title: Timelines in the management of adrenal crisis - targets, limits and reality.
abstract: OBJECTIVE
  To evaluate current management timelines in adrenal crisis (AC) and to establish time targets and time limits for emergency treatment.
  
  
  METHODS
  Patients from a prospective study who had reported an AC (n = 46) were contacted and asked about management of their AC. A survey among 24 European endocrinologists collected expert recommendations concerning time targets and time limits for contact-arrival time of emergency health professionals and presentation of emergency card-glucocorticoid (GC) injection time.
  
  
  RESULTS
  Median time targets and time limits regarded by experts as adequate for contact-arrival time were 45 and 90 min, respectively, and for card-injection time 15 and 30 min, respectively. Thirty-seven of 46 patients could be interviewed. All patients were equipped with an emergency card but only 23 (62%) with an emergency kit. Seven patients (19%) were trained in GC self-injection. The median time interval between contacting a health professional and arrival was 20 min (range 2-2880 min); ≤45 min: n = 32 (86%), <90 min: n = 34 (92%). The median time interval between arrival and administration of GC was 30 min (range 2-2400 min); ≤15 min: n = 17 (46%), ≤30 min: n = 20 (54%).
  
  
  CONCLUSIONS
  While the time between contacting health professionals and their arrival was within the limits set by experts, initiation of GC administration was delayed in 46% of patients. Thus, improved management of AC needs to focus on shortening the presentation of card-injection time. Given the current reality in the management of AC, promotion of self-injection of GC (s.c. or i.m.) is warranted.
authors.affiliation: Department of Medicine I, Endocrinology and Diabetology, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Nina
authors.initials: N
authors.lastname: Hemmelmann
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.forename: Christina
authors.initials: C
authors.lastname: Spinnler
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019468:Disease Management; D004704:Endocrinology / Q000592:standards*; D005060:Europe; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care; D013997:Time Factors
chemical_list: D005938:Glucocorticoids