Endocrine Emergencies

Cover
Half title
Copyright
Full title
Dedication
ACKNOWLEDGMENTS
PREFACE
CONTRIBUTORS
CONTENTS
Part 1 - Thyroid
Chapter 1 - Severe Thyrotoxicosis and Thyroid Storm
	Introduction
	Pathophysiology of Thyrotoxicosis and Thyroid Storm
	Evaluation of Patients for Thyrotoxicosis
		SIGNS AND SYMPTOMS OF THYROID STORM
		CAUSES OF THYROTOXICOSIS AND THYROID STORM
		LABORATORY FINDINGS
		DIAGNOSIS OF THYROID STORM
		TREATMENT OF THYROID STORM
			Supportive Care
			Beta-Blockers
			Antithyroid Drugs
			Iodine
			Lithium
			Steroids
			Adjunct Treatments
		TREATMENT OF COMPENSATED THYROTOXICOSIS
	Socioeconomic Factors
	Follow-up After Discharge
	Conclusions
	References
Chapter 2 - Amiodarone-Induced Thyrotoxicosis
	Introduction
	Pathogenesis and Subtypes
	Diagnostic Evaluation and Classification
		LABORATORY EVALUATION
		RADIOLOGIC INVESTIGATIONS
		SUMMARIZING CLASSIFICATION OF AMIODARONE-INDUCED THYROTOXICOSIS
	Approach to Management
	Adjunct Therapies
	Role of Amiodarone Discontinuation and Resumption
	Role of Thyroidectomy in Management
	Conclusions
	References
Chapter 3 - Ocular Emergencies in Graves’ Ophthalmopathy
	Introduction
	Demographics
	Clinical Evaluation
	External Pathology
		PERIORBITAL EDEMA
		UPPER AND LOWER EYELID RETRACTION
		PROPTOSIS
		SPONTANEOUS SUBLUXATION OF THE GLOBE
		DIPLOPIA
	Anterior Segment Pathology
		CORNEAL KERATOPATHY
		CONJUNCTIVAL INJECTION AND CHEMOSIS
	Posterior Segment Pathology
		RETINAL PATHOLOGY—CHOROIDAL FOLDS
		COMPRESSIVE OPTIC NEUROPATHY
	Conclusion
	References
Chapter 4 - Myxedema Coma
	Introduction
	Pathophysiology
	Clinical Presentation
		MANIFESTATIONS IN THE RESPIRATORY SYSTEM
		CARDIOVASCULAR MANIFESTATIONS
		GASTROINTESTINAL MANIFESTATIONS
		RENAL AND ELECTROLYTE MANIFESTATIONS
		HYPOTHERMIA
		NEUROPSYCHIATRIC MANIFESTATIONS
		HEMATOLOGIC MANIFESTATIONS
	Diagnosis
	Management
		THYROID HORMONE REPLACEMENT
			Routes of Administration
			Doses
			“Thyroid Sick Syndrome”
			Preferred Regimen
		ANTIBIOTIC THERAPY
		VENTILATOR SUPPORT
		HYPONATREMIA
		HYPOTHERMIA
		HYPOTENSION
		CORTICOSTEROIDS
	Myxedema Coma and Surgery
	General Supportive Measures
	Prognosis
	References
Chapter 5 - Acute Suppurative Thyroiditis
	Background
	Bacterial Infection
	Fungal Infection
	Granulomatous Infections
	Laboratory Testing and Diagnostic Imaging for Acute Suppurative Thyroiditis
	Treatment of AST and Recommended Follow-up
	References
Chapter 6 - Thyrotoxic Periodic Paralysis: A Review and Suggestions for Treatment
	Introduction
	Clinical Presentation
	Diagnosis
	Differential Diagnosis
	Pathophysiology
	Genetic Aspects
	Acute Treatment
	Definitive Treatment
	Anesthesia Considerations
	Summary
	References
Part2  - Postoperative Thyroid Surgical Emergencies
