{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:52:54Z","timestamp":1793253174546,"version":"4.5.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T00:00:00Z","timestamp":1575244800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Adrenal patients have a lifelong dependency on steroid replacement therapy and are vulnerable to sudden death from undertreated adrenal crisis. Urgent treatment with parenteral steroids is needed, often with IV saline for volume repletion. Episodes of adrenal crisis are, for most patients, relatively infrequent and they may not be well prepared to respond. This study explores how patients recall previous episodes of adrenal crisis and their satisfaction with UK emergency medical treatment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We invited members of the main UK support groups representing steroid-dependent adrenal patients to complete an online questionnaire identifying the number, causes and location of previous adrenal crises (episodes needing injected steroids and\/or IV fluids). Respondents were asked to rate the adequacy of their medical treatment in 2 successive questionnaires, conducted 2013 and 2017\u201318.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Vomiting was the major factor identified as a cause of adrenal crisis, indicated by 80% of respondents. The most common location, at 70%, was the home. Of the 30% away from home, 1 in 3 were overseas or travelling long-distance. Self-treatment played an increasing role in emergency response: in the 5\u2009year interval between questionnaires an increasing number of patients self-injected. By the time of the 2017\u201318 survey self-injection was the most common method of initial treatment, with less than two-thirds travelling to hospital for follow-up medical treatment. This finding help to explain the higher rate of adrenal crisis identified in patient surveys than in hospital records. Satisfaction with medical care received stayed constant between the 2 surveys despite growing resourcing pressures across the NHS. Two-thirds were happy with the quality of the medical treatment they received for their most recent adrenal emergency; timeliness was the main factor influencing satisfaction.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Around one-third of adrenal patients report sub-optimal treatment at emergency medical departments. Medical staff have a low probability of encountering adrenal crisis and may be unfamiliar with either the urgency of adrenal crisis or the specific treatment response it requires. Comprehensive protocols for emergency medical staff with detailed patient education and training are needed in how to respond to this infrequently encountered \u2013 but acutely life-threatening \u2013 scenario.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12902-019-0459-z","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T05:00:07Z","timestamp":1576472407000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["A retrospective analysis of adrenal crisis in steroid-dependent patients: causes, frequency and outcomes"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2255-3733","authenticated-orcid":false,"given":"Katherine G.","family":"White","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"459_CR1","unstructured":"Hospital Accident and Emergency Activity 2017\u201318, NHS Digital, 2018 https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/hospital-accident%2D%2Demergency-activity\/2017-18."},{"issue":"5","key":"459_CR2","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/EC-16-0054","volume":"5","author":"Wiebke Arlt","year":"2016","unstructured":"Society for Endocrinology Endocrine Emergency Guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients, Endocr Connect, Sept 2016. https:\/\/doi.org\/10.1530\/EC-16-0054","journal-title":"Endocrine Connections"},{"issue":"2","key":"459_CR3","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1530\/EJE-12-1057","volume":"169","author":"S Hahner","year":"2013","unstructured":"Hahner S, Burger-Stritt S, Allolio B. Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency. Eur J Endocrinol. 