Endocrine emergencies (lecture)

Question 1

29 year old male
very fit, ran
18 mile race with 2200m of ascent in morning v hot day
Regular water throughout race and all afternoon after.
That evening - drowsy at home, confused, urinary incontinent
GCS 10
ix show low Na only

what has happened to him?
what to do?

Answer 1

high ADH secretion caused by intense exercise and excessive hypotonic fluid intake

needs fall correcting as fast as poss

3.% saline 150ml bolus over 20 mins

take home message:
If acute hyponatraemia and neurological symptoms – bolus doses of hypERtonic saline, assess clinical response and re-measure Na+ and re-assess

Question 2

how long do you have to have been on exogenous steroids to be at risk of adrenal insufficiency

Answer 2

pred >+7.5 or equivalent for 3 wk or more

Question 3

treatment of pheochromocytoma

Answer 3

HDU/ITU
alpha blocker - pheyoxybenzamine
then surgery to remove it

Question 4

classic case of pheochromocytoma

Answer 4

young pt
HYPERTENSION AND TACHYCARDIA - phaeo until proven otherwise, especially in young pt

3-4/12 history
Intermittent headaches and anxiety - minutes to hours
Dizzyness
Vomiting
Sweating
Tremor
v high BPs

Question 5

ix phaeochromocytoma

Answer 5

TREAT FIRST, CONFIRM LATER buuuut
24 h urine metanephrines/catecholamines/vanillymandelic acid*
plasma metanephrines
*this goes up if you’ve eaten vanilla ice cream!
locate tumour using CT

Question 6

precipitants of phaeochromocytoma crisis

Answer 6

spontaneous haemorrhage into phaeo
exercise
abdo pressure
urinartion
some drugs

Question 7

what is pituitary apoplexy

Answer 7

infarction/haemorrhage into pituitary

Question 8

presentation of pituitary apoplexy

Answer 8

SAH symptoms (sudden headache, neck stiffness, diplopia/blurred vision, photophobia, N+V)
bitemporal hemianopia

Question 9

treatment for pituitary apoplexy

Answer 9

IV/IM hydrocort as can have adrenal failure

surgery

Question 10

what is a phaeochromocytoma

Answer 10

neuroendocrine tumour derived from chromaffin cells, usually in the adrenal medulla. occasionally may be extra-adrenal
11% are malignant
hypertension and arrhythmia are life-threatening. needs rx ASAP