Chapter 7 - Recurrent Laryngeal Nerve Paralysis – Management of Recurrent Laryngeal Nerve Injuries
	Introduction
	Intraoperative Management of the RLN With Thyroid Carcinoma Invasion
		SHAVING OFF AND PARTIAL LAYER RESECTION
		RECONSTRUCTION AFTER RESECTION OF A PORTION OF THE RLN
			Background and Mechanism
			Several Surgical Procedures for RLN Reconstruction
	Evaluation of the Outcomes of the RLN Reconstruction
	References
Chapter 8 - Post-Thyroidectomy Emergencies: Management of Tracheal and Esophageal Injuries
	Introduction
	Trachea
		ANATOMY
		INCIDENCE AND RISKS FACTORS
		CLINICAL PRESENTATION
		DIAGNOSIS AND INITIAL TREATMENT
		NONOPERATIVE MANAGEMENT
		OPERATIVE MANAGEMENT
		CONCLUSION
	Esophagus
		ANATOMY
		INCIDENCE AND RISK FACTORS
		CLINICAL PRESENTATION
		DIAGNOSIS AND INITIAL TREATMENT
		NONOPERATIVE MANAGEMENT
		ENDOSCOPIC MANAGEMENT
		OPERATIVE MANAGEMENT
		CONCLUSION
	References
Chapter 9 - Radioactive Iodine (131I) Thyroid Ablation and the Salivary Glands
	Introduction
	Reassessment of 131I Therapy
	Adverse Effects of 131I
		SIALADENITIS
			Case Reports
		HYPOSALIVATION
		TASTE
		SECONDARY PRIMARY SALIVARY GLAND MALIGNANCY
		FACIAL NERVE
	Treatment
	References
Part 3 - Parathyroid
Chapter10 - Hypercalcemic Crisis
	Introduction
	Etiology/Pathophysiology
		PTH-DEPENDENT HYPERCALCEMIA
		PTH-INDEPENDENT HYPERCALCEMIA
	Presentation, Evaluation, and Diagnosis
		PATHOPHYSIOLOGY OF SYMPTOMATIC HYPERCALCEMIA
		MANAGEMENT
	Summary
	References
Chapter11 - Hypocalcemic Crisis: Acute Postoperative and Long-Term Management of Hypocalcemia
	Introduction
	Clinical Presentation
	Physical Examination
	Diagnostic Tests
	Prevention of Postoperative Hypocalcemia
	Prophylactic Postoperative Calcium and Vitamin D Replacement
	Medical Management of Acute and Chronic Postoperative Hypocalcemia
		SUMMARY
	Chronic Management of Hypocalcemia
		GOALS IN THE MANAGEMENT OF Acute and Chronic HYPOPARATHYROIDISM
		CONVENTIONAL MANAGEMENT
			Calcium Supplements
			Vitamin D Supplements
			Cholecalciferol (Vitamin D3) or Ergocalciferol (Vitamin D2)
			Thiazide Diuretics
		NEWER APPROACHES TO THE MANAGEMENT OF CHRONIC HYPOPARATHYROIDISM
			Parathyroid Hormone
			Safety of rhPTH(1-84)
			Indications for the use for rhPTH(1-84)
	References
Part4 - Adrenal Glands
Chapter 12 - Acute Adrenal Hypertensive Emergencies: Pheochromocytoma, Cushing’s, Hyperaldosteronism
	Introduction
	Pheochromocytoma/Paraganglioma (PPGL)
		CLINICAL FEATURES
			Indications for Testing for Pheochromocytoma/Paragangliomas4,5
		DIAGNOSIS
		IMAGING
		GENETIC TESTING
		PREOPERATIVE MEDICAL MANAGEMENT
		ACUTE MEDICAL MANAGEMENT OF PPGL CAUSING HYPERTENSIVE EMERGENCY
		SURGERY
		PATHOLOGY
		FOLLOW-UP
	Primary Aldosteronism
		CLINICAL FEATURES
		DIAGNOSIS
		IMAGING
		ADRENAL VENOUS SAMPLING
		TREATMENT