2013;169(2):147\u201354. https:\/\/doi.org\/10.1530\/EJE-12-1057.","journal-title":"Eur J Endocrinol"},{"issue":"02\/03","key":"459_CR4","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1055\/a-0804-2715","volume":"127","author":"Andreas Barthel","year":"2018","unstructured":"Barthel, A., Benker, G., Berens, K., Diederich, S., Manfras, B., Gruber, M. et al. An update on Addison's disease. In: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association 2019; 127 (2\u201303), S. 165\u2013175. https:\/\/doi.org\/10.1055\/a-0804-2715.","journal-title":"Experimental and Clinical Endocrinology & Diabetes"},{"issue":"3","key":"459_CR5","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.ando.2018.03.002","volume":"79","author":"L Guignat","year":"2018","unstructured":"Guignat L. Therapeutic patient education in adrenal insufficiency. Ann Endocrinol. 2018;79(3):167\u201373. https:\/\/doi.org\/10.1016\/j.ando.2018.03.002.","journal-title":"Ann Endocrinol"},{"issue":"1","key":"459_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ando.2017.12.001","volume":"79","author":"Y Reznik","year":"2018","unstructured":"Reznik Y, Barat P, Bertherat J, Bouvattier C, Castinetti F, Chabre O, et al. SFE\/SFEDP adrenal insufficiency French consensus: introduction and handbook. Ann Endocrinol. 2018;79(1):1\u201322. https:\/\/doi.org\/10.1016\/j.ando.2017.12.001.","journal-title":"Ann Endocrinol"},{"issue":"51\u201352","key":"459_CR7","doi-asserted-by":"publisher","first-page":"882","DOI":"10.3238\/arztebl.2013.0882","volume":"110","author":"M Quinkler","year":"2013","unstructured":"Quinkler M, Beuschlein F, Hahner S, Meyer G, Sch\u00f6fl C, Stalla G. Adrenal Cortical Insufficiency\u2014a Life Threatening Illness With Multiple Etiologies. Dtsch Arztebl Int. 2013;110(51\u201352):882\u20138. https:\/\/doi.org\/10.3238\/arztebl.2013.0882.","journal-title":"Dtsch Arztebl Int"},{"issue":"3","key":"459_CR8","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/cen.13043","volume":"85","author":"G Meyer","year":"2016","unstructured":"Meyer G, Badenhoop K, Linder R. Addison's disease with polyglandular autoimmunity carries a more than 2\u00b75-fold risk for adrenal crises: German health insurance data 2010\u20132013. Clin Endocrinol. 2016;85(3):347\u201353. https:\/\/doi.org\/10.1111\/cen.13043.","journal-title":"Clin Endocrinol"},{"key":"459_CR9","doi-asserted-by":"publisher","unstructured":"Meyer G, Neumann K, Badenhoop K & Linder R, Increasing prevalence of Addison\u2019s disease in Germany: health insurance data 2007\u20132011, Endocr Abstr 2013; 32: 27 https:\/\/doi.org\/10.1530\/endoabs.32.P27, Accessed online 4 April 2019 http:\/\/www.endocrine-abstracts.org\/ea\/0032\/ea0032p27.htm.","DOI":"10.1530\/endoabs.32.P27"},{"issue":"3","key":"459_CR10","doi-asserted-by":"publisher","first-page":"R107","DOI":"10.1530\/EJE-15-1242","volume":"175","author":"S Bensing","year":"2016","unstructured":"Bensing S, Hulting A-L, Husebye E, Kampe O, Lovas K. Epidemiology, quality of life and complications of primary adrenal insufficiency: a review. Eur J Endocrinol. 2016;175(3):R107\u201316. https:\/\/doi.org\/10.1530\/EJE-15-1242.","journal-title":"Eur J Endocrinol"},{"key":"459_CR11","unstructured":"For example, Ahmed A, Shiner R, Meeran K, Assessment of the hypothalamic-pituitary-adrenal axis in patients who have been on long term oral steroids, Endocrine Abstracts 2001;2:96, Accessed online 7 2019 http:\/\/www.endocrine-abstracts.org\/ea\/0002\/ea0002p96.htm"},{"key":"459_CR12","doi-asserted-by":"publisher","unstructured":"Baxter M, Gorick S, Swords F, Recovery of adrenal function in confirmed Addison's disease, Endocr Abstr 2014;34:76, https:\/\/doi.org\/10.1530\/endoabs.34.P76, Accessed online 7 Sept 2019 http:\/\/www.endocrine-abstracts.org\/ea\/0034\/ea0034p76.htm.","DOI":"10.1530\/endoabs.34.P76"},{"issue":"2","key":"459_CR13","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1530\/EJE-08-0550","volume":"160","author":"Martina M Erichsen","year":"2009","unstructured":"Erichsen M, L\u00f8v\u00e5s K, Fougner K, Svartberg J, Hauge E, Bollerslev J et al Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death, Eur J Endocrinol 2009;160:233\u2013237. https:\/\/doi.org\/10.1530\/EJE-08-0550., http:\/\/eje-online.org\/content\/160\/2\/233.long","journal-title":"European Journal of Endocrinology"},{"key":"459_CR14","unstructured":"Kane Gorny inquest: family \u2018devastated\u2019 by number of missed opportunities. The Telegraph, 2012. Accessed online 6 Sept 2019 https:\/\/www.telegraph.co.uk\/news\/health\/news\/9386835\/Kane-Gorny-inquest-doctors-did-not-know-patient-22-who-died-of-thirst-was-there.html."