Endocrine emergencies Flashcards
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
