title: Adrenal crises: perspectives and research directions.
abstract: Adrenal crises are life-threatening complications of adrenal insufficiency. These events have an estimated incidence of between 5 and 10  adrenal crises/100 patient years and are responsible for some of the increased morbidity and excess mortality experienced by patients with adrenal insufficiency. Treatment involves urgent administration of IV/IM hydrocortisone and IV fluids. Patient education regarding preventive measures, such as increasing the dose of replacement therapy ("stress dosing") when sick, using parenteral hydrocortisone as necessary and accessing medical assistance promptly, is still considered the best approach to averting the onset of an adrenal crisis at times of physiological stress, most commonly an infection. However, recent evidence has demonstrated that patient education does not prevent many adrenal crisis events and the reasons for this are not fully understood. Furthermore, there is no widely accepted definition of an adrenal crisis. Without a validated adrenal crisis definition it is difficult to interpret variations in the incidence of adrenal crises and determine the effectiveness of preventive measures. This article aims to review the clinical aspects of adrenal crisis events, to explore the epidemiology, and to offer a definition of an adrenal crisis and to offer a perspective on future directions for research into adrenal crisis prevention.
authors.affiliation: School of Medicine, Sydney, The University of Notre Dame, Sydney, NSW, Australia. louise.rushworth@nd.edu.au.
authors.forename: R Louise
authors.identifier: http://orcid.org/0000-0002-6270-747X
authors.initials: RL
authors.lastname: Rushworth
authors.affiliation: Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Torpy
authors.affiliation: Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.|Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Henrik
authors.initials: H
authors.lastname: Falhammar
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D005440:Fluid Therapy; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone
keywords: Adrenal insufficiency; Incidence; Morbidity; Mortality; Risk factors