Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 CLINICAL CLUES: SECONDARY • PALE SKIN WITHOUT MARKED • • • • ANEMIA DEFICIENCY OF OTHER PITUITARY HORMONES PAST USE OF GLUCOCORTICOIDS HEADACHE VISUAL SYMPTOMS CAUSES: PRIMARY,CHRONIC • • • • • AUTOIMMUNE INFECTIONS: TBC,FUNGAL, HIV METASTATIC CARCINOMA ADRENOMYELONEUROPATHY ISOLATED GC DEFICIENCY CAUSES: SECONDARY,CHRONIC • • • • • • TUMORS SURGERY, IRRADIATION LYMPHOCYTIC HYPOPHYSITIS GRANULOMAS CHRONIC GC THERAPY CRH DEFICIENCY CAUSES: ACUTE • ADRENAL HEMORRHAGE/NECROSIS [SEPSIS, BLEEDING] • POSTPARTUM NECROSIS OF THE PITUITARY • PITUITARY APOPLEXY • HEAD TRAUMA LABORATORY DIAGNOSIS • BASELINE ACTH, CORTISOL • COSYNTROPIN TEST • MRI PITUITARY[ SELECTED CASES] PRIMARY VS. SECONDARY • • • • • PROLONGED ACTH STIMULATION RENIN, ALDOSTERONE INSULIN HYPOGLYCEMIA METYRAPONE CRH STIMULATION TEST 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 CASE • • • • • • 30 YEAR OLD WOMAN ADMITTED WITH PNEUMONIA MILDLY DISORIENTED TEMP. 103, PULSE 150/MIN THYROID ENLARGED TREMOR, BRISK DTR, WARM MOIST SKIN THYROID STORM: DIAGNOSIS • EVIDENCE OF SEVERE • • • • HYPERTHYROIDISM END ORGAN FAILURE: CNS,CVS MAJOR STRESSFULL EVENT TFT CONSISTENT WITH OVERT HYPERTHYROIDISM A CLINICAL DIAGNOSIS CAUSES • GRAVES” DISEASE • RARELY – TOXIC NODULAR GOITER – EXCESSIVE THYROXINE INGESTION – OTHER CAUSES • 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 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 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 DIAGNOSTIC PROBLEMS • HYPOTHERMIA HAS MANY CAUSES • COMA HAS MANY CAUSES • INFECTION IS HARD TO RECOGNIZE PREDISPOSING FACTORS • INFECTION • DRUGS: ANESTHETICS, OTHER CNS DEPRESSANTS • HYPOTENSION e.g. GI BLEEDING. • CARDIAC CAUSES: MI,CHF • PROLONGED COLD EXPOSURE 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