![Page 1: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/1.jpg)
February 2011
ENDOCRINE EMERGENCIES
A. Tuthill
![Page 2: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/2.jpg)
INTRODUCTION (1)
Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK
Diabetes mellitus is by far the most common endocrine disorder encountered in clinical practice
- Type 2 diabetes affects 5% population
- Type 1 diabetes affects 0.5 – 1% population
![Page 3: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/3.jpg)
INTRODUCTION (2)
The most common endocrine emergencies therefore relate to diabetes and are
1. Hypoglycaemia
2. Diabetic Ketoacidosis
3. Hyperosmolar Hyperglycaemic State
![Page 4: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/4.jpg)
INTRODUCTION (3)
The other emergencies which are life-threatening and frequently overlooked
- Acute adrenal insufficiency
- Pituitary apoplexy
- Phaeochromocytoma hypertensive crisis
- Thyroid storm
- Myxoedema coma
- Hypo / hypercalcaemia
![Page 5: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/5.jpg)
![Page 6: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/6.jpg)
HYPOGLYCAEMIA
In 2004-5 there were approx. 8,000 hospital admissions related to hypoglycaemia
However there can be up to 90,000 ambulance callouts per year for this condition
ALL UNCONSCIOUS PATIENTS SHOULD BE ASSUMED TO BE HYPOGLYCAEMIC UNTIL PROVEN OTHERWISE
![Page 7: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/7.jpg)
HYPOGLYCAEMIA (1)
Causes :
1. Drugs
- insulin/oral hypoglycaemics
- alcohol
- salicylates
- quinine
- beta-blockers, pentamidine, disopyramide
- prescription errors e.g. chlorpropamide for chlorpromazine
![Page 8: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/8.jpg)
HYPOGLYCAEMIA (2)
Causes :2. Tumours
- Insulinoma- Retroperitoneal sarcomas
3. Miscellaneous- Liver dysfunction
- adrenal insufficiency / hypopituitarism - renal failure - myxoedema
![Page 9: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/9.jpg)
HYPOGLYCAEMIA (3)
Presentation :
1. Autonomic (Blood glucose 3.3 – 3.6 mmol/l)
- diaphoresis
- anxiety
- palpitations / tachycardia
- tremor
- warm feeling
![Page 10: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/10.jpg)
HYPOGLYCAEMIA (4)
Presentation :2. Neuroglycopenic (Blood glucose <2.6 mmol/l) - confusion - slurred speech
- visual disturbances - being uncoordinated
- tiredness - focal neurological defects
- coma / seizures (usually with glucose <1.5 mmol/l)
![Page 11: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/11.jpg)
HYPOGLYCAEMIA (5)
Hypoglycaemia unawareness occurs in up to 1/3 patients with type 1 diabetes
Conversely, some patients have hypoglycaemic symptoms when their glucose is above the target range (> 7.0 mmol/l)
Patients post total pancreatectomy have more frequent and severe episodes because they have also lost their glucagon producing cells
![Page 12: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/12.jpg)
HYPOGLYCAEMIA (6)
Diagnosis :
- Blood glucose
- U and E, liver profile
- Insulin and C-peptide levels
- Sulphonylurea screen
- IGF-2
![Page 13: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/13.jpg)
HYPOGLYCAEMIA (7)
Treatment :
- If the patient is conscious, treat orally
- If unconscious, give 50ml 50% dextrose IV
- Glucagon 1mg i.m.
- Infusion of 10% glucose
- Consider thiamine
- Vigilance, Re-education, Support
![Page 14: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/14.jpg)
LOWS
HIGHS
![Page 15: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/15.jpg)
DIABETIC KETOACIDOSIS
DKA is a triad of hyperglycaemia, ketosis and acidaemia
Diagnostic criteria (ADA) :
- Blood glucose > 13.8 mmol/l
- pH < 7.3
- Serum bicarbonate < 18mmol/l,
- Anion gap > 10
- Ketonaemia
![Page 16: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/16.jpg)
DIABETIC KETOACIDOSIS (1)
EURODIAB study reported an incidence of DKA in type 1 diabetes of 8.6%
It is the most common cause of death in young people with diabetes and in those > 65 years of age
Precipitants include infection, MI, trauma, drugs (steroids, cocaine, antipsychotics), non-compliance.