},{"key":"459_CR15","unstructured":"North Shields family\u2019s heartbreak after daughter, 25, dies following stomach bug, Chronicle Live, 2018. Accessed online 7 Sept 2019 https:\/\/www.chroniclelive.co.uk\/news\/north-east-news\/samantha-quantrill-north-shields-tribute-14332485"},{"issue":"3","key":"459_CR16","doi-asserted-by":"publisher","first-page":"339.e1","DOI":"10.1016\/j.amjmed.2015.08.021","volume":"129","author":"TH Puar","year":"2016","unstructured":"Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR. Adrenal crisis: still a deadly event in the 21st century. Am J Med. 2016;129(3):339.e1\u20139.","journal-title":"Am J Med"},{"key":"459_CR17","doi-asserted-by":"publisher","first-page":"R115","DOI":"10.1530\/EJE-14-0824","volume":"172","author":"B Allolio","year":"2015","unstructured":"Allolio B. Extensive expertise in endocrinology: adrenal crisis. Eur J Endocrinol. 2015;172:R115\u201324.","journal-title":"Eur J Endocrinol"},{"key":"459_CR18","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1056\/NEJMra1807486","volume":"381","author":"L Rushworth","year":"2019","unstructured":"Rushworth L, Torpy D, Falhammar H. Adrenal crisis. N Engl J Med. 2019;381:852\u201361.","journal-title":"N Engl J Med"},{"key":"459_CR19","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1016\/S0140-6736(03)13492-7","volume":"61","author":"W Arlt","year":"2003","unstructured":"Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;61:1881\u201393. https:\/\/doi.org\/10.1016\/S0140-6736(03)13492-7.","journal-title":"Lancet"},{"issue":"3","key":"459_CR20","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1530\/EJE-09-0884","volume":"162","author":"S Hahner","year":"2010","unstructured":"Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010;162(3):597\u2013602. https:\/\/doi.org\/10.1530\/EJE-09-0884.","journal-title":"Eur J Endocrinol"},{"key":"459_CR21","unstructured":"Iliopoulou A, Peacey S, Emergency hospital admission rates in patients with adrenal insufficiency, Accessed online 6 Sept 2019 Endocr Abstr 2012;28:P325, http:\/\/www.endocrine-abstracts.org\/ea\/0028\/ea0028p325.htm."},{"key":"459_CR22","unstructured":"ONS, Statistical bulletin: annual mid-year population estimates 2013, Office for National Statistics, 2014; release number MYE7BL1 Accessed online 4 April 2019 http:\/\/www.ons.gov.uk\/ons\/dcp171778_367167.pdf."},{"issue":"5","key":"459_CR23","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.1210\/jc.2012-3561","volume":"98","author":"S Bj\u00f6rnsdottir","year":"2013","unstructured":"Bj\u00f6rnsdottir S, Sundstr\u00f6m A, Ludvigsson JF, Blomqvist P, K\u00e4mpe O, Bensing S. Drug prescription patterns in patients with Addison's disease: a Swedish population-based cohort study. J Clin Endocrinol Metab. 2013;98(5):2009\u201318. https:\/\/doi.org\/10.1210\/jc.2012-3561.","journal-title":"J Clin Endocrinol Metab"},{"issue":"mar26 1","key":"459_CR24","doi-asserted-by":"publisher","first-page":"g2225","DOI":"10.1136\/bmj.g2225","volume":"348","author":"A. Coulter","year":"2014","unstructured":"Coulter A, et al. Collecting data on patient experience is not enough: they must be used to improve care. BMJ. 2014, 2014;348. https:\/\/doi.org\/10.1136\/bmj.g2225.","journal-title":"BMJ"},{"key":"#cr-split#-459_CR25.1","unstructured":"Hospital Accident and Emergency Activity 1 Apr 2017-31 Mar 2018 2017-18"},{"key":"#cr-split#-459_CR25.2","unstructured":"Table 11: A&E Attendances by arrival Method, 2016-17 and 2017-18 (HES), NHS Digital, 13 Sep 2018, Accessed online 13 Jan 2019, https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/hospital-accident%2D%2Demergency-activity\/2017-18."},{"key":"459_CR26","unstructured":"Health and Social Care Information Centre, Accident and Emergency Attendances in England - 2012-13, 28\/1\/2014, ISBN: 978-1-78386-041-8, http:\/\/www.hscic.gov.uk\/catalogue\/PUB13464\/acci-emer-atte-eng-2012-2013-rep.pdf."},{"issue":"1","key":"459_CR27","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/cen.13608","volume":"89","author":"S Burger-Stritt","year":"2018","unstructured":"Burger-Stritt S, Kardonski P, Pulzer A, Meyer G, Quinkler M, Hahner S. Management of adrenal emergencies in educated patients with adrenal insufficiency-a prospective study. Clin Endocrinol. 