{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:57:29Z","timestamp":1791305849810,"version":"4.3.1"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","award":["335063"],"award-info":[{"award-number":["335063"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adrenal crisis is a life\u2010threatening emergency. Despite preventive strategies, previous reports suggest increasing incidence and substantial mortality, but robust validated data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess temporal trends in adrenal crisis incidence and identify associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied 1040 patients with autoimmune or idiopathic primary adrenal insufficiency enrolled in the Norwegian Addison Registry. Medical records were reviewed for crisis\u2010related hospitalizations between 2000 and 2023. Overt adrenal crisis was defined by acute clinical deterioration with hemodynamic or biochemical abnormalities, whereas incipient crisis was defined by typical symptoms without objective abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow\u2010up of 15 years, 660 patients (63%) experienced crisis\u2010related hospitalizations, and 265 (25%) had an overt adrenal crisis after diagnosis. The incidence of overt crises was 3.2 per 100 person\u2010years and that of incipient crises was 6.9 per 100 person\u2010years. Admission rates for incipient crises increased significantly over time (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), whereas overt crisis rates remained stable. Among 1754 admissions, five deaths (0.3%) were attributed to adrenal crisis. Both younger and older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and type 1 diabetes (incidence rate ratio 2.09, 95% confidence interval 1.45\u20133.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) were associated with increased overt crisis risk. Daily corticosteroid dose was not associated with crisis risk. Prehospital stress dosing was used in about 50% of admissions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overt adrenal crisis was uncommon and crisis\u2010related in\u2010hospital mortality was exceptionally low. Crisis risk was independent of replacement dose but increased in patients with type 1 diabetes. Strengthening education and implementation of prehospital stress dosing may further reduce the burden of adrenal crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joim.70153","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T06:01:42Z","timestamp":1787205702000},"page":"675-688","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk and outcomes of adrenal crisis in primary adrenal insufficiency: Evidence from a 24\u2010year nationwide cohort study"],"prefix":"10.1111","volume":"300","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4496-615X","authenticated-orcid":false,"given":"Ann\u2010Elin Meling","family":"Stokland","sequence":"first","affiliation":[{"name":"Department of Endocrinology Stavanger University Hospital  Stavanger Norway"},{"name":"Department of Clinical Science University of Bergen  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2889-7342","authenticated-orcid":false,"given":"Lars","family":"Breivik","sequence":"additional","affiliation":[{"name":"Department of Clinical Science University of Bergen  Bergen Norway"},{"name":"Department of Medicine Haukeland University Hospital  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8160-3211","authenticated-orcid":false,"given":"Ingvild","family":"Dalen","sequence":"additional","affiliation":[{"name":"Department of Research Stavanger University Hospital  Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9726-7582","authenticated-orcid":false,"given":"Sandra Dis","family":"Steintorsdottir","sequence":"additional","affiliation":[{"name":"Department of Clinical Science University of Bergen  Bergen Norway"},{"name":"Department of Medicine Haukeland University Hospital  Bergen Norway"},{"name":"Department of Endocrinology, Morbid Obesity and Preventive Medicine Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Kildal","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine University Hospital of North Norway  Troms\u00f8 Norway"},{"name":"UiT The Arctic University of Norway Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Nermoen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Akershus University Hospital, Nordbyhagen  L\u00f8renskog Norway"},{"name":"Institute of Clinical Medicine Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Akershus University Hospital, Nordbyhagen  L\u00f8renskog 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