Talk:Adrenal crisis

Resources

The article can be expanded further by incorporating information from the external links as well as the following resources:

• JSTOR 3522512
• Small, M (1987 May). "Missed Addisonian crisis in surgical wards". Postgraduate medical journal. 63 (739): 367–9. PMC 2428454. PMID 3671270. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Ozcan, F (2005 Nov). "Inverted T waves in patient with Addisonian crisis". Journal of the National Medical Association. 97 (11): 1539–40. PMC 2863907. PMID 16334501. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Martin, C. (14 June 2012). "Perioperative Addison-Krise". Der Anaesthesist. 61 (6): 503–511. doi:10.1007/s00101-012-2033-1. PMID 22695777. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Diptanshu^Talk 12:31, 14 August 2013 (UTC)

NEJM

doi:10.1056/NEJMra1807486 JFW | T@lk 13:00, 29 August 2019 (UTC)

GA Review

This review is transcluded from Talk:Adrenal crisis/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Just-a-can-of-beans (talk · contribs) 00:26, 1 January 2024 (UTC)

Hello, I will review this article. This is a large and important topic, so forgive me if this takes a few days to complete. Just-a-can-of-beans (talk) 00:29, 1 January 2024 (UTC)

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	Article needs some copyediting. I took care of a quick issue I saw, but I think a pass through some outside grammar checking software might be beneficial. More concerning, though, is that there are sections of confusing wordage. These areas are not necessarily inaccurate, but which require a reader to pause and figure out what you are trying to say. Allow me to present an example: "Since cortisol has a 90-minute half-life in the blood, tissues deplete several hours following cortisol deprivation." When I first read this, it didn't make sense to me. I thought, wait, why are they depleting for several hours? Is that a typo? Even now, I am only "pretty sure" I know what you mean - that after the point at which deprivation began, if it were all cut off at once, it takes several hours for tissue effects to manifest due to the half-life of 90 minutes. This meaning, if it is correct, is not clear, and it obscures the message - especially for a lay person who may read this page without any understanding of what a half-life is. Some sections are better than others regarding this confusing language. For example, the mechanism section reads much less smoothly than the Prevention section, which I think is excellent for both medical professionals and for patients who might be looking at this page to figure out the weird word their doctor said. I would request a rewrite (for better readability) of these sections because they are confusing and/or have issues with clear and concise prose: Signs and symptoms Risk factors Mechanism Diagnosis And these sections because they are too technical for a broad audience: Triggers (2nd paragraph) Children (1st para) 01:26, 1 January 2024 (UTC)
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	The lead section is too long. Please cut this down to a "nutshell" per WP:LEAD - it will probably need to be less than 1/2 of its current length. The information is good, so maybe try to redistribute less-crucial things or details to later sections of the page? 01:31, 1 January 2024 (UTC)
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	Excellent work making sure that everything is cited appropriately. And what a reflist. You've sure made my work cut out for me as I begin to verify these.01:36, 1 January 2024 (UTC)
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Some inline citations do not link to sources which directly confirm the information in that line. They are all high-quality sources, and I have not been able to identify anything I know to be inaccurate, but I suspect you may have intermixed knowledge of different sources and/or personal expertise and not remembered exactly which one said something. Regardless, the net result is the same: there are statements which are not supported by sources. In particular, I could not find anything in Coutinho AE, Chapman KE (March 2011) which supported the statements this study was used to cite in the Mechanism section. There was another example (DeVile, C. J.; Stanhope, R. (1997)) which did not directly support the claim about seizures it was used as an inline citation for in the Children section, and I was going to let this one pass because the study authors simply avoided using the term while speaking of grave neurological consequences and hypoglycemia. Because I lack the time to search through all of your extensive inline citations, and I have already found several problems, I will not do that for now. The mismatch between inline citations and statements they are intended to support is a deal-breaker for me on this review, but I will still complete the rest of the template to the best of my ability. Just-a-can-of-beans (talk) 01:58, 1 January 2024 (UTC)
	2c. it contains no original research.	02:16, 1 January 2024 (UTC)
	2d. it contains no copyright violations or plagiarism.	02:16, 1 January 2024 (UTC)
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.	The Causes section could use some more information. You refer to "any of the conditions that can cause adrenal insufficiency" earlier in the page, but the Causes section doesn't actually discuss these. Even a bulleted list would be appropriate here. Otherwise, everything is perfect. 02:16, 1 January 2024 (UTC)
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	I believe the level of detail you have in the article overall is great. However, the lead section could do with less, as mentioned previously 02:16, 1 January 2024 (UTC)
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	Neutrality is great. Encyclopedic tone is mostly consistent, but there are several points where you are overly verbose (this partially goes back to 1a). Neutrality itself, though, is excellent. If I had one nitpick, it would be that your final paragraph and sentence of the Causes section (before Risk Factors) seems unprofessional.02:16, 1 January 2024 (UTC)
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.	02:16, 1 January 2024 (UTC)
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.	01:26, 1 January 2024 (UTC)
	6b. media are relevant to the topic, and have suitable captions.	The saline bag is probably unnecessary, but this is a very minor nitpick. 01:26, 1 January 2024 (UTC)
	7. Overall assessment.	Fail, per aboveJust-a-can-of-beans (talk) 01:58, 1 January 2024 (UTC)

