Agreeing Language in Veterinary Endocrinology (ALIVE): Cushing’s Syndrome and Hypoadrenocorticism—A Modified Delphi-Method-Based System to Create Consensus Definitions

Progress in clinical practice, research, and teaching needs a common language. Agreement among veterinary endocrinologists on definitions of concepts related to Cushing's syndrome (CS) and hypoadrenocorticism is lacking. After a successful inaugural cycle on diabetes mellitus terminology, project Agreeing Language in Veterinary Endocrinology (ALIVE) held a second cycle, with simplified methodology, and brought together 10 experts of the European Society of Veterinary Endocrinology (ESVE) and the Society of Comparative Endocrinology (SCE). It employed a four-round modified Delphi Method to generate draft definitions and try and achieve consensus. A final round used an endorsement survey of the expert-generated definitions distributed to the ESVE and SCE memberships, seeking a simple majority endorsement. A minimum of 20% membership participation was sought. The 10 experts achieved 100% consensus on the definition of 35 adrenal disease-associated concepts, including disease definitions, diagnostic criteria, and test definitions, a disease classification system for CS and hypoadrenocorticism, and a clinical scoring system for CS. Definitions were subsequently assessed by 78 ESVE and SCE members (26% of combined memberships). All definitions achieved a simple majority, ranging from 83.1 to 100%. ALIVE proved effective in creating a body of terminology for adrenal disease in companion animals, which met the overall approval of a majority of those participating in the endorsement phase. The prospective use of these definitions could help improve comparability and standards for adrenal disease research, education, and clinics.