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ENDOCRINE EMERGENCIES

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... primary,chronic autoimmune infections: tbc,fungal, hiv metastatic carcinoma adrenomyeloneuropathy isolated gc deficiency causes: ... – PowerPoint PPT presentation

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Title: ENDOCRINE EMERGENCIES


1
ENDOCRINE EMERGENCIES
  • NANDALAL BAGCHI

2
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

3
CLINICAL CLUES PRIMARY
  • HYPERPIGMENTATION
  • HYPERKALEMIA
  • VITILIGO

4
CLINICAL CLUES SECONDARY
  • PALE SKIN WITHOUT MARKED ANEMIA
  • DEFICIENCY OF OTHER PITUITARY HORMONES
  • PAST USE OF GLUCOCORTICOIDS
  • HEADACHE
  • VISUAL SYMPTOMS

5
CAUSES PRIMARY,CHRONIC
  • AUTOIMMUNE
  • INFECTIONS TBC,FUNGAL, HIV
  • METASTATIC CARCINOMA
  • ADRENOMYELONEUROPATHY
  • ISOLATED GC DEFICIENCY

6
CAUSES SECONDARY,CHRONIC
  • TUMORS
  • SURGERY, IRRADIATION
  • LYMPHOCYTIC HYPOPHYSITIS
  • GRANULOMAS
  • CHRONIC GC THERAPY
  • CRH DEFICIENCY

7
CAUSES ACUTE
  • ADRENAL HEMORRHAGE/NECROSIS SEPSIS, BLEEDING
  • POSTPARTUM NECROSIS OF THE PITUITARY
  • PITUITARY APOPLEXY
  • HEAD TRAUMA

8
LABORATORY DIAGNOSIS
  • BASELINE ACTH, CORTISOL
  • COSYNTROPIN TEST
  • MRI PITUITARY SELECTED CASES

9
PRIMARY VS. SECONDARY
  • PROLONGED ACTH STIMULATION
  • RENIN, ALDOSTERONE
  • INSULIN HYPOGLYCEMIA
  • METYRAPONE
  • CRH STIMULATION TEST

10
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

11
CASE
  • 30 YEAR OLD WOMAN
  • ADMITTED WITH PNEUMONIA
  • MILDLY DISORIENTED
  • TEMP. 103, PULSE 150/MIN
  • THYROID ENLARGED
  • TREMOR, BRISK DTR, WARM MOIST SKIN

12
THYROID STORM DIAGNOSIS
  • EVIDENCE OF SEVERE HYPERTHYROIDISM
  • END ORGAN FAILURE CNS,CVS
  • MAJOR STRESSFULL EVENT
  • TFT CONSISTENT WITH OVERT HYPERTHYROIDISM
  • A CLINICAL DIAGNOSIS

13
CAUSES
  • GRAVES DISEASE
  • RARELY
  • TOXIC NODULAR GOITER
  • EXCESSIVE THYROXINE INGESTION
  • OTHER CAUSES

14
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

15
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

16
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

17
DIAGNOSTIC PROBLEMS
  • HYPOTHERMIA HAS MANY CAUSES
  • COMA HAS MANY CAUSES
  • INFECTION IS HARD TO RECOGNIZE

18
PREDISPOSING FACTORS
  • INFECTION
  • DRUGS ANESTHETICS, OTHER CNS DEPRESSANTS
  • HYPOTENSION e.g. GI BLEEDING.
  • CARDIAC CAUSES MI,CHF
  • PROLONGED COLD EXPOSURE

19
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

20
(No Transcript)
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