		ACUTE MEDICAL MANAGEMENT OF HYPERTENSIVE EMERGENCY CAUSED BY PRIMARY HYPERALDOSTERONISM
	Cushing’s Syndrome
		CLINICAL PRESENTATION
		DIAGNOSIS
		TREATMENT
			Surgery
			Radiation Therapy
			Medical Therapy
		ACUTE MEDICAL MANAGEMENT OF HYPERTENSIVE EMERGENCY CAUSED BY HYPERCORTISOLISM
	References
Chapter 13 - Pheochromocytoma: Perioperative and Intraoperative Management
	Incidence, Clinical Significance, and Diagnosis
	Preoperative Management
		CATECHOLAMINES AND ADRENORECEPTORS
		ALPHA ADRENERGIC BLOCKERS
	Anesthetic Preoperative Assessment and Optimization
		ARTERIAL PRESSURE CONTROL
		VOLUME DEPLETION
		HEART RATE AND ARRHYTHMIA CONTROL
		ASSESSMENT OF MYOCARDIAL FUNCTION
		REVERSAL OF ELECTROLYTE AND GLUCOSE DISTURBANCES
	Anesthetic Preparation and Goals for the Operating Room
	Anesthetic Induction and Monitoring
	Anesthetic Maintenance
	Anesthetic Management of Intraoperative Hypertension and Hypotension
	Postoperative Management
	Postoperative Follow-Up
	Conclusion
	References
Chapter 14 - Acute Adrenal Insufficiency
	Introduction
		DEFINITION AND PATHOPHYSIOLOGY
		EPIDEMIOLOGY
	Clinical Presentation
		RECOGNIZING ACUTE ADRENAL INSUFFICIENCY
		PRIMARY ADRENAL INSUFFICIENCY
		SECONDARY ADRENAL INSUFFICIENCY
	Diagnosis
	Management of Acute Adrenal Insufficiency
	Chronic Management of Adrenal Insufficiency and Prevention of Adrenal Crisis
	References 
Part5 - Endocrine Pancreas and Pancreatic Neuroendocrine Tumors
Chapter 15 - Diabetic Emergencies: Ketoacidosis, Hyperglycemic Hyperosmolar State, and Hypoglycemia
	Diabetic Ketoacidosis
		INTRODUCTION
		DEFINITION
			Euglycemic Diabetic Ketoacidosis
		EPIDEMIOLOGY
		PATHOPHYSIOLOGY
			Insulin Deficiency and Counterregulatory Hormones
			Free Fatty Acids in Diabetic Ketoacidosis
			Dehydration
			Pathophysiology of Euglycemic Diabetic Ketoacidosis
		CLINICAL PRESENTATION
			Clinical Findings
			Laboratory Findings
		DIFFERENTIAL DIAGNOSIS
		DIABETIC KETOACIDOSIS PRECIPITANTS
		TREATMENT
			Fluid Replacement
			Electrolyte Replacement
				Potassium
				Phosphate
				Bicarbonate
			Insulin
		RESOLUTION OF DIABETIC KETOACIDOSIS
		COMPLICATIONS OF DIABETIC KETOACIDOSIS
			Hypokalemia and Hypoglycemia
			Cerebral Edema
			Other Complications
		PREVENTION OF DIABETIC KETOACIDOSIS
	Hyperglycemic Hyperosmolar State
		INTRODUCTION
		DEFINITION
		PATHOPHYSIOLOGY
		CLINICAL PRESENTATION
			Clinical Findings
			Laboratory Findings
		TREATMENT
			Fluid Replacement
			Electrolyte Replacement
			Insulin
	Hypoglycemia
		DEFINITION
		CLINICAL PRESENTATION
		DIFFERENTIAL DIAGNOSIS
		EVALUATION
			History
			Laboratory Evaluation
		TREATMENT
			Special Considerations
		PREVENTION
	Conclusion
	References
Chapter 16 - Pancreatic Neuroendocrine Emergencies in the Adult (Gastrinoma, Insulinoma, Glucagonoma, VIPoma, Somatostatin ...
