High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study

Stefanie Hahner, Christina Spinnler, Martin Fassnacht, Stephanie Burger-Stritt, Katharina Lang, Danijela Milovanovic, Felix Beuschlein, Holger S Willenberg, Marcus Quinkler, Bruno Allolio

Research output: Contribution to journalArticlepeer-review

182 Citations (Scopus)


OBJECTIVE: Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI), which according to retrospective data represents a significant clinical complication. Here we aimed to prospectively assess incidence of AC and mortality associated with AC in patients with chronic AI.

METHODS: A total of 423 patients with AI (primary AI, n = 221; secondary AI, n = 202) were prospectively followed up for 2 years. Baseline assessment included a general questionnaire and detailed written instructions on glucocorticoid dose adaptation during stress. Patients received follow-up questionnaires every 6 months and were contacted by phone in case of reported adrenal crisis.

RESULTS: A total of 423 data sets were available for baseline analysis, and 364 patients (86%) completed the whole study. Sixy-four AC in 767.5 patient-years were documented (8.3 crises per 100 patient-years). Precipitating causes were mainly gastrointestinal infection, fever, and emotional stress (20%, respectively) but also other stressful events (eg, major pain, surgery, strenuous physical activity, heat, pregnancy) or unexplained sudden onset of AC (7%) were documented. Patients with a previous AC were at higher risk of crisis (odds ratio 2.85, 95% confidence interval 1.5-5.5, P < .01). However, no further risk factors could be identified. Ten patients died during follow-up; in four cases death was associated with AC (0.5 AC related deaths per 100 patient-years).

CONCLUSION: Even in educated patients with chronic adrenal insufficiency, AC occurs in a substantial proportion of cases. Furthermore, we identified AC-associated mortality in approximately 6% of AC. Our findings further emphasize the need for improved management of AC in patients with chronic AI.

Original languageEnglish
Pages (from-to)407-16
Number of pages10
JournalThe Journal of clinical endocrinology and metabolism
Issue number2
Publication statusPublished - Feb 2015


  • Adrenal Insufficiency
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Glucocorticoids
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prospective Studies
  • Surveys and Questionnaires
  • Young Adult


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