It may also be the presenting feature of type 1 diabetes
![Page 17: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/17.jpg)
DIABETIC KETOACIDOSIS (2)
Pathogenesis :
- insulin deficiency
- increased counter-regulatory hormones (glucagon, catecholamines, cortisol and GH)
This leads to increased glucose production by the liver and decreased utilisation in peripheral tissues. Lipolysis results in ketone body production and acidosis.
![Page 18: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/18.jpg)
DIABETIC KETOACIDOSIS (3)
Clinical Features :
- Polyuria
- Polydipsia
- Weight loss
- Vomiting / abdominal pain
- Dehydration
- Tachypnoea
- Altered mental status
![Page 19: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/19.jpg)
DIABETIC KETOACIDOSIS (4)
Laboratory Findings :
- Hyperglycaemia (> 13.8 mmol/l)
- Hyperosmolality [2x(Na+K) + Urea + Glucose]
- Ketones
- Widened anion gap metabolic acidosis (pH < 7.3)
- Elevated urea and creatinine
- Hyperkalaemia
- Leucocytosis
![Page 20: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/20.jpg)
DIABETIC KETOACIDOSIS (5)
Management :
- FLUIDS
- Fluids
- Fluids
- INSULIN
- POTASSIUM
- ± ICU admission
- Search for precipitant
- Education
![Page 21: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/21.jpg)
![Page 22: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/22.jpg)
HYPEROSMOLAR HYPERGLYCAEMIC STATE
Hyperosmolar hyperglycaemic state (HHS) is caused by deficiency of insulin usually in elderly patients; 2/3 have previously undiagnosed diabetes
Mortality up to 50% Diagnostic criteria:
- Blood glucose > 33.3 mmol/l
- pH > 7.3
- Serum bicarbonate > 15 mmol/l,
- Serum Osmolality > 320mOsm/Kg
![Page 23: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/23.jpg)
HYPEROSMOLAR HYPERGLYCAEMIC STATE
Precipitants :
- Infection
- Myocardial infarction / cerebrovascular accident
- Inadequate insulin treatment / noncompliance
- High sugar intake
- Other endocrine disorders e.g. acromegaly
- Drugs e.g. glucocorticoids, thiazides, loop diuretics, phenytoin
![Page 24: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/24.jpg)
HHS (2)
Clinical Features :
- Similar to DKA but history often several days to weeks
- As the degree of hyperglycaemia and hyperosmolarity progresses neurologic symptoms are more common including lethargy, focal signs, obtundation and coma
- Severe dehydration
![Page 25: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/25.jpg)
HHS (3)
Laboratory Findings :
- Hyperglycaemia
- Hyperosmolarity [2x(Na+K) + Urea + Glucose]
- Hypo or hypernatraemia
- Hyperkalaemia
![Page 26: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/26.jpg)
HHS (4)
Management :
- FLUIDS
- Fluids
- INSULIN
- POTASSIUM
- Anticoagulation
- ± ICU admission
- Search for precipitant
- Education
![Page 27: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/27.jpg)
![Page 28: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/28.jpg)
ACUTE ADRENAL INSUFFICIENCY
Life-threatening emergency Causes :
- Autoimmune
- Adrenal TB / haemorrhage / metastases
- Hypopituitarism
- Drugs e.g. metyrapone, ketoconazole, rifampicin
- Interruption of adrenal replacement therapy
- Adrenoleucodystrophy
![Page 29: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/29.jpg)
ACUTE ADRENAL INSUFFICIENCY(1)
Clinical Features :
- Hypotension (mineralocorticoid deficiency)
- Postural hypotension
- Nausea and vomiting, weight loss, fatigue
- Hypoglycaemia
- Hyperpigmentation
![Page 30: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/30.jpg)
![Page 31: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/31.jpg)
ACUTE ADRENAL INSUFFICIENCY(2)
Laboratory Findings: - Hyponatraemia (90%) / hyperkalaemia (65%) - Elevated Urea
- Hypoglycaemia - Anaemia (normal MCV) - Metabolic acidosis
- Hypocortisolaemia / Failure to respond adequately to synthetic ACTH
- ACTH or - Plasma renin
![Page 32: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/32.jpg)
ACUTE ADRENAL INSUFFICIENCY(3)
