Endocrine Emergencies

Posted by e-Medical PPT Monday, August 29, 2011
Spectrum of Endocrine Emergencies
Myxedema coma
Thyroid storm
Acute adrenal insufficiency
Pituitary apoplexy
Pheochromocytoma crisis
Acute hypercalcemia
Acute hypocalcaemia


Myxedema Coma
End stage of untreated or insufficiently treated hypothyroidism
Typical clinical picture:
Elderly obese female
Becoming increasingly withdrawn, lethargic, sleepy and confused
Slips into a coma
History:
Previous thyroid surgery
Radioiodine
Default thyroid hormone therapy

Precipitating Events
CVI
Myocardial infarction
Infection
UTI
Pneumonia
Gastrointestinal hemorrhage
Acute trauma
Administration of sedative, narcotic or potent diuretics

Thyroid Storm - Acute life threatening exacerbation of thyrotoxicosis
Clinical Setting
Patient with Graves disease who has discontinued antithyroid medication OR is previously undiagnosed
Hyperpyrexia ( >40 0C )
Sweating
Tachycardia with or without AF
Nausea, vomiting and diarrhea
Tremulousness and delirium, occasionally apathetic

Acute Adrenal Insufficiency
Causes of Acute Adrenal insufficiency
Usually presents as an acute process in a patient with underlying chronic adrenal insufficiency
Causes of Primary adrenal insufficiency
 Auto-immune
 TB of adrenals
 Metastatic malignancy to adrenals
Causes of secondary adrenal insufficiency
 Pituitary or hypothalamic disease
Acute destruction of the adrenals can occur with bleeding in the adrenals
 Sepsis
 DIC or
 complication of anticoagulant therapy

Clinical Presentation
Nausea and vomiting
Hyperpyrexia
Abdominal pain
Dehydration
Hypotension and shock

Pituitary Apoplexy
Sudden crisis in a patient with known or previously unknown pituitary tumor
It may occur in a normal gland during and after child birth, or with head trauma, or in patient on anticoagulation therapy

Symptoms and Signs
Severe headache and visual disturbance
Bitemporal hemianopia
N III palsy
Meningeal symptoms with neck stiffness
Symptoms of acute secondary adrenal insufficiency
Nausea vomiting , hypotension and collapse

Acute Hypercalcaemia
Most Common Causes
Endocrine:
 Hyperparathyroidism
 MEN
 PTHrp by solid tumors
Neoplastic:
 Ca with bone metastases
 Myeloma
Granulomatous:
 Sarcoidosis
 Tuberculosis

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