12.16 Endocrine Emergencies

Question 1

Diabetic Ketoacidosis
General
Pathophysiology
Affected when insuf insulin
Symptoms

Answer 1

General
- No insulin – no glucose inside cell
- Insulin suppresses gluconeogenesis and lipolysis under normal physiological circumstances
- Prevents increase in glucose (due to gluconeogenesis)
- Perceived as intracellular starvation – gluconeogenesis not suppressed
- Ketone bodies
- metabolic acidosis

Pathophysiology
- Cells deprived of glucose despite high glucose in the blood – perceived as “hypoglycemia” or starvation
- Attempts to generate energy intracellularly

Affected when insufficient insulin:
- muscle (amino acid)
- fat cell (glycerol; fatty acid)
- liver

Symptoms:
- Dehydration ——> Dry tongue, loss of skin turgor, tachycardia and hypotension
- Hyperglycaemia ——> Polyuria, polydipsia, fatigue, headache, abdominal pain (impaired gastrointestinal motility)
- Ketoacidosis ——> Deep breathing (Kussmaul’s sign), sweet smell of mouth breath (acetone)

Question 2

Hypoglycemia
General
Whipple’s triad ]
Symptoms

Answer 2

• Diabetic (<4mmol/l)
• Non-diabetic (Whipple’s traid)

Whipple’s triad
- Low plasma glucose (<3.5mmol/l)
- symptoms attributed to hypoglycemia compatible with the physiological responses associated with ⬇️ blood glucose
- symptoms resolve by normalising glucose

Symptoms
Autonomic response (tends to occur with blood glucose below 65mg/dL)
- Sweating
- Weakness
- Tachycardia
- Palpitations
- Tremor
- Nervousness
- Hunger
- Paresthesias
Neuroglycopenia
- Irritability
- Confusion
- Uncharacteristic behavior
- Seizure
- Occasionally, transient neurologic deficits
- Loss of consciousness
- Visual disturbance

Question 3

Causes of Hypocalcemia associated with PTH

Answer 3

Low PTH
- Acquired hypoparathyroidism (surgery or autoimmune)
- Hereditary hypoparathyroidism
- Hypomagnesemia (people using diruretics)
- Abnormal parathyroid gland development (DiGeorge svndrome)

High PTH
- Vitamin D deficiency (decreased intake or malabsorption)
- Vitamin D-dependent rickets
- Chronic kidney disease
- Sepsis
- Hyperphosphatemia (tumor lysis syndrome or acute kidney injury)

Question 4

Hungry bone syndrome

Answer 4

• Calcium removed from bone with high PTH - hypercalcemia
• Problem (PTH) removed (e.g parathyroidectomy) – bone “sucks” Ca and P
• Parathyroid surgically removed = hungry bone syndrome after

Question 5

Hypercalcemia
Symptoms

Answer 5

• Painfull bones
• Renal stones
• Abdominal groans
• Sitting on the throne (toilet) –constipation and polyuria
• Psychiatric overtones

Question 6

Pituitary apoplexy classic traid

Answer 6

• headache
• vomiting
• visual impairment