Management :
- Intravenous fluids (Saline)
- Steroids
- Dextrose
- Evaluate cause (antibodies, imaging, VLCFA)
- Investigate for other endocrinopathies
- Steroid alert card / bracelet
- Education
![Page 33: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/33.jpg)
![Page 34: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/34.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS
Phaeochromocytomas are catecholamine secreting tumours of the adrenal medulla
< 0.1% Hypertension, but may cause hypertensive emergencies (SBP > 220mmHg or DBP > 120 mmHg)
10% bilateral 10% extra-adrenal 10% malignant 10% familial (Neurofibromatosis, Von Hippel Lindau,
MEN 2, SDHD/SDHB mutations)
![Page 35: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/35.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS(1)
Secretory Products:
- Noradrenaline / normetanephrines
- Adrenaline / metanephrines
- Dopamine
![Page 36: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/36.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS(2)
Clinical Features :
- Hypertension
- Anxiety attacks
- Sweating and heat intolerance
- Flushing / Pallor, palpitations, pounding headaches, pyrexia
- Tachycardia / arrhythmias
![Page 37: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/37.jpg)
![Page 38: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/38.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS(3)
Crisis Precipitants :
- Straining
- Exercise
- Pressure on abdomen
- Surgery
- Drugs
![Page 39: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/39.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS(4)
Laboratory Findings :
- Hyperglycaemia
- Hypokalaemia
Investigations :
- Urinary catecholamines
- Chromogranin A, B
- MRI / MIBG
![Page 40: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/40.jpg)
PHAEOCHROMOCYTOMA / CATECHOLAMINE CRISIS(5)
Management :
- Rehydration
- Alpha blockade (Phentolamine / phenoxybenzamine)
- LATER, Beta blockade
- Surgical resection
- Screening for associated conditions
![Page 41: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/41.jpg)
![Page 42: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/42.jpg)
PITUITARY APOPLEXY
Apoplexy refers to infarction of the pituitary gland due either to haemorrhage or ischaemia
Causes : - Spontaneous haemorrhage - Anticoagulant therapy - Head trauma - Radiation therapy - Drugs (Bromocriptine) - Pituitary function testing
![Page 43: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/43.jpg)
PITUITARY APOPLEXY(1)
Rare 0.6 – 25% cases of treated pituitary adenoma
Clinical Features :
- Headaches
- Nausea, vomiting
- Visual disturbance
- Cranial nerve palsy
- Meningism
![Page 44: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/44.jpg)
PITUITARY APOPLEXY(2)
Diagnosis :
- High degree of suspicion
- Brain imaging
- Hypo / hypernatraemia may occur
- Baseline pituitary function tests
- Visual fields
![Page 45: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/45.jpg)
![Page 46: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/46.jpg)
![Page 47: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/47.jpg)
PITUITARY APOPLEXY(3)
Management :
- Stabilise the patients (A, B, C)
- Hydrocortisone
- Fluid balance
- Early neurosurgical intervention particularly if significant visual involvement
- Reassess pituitary function once acute apoplexy resolved
![Page 48: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/48.jpg)
![Page 49: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/49.jpg)
HYPOCALCAEMIA
Usually the result of failure of PTH secretion or inability to release calcium from bone
Causes : - Hypoparathyroidism (autoimmune, surgical,
radiation, infiltration) - Failure of parathyroid development - Failure of PTH secretion (Magnesium deficiency) - Failure of parathyroid action
(Pseudohypoparathyroidism)
![Page 50: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/50.jpg)
HYPOCALCAEMIA(1)
Causes : (contd.)