If you wish to act on anything listed in this table before I complete the rest of the review, please add a comment here informing me what you have changed so that I can examine the changes.Just-a-can-of-beans (talk) 01:26, 1 January 2024 (UTC)

Typing this after I've done the reference checks that made me decide to fail the article - I still have sections 2c through 5 to complete, and I will do them now, to hopefully add feedback before you resubmit later Just-a-can-of-beans (talk) 02:02, 1 January 2024 (UTC)

@Just-a-can-of-beans Thank you so much for the review. I had a lot sources open and I most likely confused some of my sources. I'm going to go through and check every source and properly track down where I got that exact info! My writing skills are rough, I often have a hard time making my sentences sound fluid if that makes sense. It's something I'm trying to work on. I will read through it again and try to make things more fluid! I really appreciate how detailed your response was! This review will really help me with my overall writing of Wikipedia pages. I'm going to focus on fixing up what you wrote and then maybe try again for a GA status once I've really dissected this page and made it perfect! Thank you again! CursedWithTheAbilityToDoTheMath (talk) 21:49, 1 January 2024 (UTC)

You're very welcome. And I'm glad you're taking this path, because in terms of information and content, this page is exceptional. Keep up the good work :) Just-a-can-of-beans (talk) 21:51, 1 January 2024 (UTC)

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

This review is transcluded from Talk:Adrenal crisis/GA2. The edit link for this section can be used to add comments to the review.

Nominator: CursedWithTheAbilityToDoTheMath (talk · contribs) 02:41, 28 March 2024 (UTC)

Reviewer: Wolverine XI (talk · contribs) 07:27, 18 August 2024 (UTC)

I'll be reviewing this now. Wolverine XI ^{(talk to me)} 07:27, 18 August 2024 (UTC)

Looking at this diff, I see you have done some extensive work with the sourcing but I don't see any work done on prose. Wolverine XI ^{(talk to me)} 07:32, 18 August 2024 (UTC)

Have you completely rewritten the following sections as the last reviewer suggested: Signs and symptoms, Risk factors, Mechanism, and Diagnosis? If not, then I'll give you a few days to adequately address them. Wolverine XI ^{(talk to me)} 07:35, 18 August 2024 (UTC)

@Wolverine XI Thank you for agreeing to review this article, I know it is a big task! I did a lot of my editing spread out so it's a bit hard to find exact diffs for changes in prose. I could have sworn I had made bigger changes to the mechanism, risk factors, and diagnosis section but it appears I didnt. Maybe I left it in a sandbox somewhere. Either way I apologize for not doing my due diligence and double checking that I had properly fixed those concerns. I have made some edits to those sections and I do feel they have improved however I do really struggle with prose and wording things correctly so please let me know if sections need to be improved further. CursedWithTheAbilityToDoTheMath (talk) 22:35, 18 August 2024 (UTC)

I don't think you addressed the concerns brought up by the last reviewer. I'll generate a list of all the parts that need work in about 10 or more hours. Wolverine XI ^{(talk to me)} 04:03, 19 August 2024 (UTC)

Thank you for taking the time to do this. CursedWithTheAbilityToDoTheMath (talk) 22:37, 19 August 2024 (UTC)

The list is almost done; do expect a full set of comments sometime today. Wolverine XI ^{(talk to me)} 03:55, 20 August 2024 (UTC)

Review

• Adrenal crisis can be the first presentation of patients with adrenal insufficiency, occurring in up to 50% of patients with Addison's disease.

