Thyroid Storm
Definition:
➧ Acute life-threatening exacerbation of thyrotoxicosis
Precipitating factors:
➧ Withdrawal of antithyroid drugs
➧ Severe infection
➧ Diabetic ketoacidosis (DKA)
➧ Cerebro-vascular accident (CVA)
➧ Cardiac failure
➧ Surgery
➧ Trauma
➧ Radioiodine
➧ Drug reaction
➧ Iodinated contrast medium
Clinical picture:
➧ Patient with Graves disease who has discontinued antithyroid medication OR is previously...
Myxedema Coma
Myxedema Coma
Definition:
➧ The end-stage of untreated or insufficiently treated hypothyroidism.
Pathogenesis of Myxedema: (Figure 1)
Figure 1: Pathogenesis of Myxedema Coma
Precipitating factors:
➧ CVA
➧ Myocardial infarction
➧ Infection (UTI, Pneumonia)
➧ Gastrointestinal hemorrhage
➧ Acute trauma
➧ Administration of sedative, narcotic, or potent diuretics
Typical...
Acute Adrenal Insufficiency
Acute Adrenal Insufficiency
Causes:
➧ Usually presents as an acute process in a patient with underlying chronic adrenal insufficiency
➧ Causes of Primary adrenal insufficiency:
- Auto-immune
- TB of adrenals
- Metastatic malignancy to adrenals
➧ Causes of Secondary or Tertiary adrenal insufficiency
- Pituitary or hypothalamic disease
➧ Acute destruction of the adrenals...
Pituitary Apoplexy
Pituitary ApoplexyClinical Setting:
➧ Hemorrhagic infarction of a pituitary adenoma/tumor.
➧ Sudden crisis in a patient with a known or previously unknown pituitary tumor.
➧ It may occur in a normal gland during and after childbirth, with head trauma, or in a patient on anticoagulation therapy.
➧ Sheehan’s Syndrome:
-Refers to pituitary apoplexy of the...
Pheochromocytoma Crisis
Pheochromocytoma Crisis
Causes:
➧ The action of unopposed high circulating levels of catecholamines
- α - receptors: Pressor response
- β - receptors: positive ino- and chrono-topic
Precipitating factors:
➧ Spontaneous
➧ Hemorrhage into pheochromocytoma
➧ Exercise
➧ Pressure on the abdomen
➧ Urination
➧ Drugs: glucagon, naloxone, metoclopramide,...
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