	Overview
	Gastrinoma
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Hemorrhage
			Perforation
			Gastric Outlet Obstruction
			Outcomes
	Insulinoma
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Undifferentiated Hypoglycemia
			Refractory Hypoglycemia With Known Insulinoma
			Outcomes
	Glucagonoma
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Pulmonary Embolism
			Outcomes
	VIPoma
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Outcomes
	Somatostatinoma
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Outcomes
	PPoma/Nonfunctional Neuroendocrine Tumors
		ACUTE/EMERGENT DISEASE: PRESENTATION, MANAGEMENT, AND OUTCOMES
			Outcomes
	References
Part6 - Neuroendocrine Tumors: Gastrointestinal Neuroendocrine Tumors
Chapter 17 - Carcinoid Syndrome and Carcinoid Crisis
	Introduction
	Definition
	Incidence
	Risk Factors
	Current Understanding of Pathophysiology
	Treatment With Somatostatin Analogues (Octreotide)
	Treatment With Vasopressors, Including β-Adrenergic Agonists
	Conclusion
	References
Part7 - Pituitary
Chapter 18 - Postsurgical and Posttraumatic Hyponatremia
	Introduction
	Definition and Classification of Hyponatremia
	Arginine Vasopressin
	General Treatment Considerations for Hyponatremia
	Hyponatremia in the Surgical and TBI Setting: Preoperative Hyponatremia
	Hyponatremia in the Surgical and TBI Setting: Postoperative Hyponatremia
	Neurosurgical Patients
	Traumatic Brain Injury Patients
	Evaluation of Postoperative and Post-TBI Hyponatremia
	Treatment of Postoperative and Post-TBI Hyponatremia
	Summary
	References 
Chapter 19 - Diabetes Insipidus and Acute Hypernatremia
	Introduction
	Physiology of Water and Sodium Homeostasis
	Etiologies of Hypernatremia
	Clinical Presentation of Hypernatremia
	Diagnostic Evaluation
	Management
	Prognosis
	References
Chapter 20 - Hypopituitarism
	Introduction
		EPIDEMIOLOGY
		ETIOLOGIES
		DIAGNOSIS
	Central Adrenal Insufficiency
		INTRODUCTION
		CLINICAL PRESENTATION
		DIAGNOSTIC EVALUATION
		MANAGEMENT
	Central Hypothyroidism
		INTRODUCTION
		CLINICAL PRESENTATION
		DIAGNOSTIC EVALUATION
		MANAGEMENT
	Central Hypogonadism
		INTRODUCTION
		CLINICAL PRESENTATION
		DIAGNOSTIC EVALUATION
		MANAGEMENT
	Growth Hormone Deficiency
		INTRODUCTION
		CLINICAL PRESENTATION
		DIAGNOSTIC EVALUATION
		MANAGEMENT
	Prolactin Deficiency
	Interactions Between Hormones
		GLUCOCORTICOIDS AND THYROID HORMONE
		GLUCOCORTICOIDS AND ESTROGEN
		GLUCOCORTICOIDS AND GROWTH HORMONE
		GLUCOCORTICOIDS AND VASOPRESSIN
		THYROID HORMONE AND GROWTH HORMONE
		THYROID HORMONE AND ESTROGEN
		GROWTH HORMONE AND ESTROGEN
	Special Situations
		PITUITARY SURGERY
		TRAUMATIC BRAIN INJURY
		RADIATION
		APOPLEXY
		IMMUNE CHECKPOINT INHIBITOR TOXICITY
		PREGNANCY
			Diagnosis of Hypopituitarism During Pregnancy
			Treatment of Hypopituitarism During Pregnancy
	References
Chapter 21 - Pituitary Apoplexy
	Introduction
	Epidemiology
		PRESENCE OF PITUITARY ADENOMA
	Pathophysiology
	Precipitating Factors
		VASCULAR FACTORS: BLOOD PRESSURE FLUCTUATIONS AND BLEEDING RISK
		INCREASED DEMAND: PREGNANCY, PITUITARY GLAND TESTING, AND HORMONAL THERAPY
	Clinical Presentation