I'm not quite sure why you decided to cite the 1994 source used by the 2016 journal article.

Article says

Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously.

Source says

The diagnosis may be delayed, as most of the symptoms and signs of adrenal insufficiency occur insidiously and are nonspecific

First of, the statement that symptoms are mostly nonspecific is not supported, and second the phrasing here is too-close.

Article says

Those in an adrenal crisis often go into hypotensive shock and may exhibit sensorium alterations.

Source says

Patients presenting with adrenal crisis are often in hypotensive shock, and may have altered sensorium.

Again, too-close.

Article says

They often present with gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain, which can mistakenly be diagnosed as gastroenteritis or acute abdomen.

Source says

They frequently have gastrointestinal symptoms like abdominal pain, nausea, vomiting and diarrhea, leading to an erroneous diagnosis of an acute abdomen or gastroenteritis.

Yet another example.

Article says

Glucocorticoids have a permissive effect on catecholamine action, which leads to hypotension secondary to hypovolemia and hypocortisolism in adrenal insufficiency.

Source says

Hypotension occurs secondary to hypovolemia, but also due to hypocortisolism, as glucocorticoids exert a permissive effect on catecholamine action.

How come you used the same source as the journal article, just like you did in the first one? Furthermore, the phrasing is close; simply altering the sequence does not absolve you of copyright infringements.

Sample

In secondary adrenal insufficiency, hyponatremia results from decreased kidney excretion of electrolyte-free water and the inability to suppress vasopressin.

I don't see where this is supported.

Article says

Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia.

I don't see this in the source provided but I do see it in the 2016 source, which again, suffers from too-close paraphrasing.

Source says

In primary adrenal insufficiency, hyponatremia is due to concomitant aldosterone deficiency, which leads to natriuresis, volume depletion, and hyperkalemia.

Article says

Additional biochemical characteristics include hypercalcemia, which is a result of increased bone resorption and reduced renal excretion of calcium, and rarely hypoglycemia.

Source says

Other biochemical features include hypoglycemia and, rarely, hypercalcemia, which is due to decreased renal excretion of calcium and increased bone resorption.

Once more, you referenced the same 2003 source that this 2016 journal offered, which is, if I may say, still a case of close paraphrase.

I decided to do some spot checks before proceeding to other parts of the review, but what I found was discouraging so this where my review ends. Almost every sentence I examined in the signs and symptoms section had some form of close paraphrasing. Additionally, I would want to point out that you only utilized one 2016 source throughout the entire section; the other sources you listed are only those the journal article itself uses. This seems to be a common theme across the entire article, thus I believe it is a good way off GA and needs to be entirely reworked. I'm not sure if this is a clear-clut quickfail, so I'm pinging Thebiguglyalien to confirm. Wolverine XI ^{(talk to me)} 20:06, 20 August 2024 (UTC)

This article is a bit beyond my area of expertise, but it really comes down to whether it's specific instances or a broad problem. If a large portion of your checks turn up the same issue, and it would require significant reworking of the article to remove the issue, then the review should be closed so the article can be reworked. Of particular concern here is WP:MEDRS, which I'm not terribly familiar with but is essential to avoiding OR in medical articles. Regardless of whether this is closed for close paraphrasing, it might be worth getting input from WP:MEDICINE. Thebiguglyalien (talk) 20:57, 20 August 2024 (UTC)

I wrote the majority of this article awhile ago so how I write has changed quite a bit however for most of this article I would read large review papers, like the 2016 one, and then also read the studies they cited to get further insights. I've stopped using this method as much because it did lead to some problems, mainly that it was easy for me to mess up where I was getting my information from when I had so many open tabs. I do struggle a lot with finding ways to put things into my own words without losing the original meaning. How many different ways can you reword "Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously." without losing the original meaning or making it sound overly fluffy?

I am a bit confused by you saying that the source doesn't back up the claim that symptoms are nonspecefic as i cited the Adrenal Crisis: Still a Deadly Event in the 21st Century article which does support that statement.

