Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jun;23(3, Neurology of Systemic Disease):778-801.
doi: 10.1212/CON.0000000000000467.

Endocrine Emergencies With Neurologic Manifestations

Makoto Ishii
Review

Endocrine Emergencies With Neurologic Manifestations

Makoto Ishii. Continuum (Minneap Minn). 2017 Jun.

Abstract

Purpose of review: This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities.

Recent findings: To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. A 2015 prospective study in patients with adrenal insufficiency found a significant number of adrenal crisis-related deaths despite all study patients receiving standard care and being educated on crisis prevention strategies, highlighting that current prevention strategies and medical management remain suboptimal.

Summary: Early diagnosis and prompt treatment of endocrine emergencies are essential but remain challenging because of a lack of objective diagnostic tools. The optimal management is also unclear as prospective and randomized studies are lacking. Additional research is needed for these clinical syndromes that can be fatal despite intensive medical intervention.

PubMed Disclaimer

Figures

FIGURE 8-1
FIGURE 8-1
Sagittal postcontrast T1-weighted (A), T1-weighted (B), and T2-weighted (C) MRIs show hemorrhage within a pituitary adenoma with expansion of the sella.
FIGURE 8-2
FIGURE 8-2
Flowchart illustrating assessment using the Pituitary Apoplexy Grading System. GCS = Glasgow Coma Scale; p modifier = prolactinoma; r modifier = hemorrhagic Rathke cleft cyst; s modifier = significant comorbidities. Modified with permission from Jho DH, et al, World Neurosurg. © 2011 Elsevier. worldneurosurgery.org/article/S1878-8750(14)00548-8/abstract.
FIGURE 8-3
FIGURE 8-3
Brain CT (A) and brain MRI (B) of a patient with hemichorea-hemiballismus secondary to a hyperglycemic-hyperosmolar state. CT shows hyperdensity in the left caudate and putamen, which was confirmed by subsequent T1-weighted MRI. Reprinted with permission from Vale TC, et al, Neurology. © 2013 American Academy of Neurology. neurology.org/content/80/16/e178.short.
See this image and copyright information in PMC

References

    1. Briet C, Salenave S, Bonneville JF, et al. Pituitary apoplexy. Endocr Rev 2015;36(6):622–645. doi:10.1210/er.2015-1042. - PubMed
    1. Diri H, Karaca Z, Tanriverdi F, et al. Sheehan’s syndrome: new insights into an old disease. Endocrine 2016;51(1):22–31. doi:10.1007/s12020-015-0726-3. - PubMed
    1. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010;72(3):377–382. doi:10.1111/j.1365-2265.2009.03667.x. - PubMed
    1. Raappana A, Koivukangas J, Ebeling T, Pirila¨ T. Incidence of pituitary adenomas in Northern Finland in 1992-2007. J Clin Endocrinol Metab 2010;95(9):4268–4275. doi:10.1210/jc.2010-0537. - PubMed
    1. Sivakumar W, Chamoun R, Nguyen V, Couldwell WT. Incidental pituitary adenomas. Neurosurg Focus 2011;31(6):E18 doi:10.3171/2011.9.FOCUS11217. - PubMed

MeSH terms