key regulators of blood pressure and electrolyte balance, PAI patients are often at a higher risk of adrenal crisis compared with patients with SAI and may develop more severe adrenal crisis.32”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [32]

  • In a recent prospective study of patients with chronic AI who presented to the emergency room, 62% of those who self-injected glucocorticoid were treated in the outpatient setting, compared with 27% of the patients who received parenteral glucocorticoid from a medical professional (p = 0.008).

    “In a recent prospective study of patients with chronic AI who presented to the emergency room, 62% of those who self-injected glucocorticoid were treated in the outpatient setting, compared with 27% of the patients who received parenteral glucocorticoid from a medical professional (p = 0.008)”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [32]

  • In the same study, 84% of patients indicated a need for an easier method of self-injection.

    “However, 84% of the patients in this study did indicate a need for an easier method of self-injection.32”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [32]

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Authors
Burger‐Stritt, S., Kardonski, P., Pulzer, A., Meyer, G., Quinkler, M., & Hahner, S.
Affiliations
  • Universitätsklinikum Würzburg (DE)
  • University Hospital Frankfurt (DE)
  • Endocrinology in Charlottenburg Berlin Germany
Corresponding author
Hahner, Stefanie
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2018-04-24
Volume
89
Issue
1
Pages
22-29
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.13608
OpenAlex
W2796384467
Cited by
44
References
21
Citations by year
2026: 5 · 2025: 7 · 2024: 2 · 2023: 6 · 2022: 3 · 2021: 7 · 2020: 8 · 2019: 6
FWCI
4.18
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Deutsche Forschungsgemeinschaft (DFG) (within the CRC/Transregio 205/1 “The Adrenal: Central Relay in Health and Disease”)
  • IZKF Wuerzburg (Z-2/62)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords
chronic adrenal insufficiency, self-injection, emergency management, patient education, time to treatment, outpatient care
MeSH terms
Adrenal Insufficiency, Adult, Aged, Aged, 80 and over, Female, Glucocorticoids, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Multicenter Studies as Topic, Young Adult

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