Endocrine emergencies Flashcards
29 year old male 18 mile race on hottest day of the year, collapsed O/E: GCS 10 Ix: low Na, low plasma osmolality - Cause? - 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
- Diagnosis?
- Management?
- 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?
b) management?
c) investigations?
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
d) Paraganglioma
24 year old woman, sudden headache, neck stiffness, diplopia (CN IV palsy)
- Ix: mass in pituitary fossa
a) Diagnosis?
b) Initial management?
a) PItuitary apoplexy (DD: SAH)
- usually history of pituitary mass or signs of hormone excess/deficiency
b) IV hydrocortisone
58 year old woman, low mood, polydipsia, confusion, constipation
a) Diagnosis?
b) What blood tests should you carry out?
c) Rx?
a) Hypercalcaemia
b) Adjusted calcium and PTH (low in malignancy, high in primary hyperparathyroidism)
c) IV fluids +/- IV bisphosphonates
- Then investigate for cause