2018 Jul;89(1):22\u20139. https:\/\/doi.org\/10.1111\/cen.13608.","journal-title":"Clin Endocrinol"},{"issue":"3","key":"459_CR28","doi-asserted-by":"publisher","first-page":"R115","DOI":"10.1530\/EJE-14-0824","volume":"172","author":"B Allolio","year":"2015","unstructured":"Allolio B. Extensive experience in endocrinology: adrenal crisis. Eur J Endocrinol. 2015;172(3):R115\u201324. https:\/\/doi.org\/10.1530\/EJE-14-0824.","journal-title":"Eur J Endocrinol"},{"issue":"1","key":"459_CR29","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1530\/EJE-09-0559","volume":"162","author":"K White","year":"2010","unstructured":"White K, Arlt W. Adrenal crisis in treated Addison's disease: a predictable but under-managed event. Eur J Endocrinol. 2010;162(1):115\u201320. https:\/\/doi.org\/10.1530\/EJE-09-0559.","journal-title":"Eur J Endocrinol"},{"key":"459_CR30","unstructured":"How to give an emergency injection of Hydrocortisone Sodium Phosphate100mg\/ml), Great Ormond Street Hospital for Children, checked online 13 Jan 2019 https:\/\/www.gosh.nhs.uk\/medical-information\/medicines-information\/how-give-emergency-injection-hydrocortisone-hydrocortisone-sodium-phosphate-100mgsml."},{"key":"459_CR31","unstructured":"Steroid information pack, St Georges Healthcare Trust, accessed online 13 Jan 2019, Accessed online 6 Sept 2019, https:\/\/www.stgeorges.nhs.uk\/wp-content\/uploads\/2013\/05\/steroid-information-pack-mobile.pdf."},{"key":"459_CR32","unstructured":"Emergency hydrocortisone: information for patients, Leeds Teaching Hospitals, accessed online 7 Sept 2019, http:\/\/flipbooks.leedsth.nhs.uk\/LN000085.pdf."},{"key":"459_CR33","unstructured":"Intramuscular injections of hydrocortisone for adrenal insufficiency, The Rotherham NHS Foundation Trust, https:\/\/www.therotherhamft.nhs.uk\/Patient_Information\/Patient_Information_Leaflets\/Instructions_for_giving_Intramuscular_injections_of_hydrocortisone_-_Children\/. Accessed online 6 Sept 2019."},{"key":"459_CR34","unstructured":"Addison\u2019s Disease Self Help Group emergency injection video series, https:\/\/www.youtube.com\/user\/addisonsuk Accessed online 7 Sept 2019."},{"key":"459_CR35","unstructured":"Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Supplementary guidelines 2017, now incorporated within 2019 edition and also available as a downloadable App. Class Professional Publishing, see https:\/\/www.classprofessional.co.uk\/?id=-200221. Accessed online 8 Sept 2019."},{"key":"459_CR36","unstructured":"See for example: https:\/\/pituitary.org.uk\/get-involved\/awareness\/archive-of-activities\/campaigns-work-archive\/awareness-month-2015-get-red-flagged\/ Accessed online 6 Sept 2019."},{"issue":"4","key":"459_CR37","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1111\/cen.12609","volume":"82","author":"S Hahner","year":"2015","unstructured":"Hahner S, Hemmelmann N, Quinkler M, Beuschlein F, Spinnler C, Allolio B. Timelines in the management of adrenal crisis - targets, limits and reality. Clin Endocrinol. 2015;82(4):497\u2013502. https:\/\/doi.org\/10.1111\/cen.12609.","journal-title":"Clin Endocrinol"},{"issue":"6","key":"459_CR38","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1111\/cen.12457","volume":"81","author":"AL Mitchell","year":"2014","unstructured":"Mitchell AL, Napier C, Asam M, Siddaramaiah N, Heed A, Morris M, Miller M, Perros P, James RA, Ball SG, Pearce SH, Quinton R. Saving lives of in-patients with adrenal insufficiency: implementation of an alert scheme within the Newcastle-upon-Tyne hospitals e-prescribing platform. Clin Endocrinol. 2014;81(6):937\u20138. https:\/\/doi.org\/10.1111\/cen.12457.","journal-title":"Clin Endocrinol"},{"issue":"6","key":"459_CR39","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1111\/cen.13455","volume":"87","author":"AL Mitchell","year":"2017","unstructured":"Mitchell AL, Devine K, Lal V, Galloway P, Houser M, White K, Watson J, Parry S, Miller M, Morris M, James RA, Perros P, Pearce SHS, Quinton R, Quinton R. Improving the prehospital safety of steroid-dependent patients in northern England: a hospital-initiated ambulance service registration pathway. Clin Endocrinol. 2017;87(6):881\u20132. https:\/\/doi.org\/10.1111\/cen.13455.","journal-title":"Clin Endocrinol"},{"key":"459_CR40","first-page":"P43","volume":"35","author":"M Quinkler","year":"2014","unstructured":"Quinkler M, Ekman B, Fitts D, Marelli C, Murray R, Zelissen. Detection of high rate of intercurrent illnesses and adrenal crisis in patients with adrenal insufficiency by using a patient's diary. Endocr Abstr. 