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Endocrine Emergencies

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Endocrine Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Diabetic Ketoacidosis (DKA)	Polyuria, polydipsia, nausea, vomiting, abdominal pain, and altered mental status. Signs of dehydration, Kussmaul respirations (deep, rapid breathing), and fruity breath odor. Often occurs in patients with type 1 diabetes, but can also occur in type 2 diabetes under stress conditions.	Elevated blood glucose (>250 mg/dL), ketonemia or ketonuria, and anion gap metabolic acidosis (low bicarbonate, pH <7.3). Serum electrolytes showing hyperkalemia (but total body potassium is depleted) and hyponatremia. Blood gas analysis showing metabolic acidosis.	IV fluids (normal saline) for rehydration. IV insulin infusion to reduce blood glucose and stop ketogenesis. Electrolyte replacement, particularly potassium, as insulin therapy may cause hypokalemia. Monitor blood glucose, electrolytes, and acid-base status closely until resolved.
Hyperosmolar Hyperglycemic State (HHS)	Severe hyperglycemia, dehydration, altered mental status, and weakness. Absent or mild ketosis and no significant acidosis. Commonly occurs in elderly patients with type 2 diabetes, often triggered by infection, stroke, or other acute illnesses.	Extremely high blood glucose levels (>600 mg/dL) and high serum osmolality (>320 mOsm/kg). Serum electrolytes showing hypernatremia, and mild or absent ketonemia. Blood gas analysis typically showing normal or near-normal pH.	IV fluids (initially normal saline, then switch to hypotonic saline once stabilized) for rehydration. IV insulin to gradually lower blood glucose. Electrolyte management, particularly potassium and sodium. Monitoring and treatment of underlying precipitating factors (e.g., infection).
Thyroid Storm	Severe hyperthyroidism symptoms: tachycardia, fever, hypertension, agitation, delirium, and gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). May progress to heart failure, shock, and coma if untreated. Often triggered by infection, surgery, trauma, or discontinuation of antithyroid medications in patients with Graves' disease or toxic multinodular goiter.	Elevated free T4 and T3 levels with suppressed TSH. Electrolytes and liver function tests may be abnormal. Clinical diagnosis based on symptoms and history; thyroid function tests confirm the diagnosis.	Beta-blockers (e.g., propranolol) to control tachycardia and reduce peripheral effects of thyroid hormones. Antithyroid drugs (e.g., propylthiouracil, methimazole) to inhibit thyroid hormone synthesis. IV glucocorticoids (e.g., hydrocortisone) to reduce T4 to T3 conversion and manage adrenal insufficiency. Supportive care with IV fluids, cooling measures, and treatment of precipitating factors.
Myxedema Coma	Severe hypothyroidism symptoms: hypothermia, bradycardia, hypotension, altered mental status, and respiratory depression. May present with hyponatremia, hypoglycemia, and pericardial or pleural effusion. Commonly occurs in elderly patients with untreated or poorly controlled hypothyroidism, often precipitated by infection, cold exposure, or medications.	Low free T4 and T3 levels with elevated TSH (primary hypothyroidism). Hyponatremia, hypoglycemia, and elevated serum creatine kinase (CK). Arterial blood gas may show respiratory acidosis or hypoxia.	IV thyroid hormone replacement (e.g., levothyroxine, and sometimes liothyronine). IV glucocorticoids (e.g., hydrocortisone) to treat possible adrenal insufficiency. Supportive care with warming measures, IV fluids, and respiratory support as needed. Treat underlying causes (e.g., infection, discontinuation of thyroid medication).
Adrenal Crisis	Severe hypotension, shock, and hypoglycemia. Nausea, vomiting, abdominal pain, and confusion. History of adrenal insufficiency (e.g., Addison's disease) or long-term steroid use with abrupt cessation.	Hyponatremia, hyperkalemia, hypoglycemia, and elevated BUN/creatinine. Low cortisol levels, often with elevated ACTH if primary adrenal insufficiency. ACTH stimulation test may be performed if diagnosis is uncertain, though treatment should not be delayed.	Immediate IV glucocorticoids (e.g., hydrocortisone) to replace deficient cortisol. IV fluids with dextrose to correct hypotension, dehydration, and hypoglycemia. Electrolyte management, particularly addressing hyperkalemia and hyponatremia. Treat underlying precipitating factors (e.g., infection, stress).
Pheochromocytoma Crisis	Severe hypertension, tachycardia, palpitations, and headache. Diaphoresis, tremors, and anxiety; may progress to hypertensive emergency with end-organ damage. Triggered by surgery, anesthesia, stress, or medications in patients with a known or occult pheochromocytoma.	Elevated plasma free metanephrines or urinary catecholamines. CT or MRI of the abdomen to locate the adrenal tumour. ECG may show arrhythmias or signs of myocardial ischaemia.	Alpha-blockers (e.g., phenoxybenzamine) followed by beta-blockers (e.g., propranolol) to control blood pressure and heart rate. IV fluids to maintain adequate intravascular volume. Surgical resection of the tumour once the patient is stabilized. Avoidance of triggering factors and careful preoperative preparation.
Hypoglycemia	Symptoms of adrenergic response: sweating, tremors, palpitations, anxiety. Neuroglycopenic symptoms: confusion, seizures, altered consciousness, and coma. Commonly seen in patients with diabetes on insulin or oral hypoglycemic agents.	Blood glucose level <70 mg/dL; symptoms typically occur at lower levels. Serum insulin, C-peptide, and sulfonylurea levels may be assessed in recurrent or unexplained cases. Blood gas analysis may show metabolic acidosis in severe cases.	Immediate administration of oral glucose or IV dextrose. Glucagon injection if IV access is not available. Frequent monitoring of blood glucose levels and adjusting the dose of diabetic medications. Identify and address the underlying cause to prevent recurrence.
Hypertensive Crisis due to Hyperaldosteronism	Severe hypertension, headache, muscle weakness, and fatigue. Hypokalemia, leading to muscle cramps, palpitations, and possibly arrhythmias. Common in patients with primary hyperaldosteronism (e.g., Conn's syndrome).	Serum electrolytes showing hypokalemia and hypernatremia. Elevated plasma aldosterone concentration (PAC) with suppressed plasma renin activity (PRA). CT or MRI of the adrenal glands to identify adrenal adenoma or hyperplasia.	Spironolactone or eplerenone to block the effects of aldosterone. Potassium supplementation and dietary sodium restriction. Surgical resection of adrenal adenoma if identified and confirmed as the source. Manage hypertension with appropriate antihypertensive therapy.

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