- Failure of 1,25 (OH)2D levels (drugs, pancreatitis)
- Failure of calcium release from bone (osteomalacia, renal failure, hungry bone syndrome)
- Complexing of calcium from the circulation (multiple blood transfusion, pancreatitis)
![Page 51: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/51.jpg)
HYPOCALCAEMIA(2)
Clinical Features :
- Tingling and numbness espec. of fingers, toes or lips
- Cramps
- Carpopedal spasm
- Tetanic contractions (may include laryngospasm)
- Seizures
- Hypotension, bradycardia, arrhythmias, CCF
![Page 52: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/52.jpg)
Trousseau’s Sign
![Page 53: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/53.jpg)
![Page 54: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/54.jpg)
HYPOCALCAEMIA(3)
Investigations :
- Plasma calcium, albumin and phosphate
- Magnesium
- U and E’s
- PTH
- ECG
- 25 (OH) Vit D
![Page 55: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/55.jpg)
HYPOCALCAEMIA(4)
Management :
- Patients with tetany or seizures require urgent intravenous treatment with calcium gluconate followed by an infusion for maintenance
- Chronic hypocalcaemia is best managed with oral calcium and vitamin D
![Page 56: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/56.jpg)
HYPERCALCAEMIA
Found in 5% hospital patients but only 0.5% general population
Frequently picked up by routine biochemical screen in an asymptomatic patient
![Page 57: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/57.jpg)
HYPERCALCAEMIA(1)
Causes :
- Hyperparathyroidism
- Malignancy
- Hyperthyroidism
- Sarcoidosis
- Drug related (thiazides, vitamin D, lithium)
- Immobilisation
- Miscellaneous (Benign Familial Hypocalciuric Hypercalcaemia)
![Page 58: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/58.jpg)
HYPERCALCAEMIA(2)
Clinical Features :
- Polyuria, polydipsia, dehydration
- Tiredness, weakness, anorexia, malaise, nausea
- Abdominal pain, constipation
- Confusion, lethargy, depression
- Renal calculi, renal failure
- Sudden cardiac arrest
![Page 59: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/59.jpg)
HYPERCALCAEMIA(3)
Investigations : - Plasma Calcium (corrected for albumin) - Phosphate, Magnesium - U and E’s - LFT’s - PTH - 24 hr urine Calcium - ECG
![Page 60: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/60.jpg)
![Page 61: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/61.jpg)
HYPERCALCAEMIA(4)
Additional Investigations :
- Myeloma screen
- TFT’s
- Short synacthen test
- Renal US
- DEXA
![Page 62: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/62.jpg)
HYPERCALCAEMIA(5)
Management :
- Rehydration (Saline)
- ± Loop diuretic
- IV Bisphosphonate
- Salmon calcitonin
- Steroids
![Page 63: February 2011 ENDOCRINE EMERGENCIES A. Tuthill. INTRODUCTION (1) Endocrine emergencies comprise approx. 1.5% of all hospital admissions in the UK Diabetes](https://reader035.vdocuments.site/reader035/viewer/2022062515/56649d1f5503460f949f39b9/html5/thumbnails/63.jpg)
SUMMARY
Most endocrine emergencies encountered by general physicians relate to hyperglycaemia and hypoglycaemia in diabetes
The remaining endocrine emergencies are very rare
Treatment should never be delayed for a confirmatory test
CONSIDER THE DIAGNOSIS