2014;35:P43 http:\/\/www.endocrine-abstracts.org\/ea\/0035\/ea0035p43.htm.","journal-title":"Endocr Abstr"},{"key":"459_CR41","doi-asserted-by":"publisher","unstructured":"Meyer G et al, High risk for adrenal crises in patients with autoimmune Addison\u2019s disease: Health insurance data 2008\u20132012, Endocr Abstr 2014;35:34, https:\/\/doi.org\/10.1530\/endoabs.35.P34, Accessed online 6 Sept 2019, http:\/\/www.endocrine-abstracts.org\/ea\/0032\/ea0032p27.htm.","DOI":"10.1530\/endoabs.35.P34"},{"issue":"2","key":"459_CR42","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1210\/jc.2014-3191","volume":"100","author":"S Hahner","year":"2015","unstructured":"Hahner S, Spinnler C, Fassnacht M, Burger-Stritt S, Lang K, Milovanovic D, Beuschlein F, Willenberg HS, Quinkler M, Allolio B. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab. 2015;100(2):407\u201316. https:\/\/doi.org\/10.1210\/jc.2014-3191.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"459_CR43","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/cen.12865","volume":"84","author":"LCCJ Smans","year":"2016","unstructured":"Smans LCCJ, van der Valk ES, Hermus ARMM, Zelissen PMJ. Incidence of adrenal crisis in patients with adrenal insufficiency. Clin Endocrinol. 2016;84(1):17\u201322. https:\/\/doi.org\/10.1111\/cen.12865.","journal-title":"Clin Endocrinol"},{"issue":"1","key":"459_CR44","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12902-017-0208-0","volume":"17","author":"M Iwasaku","year":"2017","unstructured":"Iwasaku M, Shinzawa M, Tanaka S, Kimachi K, Kawakami K. Clinical characteristics of adrenal crisis in adult population with and without predisposing chronic adrenal insufficiency: a retrospective cohort study. BMC Endocr Disord. 2017;17(1):58. https:\/\/doi.org\/10.1186\/s12902-017-0208-0.","journal-title":"BMC Endocr Disord"},{"key":"459_CR45","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1530\/EJE-16-0803","volume":"176","author":"Y Ono","year":"2017","unstructured":"Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical features and practice patterns of treatment for adrenal crisis: a nationwide cross-sectional study in Japan. Eur J Endocrinol. 2017;176:329\u201337.","journal-title":"Eur J Endocrinol"},{"key":"459_CR46","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/1472-6823-14-79","volume":"14","author":"RL Rushworth","year":"2014","unstructured":"Rushworth RL, Torpy D. A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections. BMC Endocr Disord. 2014;14:79. https:\/\/doi.org\/10.1186\/1472-6823-14-79 http:\/\/www.biomedcentral.com\/1472-6823\/14\/79.","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"459_CR47","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/cen.13609","volume":"89","author":"M Quinkler","year":"2018","unstructured":"Quinkler M, Ekman B, Zhang P, Isidori AM, Murray RD. EU-AIR investigators, mortality data from the European adrenal insufficiency registry\u2014patient characterization and associations. Clin Endocrinol. 2018;89(1):30\u20135. https:\/\/doi.org\/10.1111\/cen.13609.","journal-title":"Clin Endocrinol"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-019-0459-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12902-019-0459-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-019-0459-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T19:33:21Z","timestamp":1606764801000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-019-0459-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["459"],"URL":"https:\/\/doi.org\/10.1186\/s12902-019-0459-z","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"26 April 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The two online questionnaires analysed in this paper did not require institutional ethics approval or formal consent to participate due to their anonymous and discretionary nature.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All survey participants were anonymous and cannot be contacted. Consent for publication not required as publishing the results was explained as a primary purpose for the questionnaire in the introduction and explanatory materials available to participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"129"}}