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ENDOCRINE EMERGENCIES

ENDOCRINE EMERGENCIES. NANDALAL BAGCHI. CASE 1. 40 YEAR OLD WOMAN ONE DAY AFTER GALL BLADDER SURGERY NAUSEA , VOMITING EXTREME WEAKNESS HYPOTENSION, POOR RESPONSE TO FLUIDS AND PRESSORS SERUM K-5.5, Na-120. CLINICAL CLUES: PRIMARY. HYPERPIGMENTATION HYPERKALEMIA VITILIGO.

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ENDOCRINE EMERGENCIES

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  1. ENDOCRINE EMERGENCIES NANDALAL BAGCHI

  2. CASE 1 • 40 YEAR OLD WOMAN • ONE DAY AFTER GALL BLADDER SURGERY • NAUSEA , VOMITING • EXTREME WEAKNESS • HYPOTENSION, POOR RESPONSE TO FLUIDS AND PRESSORS • SERUM K-5.5, Na-120

  3. CLINICAL CLUES: PRIMARY • HYPERPIGMENTATION • HYPERKALEMIA • VITILIGO

  4. CLINICAL CLUES: SECONDARY • PALE SKIN WITHOUT MARKED ANEMIA • DEFICIENCY OF OTHER PITUITARY HORMONES • PAST USE OF GLUCOCORTICOIDS • HEADACHE • VISUAL SYMPTOMS

  5. CAUSES: PRIMARY,CHRONIC • AUTOIMMUNE • INFECTIONS: TBC,FUNGAL, HIV • METASTATIC CARCINOMA • ADRENOMYELONEUROPATHY • ISOLATED GC DEFICIENCY

  6. CAUSES: SECONDARY,CHRONIC • TUMORS • SURGERY, IRRADIATION • LYMPHOCYTIC HYPOPHYSITIS • GRANULOMAS • CHRONIC GC THERAPY • CRH DEFICIENCY

  7. CAUSES: ACUTE • ADRENAL HEMORRHAGE/NECROSIS [SEPSIS, BLEEDING] • POSTPARTUM NECROSIS OF THE PITUITARY • PITUITARY APOPLEXY • HEAD TRAUMA

  8. LABORATORY DIAGNOSIS • BASELINE ACTH, CORTISOL • COSYNTROPIN TEST • MRI PITUITARY[ SELECTED CASES]

  9. PRIMARY VS. SECONDARY • PROLONGED ACTH STIMULATION • RENIN, ALDOSTERONE • INSULIN HYPOGLYCEMIA • METYRAPONE • CRH STIMULATION TEST

  10. TREATMENT • HYDROCORTISONE IV 100MG FOLLOWED BY 100-200MG OVER NEXT 24H • GLUCOSE SALINE 2-3L • MONITOR ELECTROLYTES • ORAL THERAPY IN 1-2 DAYS • HYDROCORTISONE • FLUDROCORTISONE

  11. CASE • 30 YEAR OLD WOMAN • ADMITTED WITH PNEUMONIA • MILDLY DISORIENTED • TEMP. 103, PULSE 150/MIN • THYROID ENLARGED • TREMOR, BRISK DTR, WARM MOIST SKIN

  12. THYROID STORM: DIAGNOSIS • EVIDENCE OF SEVERE HYPERTHYROIDISM • END ORGAN FAILURE: CNS,CVS • MAJOR STRESSFULL EVENT • TFT CONSISTENT WITH OVERT HYPERTHYROIDISM • A CLINICAL DIAGNOSIS

  13. CAUSES • GRAVES” DISEASE • RARELY • TOXIC NODULAR GOITER • EXCESSIVE THYROXINE INGESTION • OTHER CAUSES

  14. TREATMENT • BLOCK HORMONE SYNTHESIS • PTU 150MG EVERY 6H • BLOCK HORMONE RELEASE • SSKI 5-10 DROPS EVERY 8H • BLOCK BETA ADRENERGIC SYSTEM • PREDNISONE 30-40 MG OVER 24H • PLASMAPHERESIS, DIALYSIS • FLUIDS, COOLING, NO ASA

  15. CASE • 70 YEAR OLD WOMAN, LIVES ALONE • POORLY RESPONSIVE • VITALS: T 92, P 50/M, R 10/M, BP 90/60 • COOL DRY SKIN,PUFFY EYES • THYROID NOT PALPABLE, NO NECK SCAR • DTR: SLOW RETURN • STOOL: MELENA

  16. MYXEDEMA COMA: DIAGNOSIS • EVIDENCE OF SEVERE HYPOTHYROIDISM • EVIDENCE OF END ORGAN FAILURE • CNS,CVS,RENAL,RESPIRATORY • PREDISPOSING CAUSES • R/O OTHER CAUSES OF HYPOTHERMIA • LABS CONSISTENT WITH SEVERE DISEASE

  17. DIAGNOSTIC PROBLEMS • HYPOTHERMIA HAS MANY CAUSES • COMA HAS MANY CAUSES • INFECTION IS HARD TO RECOGNIZE

  18. PREDISPOSING FACTORS • INFECTION • DRUGS: ANESTHETICS, OTHER CNS DEPRESSANTS • HYPOTENSION e.g. GI BLEEDING. • CARDIAC CAUSES: MI,CHF • PROLONGED COLD EXPOSURE

  19. TREATMENT • SUPPORTIVE • CAREFUL WARMING • SUPPORT BP, RESPIRATION • TREAT UNDERLYING DISEASE • L-THYROXINE IV 250-500 mcg BOLUS, THEN 100 mcgDAILY AFTER 48H OR, • TRIIODOTHYRONINE 12.5 mcg EVERY 8H

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