As for the statement "Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia." I did cite the 2016 study which backs up this claim.

"Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia." cites "A Case of Severe Hyponatremia in a Patient With Primary Adrenal Insufficiency" your right that it doesn't support my full claim (doesn't support the volume depletion and natriuresis part) and I should have caught this sooner.

The reason I cited the 2003 source for the "Other biochemical features include hypoglycemia and, rarely, hypercalcemia, which is due to decreased renal excretion of calcium and increased bone resorption." is because I was also using that article to get information.

Thank you for taking the time to review this. I'm more than fine with a quick fail if that is what is appropriate here. CursedWithTheAbilityToDoTheMath (talk) 22:25, 20 August 2024 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

GA Review

This review is transcluded from Talk:Adrenal crisis/GA3. The edit link for this section can be used to add comments to the review.

Nominator: IntentionallyDense (talk · contribs) 04:13, 3 September 2024 (UTC)

Reviewer: DoctorWhoFan91 (talk · contribs) 06:36, 30 October 2024 (UTC)

I'll take this one. Expect remarks in a few hours. DoctorWhoFan91 (talk) 06:36, 30 October 2024 (UTC)

I'll go section by section.

Lead

• Remove the technical terms in parenthesis- the lead does not have to be technical

 Done Special:Permalink/1254409381 IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Signs and symptoms

• In an adrenal crisis, hypotension occurs due to hypocortisolism and is secondary to hypovolemia.: What does this mean?  Done

Does this look better? IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Diagnosis

• First para is slightly confusing, and reads kind of like a manual, rephrase.  Done

Does this look better? IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Prevention

• which is a serious cause for concern.: I'm not sure if this is encyclopaedic.  Done

Removed. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• Use different words than "should" for most/all instances; should here and in the article as a whole makes it sound like a manual most of the time  Done

Fixed. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Treatment

• along with suppress antidiuretic hormone: typo?  Done

Changed wording to make clearer. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Outlook

• People with hypoadrenalism are more likely to die from adrenal crises; the death rate from adrenal crises can amount to 6% of crisis events: huh? rephrase  Done

Rephrased, hopefully that is clearer. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Epidemiology

all fine

Special Populations

• Older adults frequently experience falls and fractures, which may be linked to postural hypotension, especially in those who have primary adrenal insufficiency.: rephrase to center primary adrenal insufficiency  Done

I'm not 100% sure what you meant by this but I rephrased it as Older adults, especially those who have primary adrenal insufficiency, frequently experience falls and fractures, which may be linked to postural hypotension. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• Older people ... the same population.: Merge these paragraphs, too small alone  Done

Done. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• Most cases of adrenal insufficiency in pregnancy are identified before conception.: Rephrase, I understand what it means, but in pregnancy and before conception is just jarring  Done

I just removed the "in pregnancy" part as it seems a bit unneeded. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• It has been estimated that 5–10 episodes of adrenal crisis occur for every 100 patient-years in those with adrenal insufficiency: What is this sentence trying to say?  Done

Is this better? IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Mechanism

half-life meaning that: comma between life and meaning

• it effects: "this effects" will be better

 Done both. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

References

They look fine.

Causes

• An absolute or relative lack of cortisol, causes adrenal crises as there is not enough tissue glucocorticoid activity to preserve homeostasis.[10]: Remove, I think this got accidently repeated here

 Done IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• congenital disorders such as: or congential disorders... (also, is everything after this until the period an example?)  Done

Changed wording and yes everything after that is congenital. IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• haemochromatosis have been known: .. have also been known...  Done

Done IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• in rectal, paraspinal, intradermal, intraarticular, injectable, nasal, inhaled, or topical preparations.: I think some of the easier ones(intradermal, intraarticular) can use their common terms and the technical one in brackets  Done

Done IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• insipidus are more likely: are even more likely  Done

Done IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

• for hydrocortisone.: Mention why that would lead to decrease in cortisol  Done

Added since hydrocortisone is being metabolized faster, does that look better? IntentionallyDense (talk) 22:09, 30 October 2024 (UTC)

Good enough

Spot-check

Doing a double check on every 8th ref in general (deeper than my usual, due to the reasons brought up in GA1 and GA2)

