Endocrine emergencies Flashcards
(31 cards)
What is Kallmann’s syndrome?
GnRH deficiency
causes low FSH and LH and Testosterone
What antibodies are positive in Addison’s disease?
21-hydroxylase antibodies
Addison’s signs and symptoms
pigmentation - looks tanned
fatigue
weight loss
postural hypotension (due to additional loss of mineralocorticoid, not enough aldosterone to increase BP)
abdominal pain/diarrhoea
weakness
vitiligo
hypothyroidism
Adrenal crisis symptoms
fever
syncope
convulsions
hypoglycaemia
hyponatraemia
severe vomiting/diarrhoea
Investigation findings in adrenal insufficiency
low sodium
high potassium
high urea
mildly high calcium
mild normocytic anaemia
low glucose
What is Schmidt syndrome?
autoimmune syndrome that commonly has the constellation of 3 diseases:
- diabetes mellitus type 1
- hypothyroidism
- adrenal insufficiency
When would a random cortisol test be done?
if a patient is unstable and you are suspecting adrenal insufficiency
cortisol should raise when the body is under stress (eg. illness), therefore if the cortisol is low even when unstable it shows cortisol deficiency
Adrenal crisis treatment
IV hydrocortisone 100mg
then 50mg 6 hourly IM/200mg IV via infusion pump over 24h
IV normal saline
glucose if required
Long term management of Addison’s disease
hydrocortisone 20mg/day PO in divided doses
fludrocortisone 50-100 mcg/day
steroid card
medical alert bracelet
If a patient needs both cortisol and thyroxine, which should be replaced first?
replace cortisol first then thyroxine later
or risk adrenal crisis
What is pituitary apoplexy?
acute clinical syndrome caused by either haemorrhagic or non-haemorrhagic necrosis of the pituitary gland
How is pituitary apoplexy diagnosed?
MRI
What can cause pituitary apoplexy?
Sheehan’s syndrome
large macroadenoma
Pituitary apoplexy symptoms
headache
vomiting
visual disturbance
meningism
cranial nerve palsy (particularly 3)
decreased LOC
hypopituitarism
Addisonian crisis
SAH
What is thyroid storm?
rare but life threatening exacerbation of thyrotoxicosis
Signs and symptoms of thyroid storm
fever>38
tachycardia>110 +/- AF
cardiac failure
agitation
+/- dehydration, confusion
weight loss
tremor
diarrhoea
heat intolerance
What can precipitate a thyroid storm?
acute infection
thyroid surgery
radioiodine
untreated thyrotoxicosis
Thyroid storm investigations
T4, T3, TSH
Calcium
LFTs
Septic screen: CXR, blood + urine cultures
ECG
Thyroid storm treatment
propranolol - decreases heart rate, blocks effect of thyroid hormones
propylthiouracil - blocks iodine organification and the coupling of iodotyrosines
potassium iodide - at least 60 mins after PTU, prevents further release of pre-formed thyroid hormones
steroids - IV hydrocortisone followed by oral prednisolone - blocks conversion of T4->T3
What is myxoedema coma?
longstanding severe hypothyroidism
Myxoedema coma clinical features
hypothermia
bradycardia +/- hypotension
low output cardiac failure
decreased LOC –> coma
+/- resp depression
slow relaxing reflexes
Myxoedema coma investigation results
T4 low, TSH v high
low sodium, low glucose
ABG - type 2 resp failure due to hypoventilation
Septic screen - CXR, blood + urine cultures
ECG - bradycardia, small complexes, acute ischaemia, J waves in hypothermia
Myxoedema coma treatment
100mg hydrocortisone IM when diagnosis suspected, then 6 hourly
Liothyronine (T3) NG/PO - NOT IV
slow rewarming + cardiac monitoring, 4 hourly BMs + correct hypoglycaemia
continue liothyronine 10mcg 12 hourly, increasing dose (normally 20mcg BD after 3 days)
start levothyroxine (T4) 25mcg (usually after 3-5 days)
Hypercalcaemia symptoms
polyuria
polydipsia
renal stones
anorexia
vomiting
constipation
abdo pain
lethargy
depression
confusion
bone pain
