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CORTISOL is an essential stress hormone produced by the adrenal glands and tightly regulated via the hypothalamic-pituitary-adrenal axis. Cortisol deficiency is a rare, but life-threatening condition, requiring immediate diagnosis and treatment. The most common cause of primary adrenal insufficiency (AI) is an autoimmune process [1], but also infections, tissue infiltration, drugs or surgery may lead to insufficient production of glucocorticoids (GC) in the adrenal glands [2]. Secondary and tertiary AI are most often due to a pituitary adenoma or traumatic injury [3].Regardless of the aetiology, patients with cortisol deficiency need an individual substitution treatment plan, which has to be adjusted in stressful situations. Abstract. Patients with adrenal insufficiency (AI) require life-long glucocorticoid (GC) replacement treatment and dose adjustment in stress situations to prevent life-threatening adrenal crises. Herein this study we evaluated the patients' healthcare situation and their knowledge on AI, comparing various aspects to a prior survey in 209 physicians. Using a questionnaire, we conducted a comprehensive survey among 33 AI patients who were treated at the endocrine outpatient clinics of two University Hospitals in Germany. The majority of AI patients (97%) named their treating physician as main source for information. Overall, 89.7% of interviewees were satisfied with their medical treatment; however, about 1/3 reported controversies with healthcare professionals regarding GC replacement in various situation. Two thirds of AI patients increased their substitution dose temporarily within the last 12 months. However, not all patients had an emergency ID, and only 64.5% an emergency kit. None of the interviewed patients identified the need for adjustment in all given situations correctly. Almost 80% of patients did not correctly identify all symptoms of GC over-and under-replacement. Interestingly, we found no significant differences between patients and physicians regarding specific aspects of GC replacement. We showed that: (i) AI patients have some knowledge gaps on modalities and adequacy of GC replacement therapy; (ii) long-term management of patients with AI remains a challenge requiring an experienced specialist; and (iii) further education of physicians as primary source of information is necessary. Additional education may help AI patients to empower them to adequate self-treatment. Self-management in adrenal insufficiency

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