• Ref-1: Acute adrenal insufficiency ... Also Known As Addisonian crisis, ... adrenal crisis ...
• Ref-9: predominant clinical features of adrenal crisis include hypotension and hypovolaemia (the whole article really)
• Ref-17: Patients with an adrenal crisis often present with gastrointestinal symptoms, Chronic gastrointestinal symptoms are more prevalent in AI patients compared to controls
• Ref-25: provision of devices, such as a MedicAlert bracelet or necklace ... when patients cannot communicate verbally.
• Ref-33: 200 mg (50–100 mg/m2 for children) of hydrocortisone/24 hours (via continuous iv therapy or 6 hourly injection)
• Ref-41: Both absolute (sBP < 100 mm Hg) and relative (>20 mm Hg lower than usual sBP) are considered indicative of an AC but ... unable to assess relative hypotension ... affected the estimation of hypotension in older patients especially, given the elevation in blood pressure with increasing age.
• Ref-50: The diagnosis of adrenal insufficiency in pregnancy is relatively rare ... diagnosis can be challenging as many of the symptoms overlap with normal symptoms of pregnancy.
• Ref-56: deaths among children in hospital due to an AC were found to be very uncommon

Overall

• It's long, might take some time, but having read GA1 and GA2, should pass easily. DoctorWhoFan91 (talk) 07:58, 30 October 2024 (UTC)
• Some more sections reviewed. Just phrasing issues, more or less. DoctorWhoFan91 (talk) 15:50, 30 October 2024 (UTC)
• Review done, IntentionallyDense. DoctorWhoFan91 (talk) 16:48, 30 October 2024 (UTC)
• I'll pass it later in the day after a second read-through. DoctorWhoFan91 (talk) 07:54, 31 October 2024 (UTC)

  Sounds good, thanks! IntentionallyDense (talk) 15:00, 31 October 2024 (UTC)

• Did the spot check, IntentionallyDense, everything looks great. Well done, a very great article. Congratulations, keep up the good work! DoctorWhoFan91 (talk) 18:09, 31 October 2024 (UTC)

  Thank you! You as well! IntentionallyDense (talk) 18:15, 31 October 2024 (UTC)

GA review (see here for what the criteria are, and here for what they are not)
It is reasonably well written. a (prose, spelling, and grammar): b (MoS for lead, layout, word choice, fiction, and lists): It is factually accurate and verifiable, as shown by a source spot-check. a (references): b (citations to reliable sources): c (OR): d (copyvio and plagiarism): It is broad in its coverage. a (major aspects): b (focused): It follows the neutral point of view policy. Fair representation without bias: It is stable. No edit wars, etc.: It is illustrated by images, where possible and appropriate. a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):
Overall: Pass/Fail:
· · ·

Did you know nomination

The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: promoted by AirshipJungleman29 talk 00:21, 7 December 2024 (UTC)

(

• Comment or view
• Article history

)

Forty-nine year-old with an adrenal crisis.

• ... that the death rate from adrenal crises can amount to 6%? Source: Hahner et al. 2015
  • Reviewed:

Improved to Good Article status by IntentionallyDense (talk). Number of QPQs required: 0. Nominator has fewer than 5 past nominations.

IntentionallyDense (talk) 03:39, 1 November 2024 (UTC).

General: Article is new enough and long enough
New enough: Long enough:

Policy: Article is sourced, neutral, and free of copyright problems
Adequate sourcing: Neutral: Free of copyright violations, plagiarism, and close paraphrasing:

Hook: Hook has been verified by provided inline citation
Cited: Interesting:

Image: Image is freely licensed, used in the article, and clear at 100px.
Freely licensed: Used in article: Clear at 100px:

QPQ: None required.

Overall: New enough and long enough. Image is free and clear, but I personally would recommend against using it due to the size. Earwig raises some flags, but those appear to only be article titles. Good to go!  — Chris Woodrich (talk) 00:46, 30 November 2024 (UTC)

IntentionallyDense what does "can amount to" mean here? ~~ AirshipJungleman29 (talk) 12:07, 5 December 2024 (UTC)

AirshipJungleman29 Can get as high as. Meaning some studies report figures lower than 6%. IntentionallyDense ^(Contribs) 16:49, 5 December 2024 (UTC)