		HEADACHE AND IMPAIRED CONSCIOUSNESS
		VISUAL DISTURBANCES AND OTHER FOCAL NEUROLOGIC DEFICITS
		ENDOCRINE DYSFUNCTION
	Diagnosis
		CLINICAL ASSESSMENT
		RADIOLOGIC IDENTIFICATION
			Computed Tomography
			Magnetic Resonance Imaging
	Management
		GRADING SYSTEM
		ACUTE MANAGEMENT
		SURGICAL MANAGEMENT
		CONSERVATIVE MEDICAL MANAGEMENT
	Outcomes
		NEURO-OPHTHALMOLOGIC AND NEUROLOGIC SYMPTOMS
		PITUITARY FUNCTION
		ASSESSING OUTCOMES BETWEEN SURGICAL AND MEDICAL MANAGEMENT
		RECURRENCE AND FOLLOW-UP
	Conclusion
	References
Part8 - Endocrine Emergencies During Pregnancy
Chapter 22 - Endocrine Emergencies in Obstetrics
	Thyroid Storm
	Diabetic Ketoacidosis
	Hyperparathyroidism
	References
Chapter 23 - Graves’ Hyperthyroidism in Pregnancy
	Background
	Pathophysiology and Natural History of Graves’ Hyperthyroidism During Pregnancy
	Clinical Presentation of Graves’ Hyperthyroidism in Pregnancy
	Etiology of Hyperthyroidism in Pregnancy
	Laboratory Measurements and Considerations in Pregnancy
		THYROID-STIMULATING HORMONE
		THYROXINE
		TRIODOTHYRONINE (T3)
		THYROID-STIMULATING IMMUNOGLOBLULINS (TSI) AND THYROID-STIMULATING HORMONE RECEPTOR ANTIBODIES (TRAb)
	Management and Treatment Options
	Complications of Graves’ Hyperthyroidism in Pregnancy
		THYROID STORM
		FETAL THYROTOXICOSIS
		FETAL HYPOTHYROIDISM
		NEONATAL HYPERTHYROIDISM
		NEONATAL HYPOTHYROIDISM
	Postpartum Considerations
	Prevention—Preconception Counseling
	Summary
	References
Part9 - Immunotherapy–Associated Endocrinopathies
Chapter 24 - Endocrinopathies Associated With Immune Checkpoint Inhibitors
	Mechanism of Action of Anti-cytotoxic T-Lymphocyte Antigen 4 and Anti-programmed Death 1/or Its Ligand for Cancer Therapy
	Specific Endocrinopathies Associated With Immune Checkpoint Inhibitor Therapy
		HYPOPHYSITIS
		PRIMARY THYROID DYSFUNCTION
		PRIMARY ADRENAL INSUFFICIENCY
		INSULIN-DEPENDENT DIABETES
	Combination Therapy
	Endocrinopathies and Treatment Response
	Diagnosis and Management
		HYPOPHYSITIS
		PRIMARY THYROID DYSFUNCTION
		PRIMARY ADRENAL INSUFFICIENCY
		INSULIN-DEPENDENT DIABETES
		COMBINATION THERAPY
	Conclusions
	References
Part10 - Endocrine Responses in Critically Ill Trauma Patients: Nuclear Emergency
Chapter 25 - Endocrine Responses in Critically Ill and Trauma Patients
	Introduction
	Normal Response to Stress
		SYMPATHETIC NERVOUS SYSTEM
		RENIN–ANGIOTENSIN–ALDOSTERONE SYSTEM
		ARGININE VASOPRESSIN
		GROWTH HORMONE
		HYPOTHALAMIC–PITUITARY–ADRENAL AXIS
			Regulation of the HPA Axis
			Glucocorticoids in Acute Critical Illness
			Glucocorticoids in Chronic Critical Illness
	Inappropriate or Inadequate Response to Stress
		ADRENAL INSUFFICIENCY
		THYROIDAL DISEASE
		GLYCEMIC DYSREGULATION
	Summary
	References
Chapter 26 - Use of Potassium Iodide in a Nuclear Emergency
	Preamble
	How Does Potassium Iodide Protect the Thyroid?
	What Are the Sources of Exposure to Radioactive Iodine?
	What Are the Risks of Exposure to Radioactive Iodine?
	Availability of Potassium Iodide in the United States
	Guidelines for Use
	Safety and Possible Side Effects of Potassium Iodide
	Additional Measures to Protect the Thyroid
	The Aftermath
	References
Index