Flashcards in Endocrine emergencies Deck (5)
29 year old male
18 mile race on hottest day of the year, collapsed
O/E: GCS 10
Ix: low Na, low plasma osmolality
- What is the management?
a) Excessive hypotonic fluids
b) Hypertonic saline bolus (3.0% NaCl, 150ml over 20 mins) - rapid fall so rapid correction is permissible (if chronic, risk of central pontine myelinolysis)
20 year old female, taking levothyroxine
O/E: Thin, low BP
Ix: hyponatraemic, low plasma Osm, normal TSH
- Gold standard diagnostic test? (after treatment)
a) Addisonian crisis
b) - IV hydrocortisone (better than dexamethasone as had mineralocorticoid effects at high doses),
- then maintenance IM hydorcortisone (more stable doses than IV)
- Also fluids - 0.9% NaCl
c) SynACTHen test (test for cortisol rise (>500 = normal)
Headaches, anxiety, dizziness, sweating
- O/E: BP 220/130, HR 120
a) diagnosis? - what might preciptate crisis?
d) if extra-adrenal, called..?
a) Phaeo (tachy + HTN = phaeo U.P.O)
- crisis might be preciptated by: beta-blockade, bleeding into tumour, abdominal pressure, exercise, urination, etc.
b) - Alpha blockade (e.g. phenoxybenzamine) to lower BP
- then beta-blockade (if at all)
- Definitive: resect tumour
c) 24-hour plasma and urine metanephrines (breakdown products after adrenaline/noradrenaline), after treating
24 year old woman, sudden headache, neck stiffness, diplopia (CN IV palsy)
- Ix: mass in pituitary fossa
b) Initial management?
a) PItuitary apoplexy (DD: SAH)
- usually history of pituitary mass or signs of hormone excess/deficiency
b) IV hydrocortisone