Endocrine problems in the critically ill 2: endocrine emergencies

Key points

• Most endocrine emergencies are triggered by a secondary insult, which should be sought and managed appropriately.
• Clinical features may be non-specific, mimicking other disease processes. Maintain a high index of suspicion.
• Derangement of thyroid/adrenal function is common in the critically ill; correction of these derangements in the absence of underlying adrenal or thyroid disease is not required.
• Confirmation of diagnosis should not delay treatment in suspected acute adrenal insufficiency.
• Vitamin D deficiency is associated with increased all-cause mortality, yet there is no current evidence to support its routine replacement in critical illness.

Endocrine emergencies account for approximately 1.3% of UK critical care admissions. Although relatively uncommon, many of these emergencies are potentially life-threatening. Most endocrine crises are triggered by a secondary insult, commonly infection, and clinical features are often vague and potentially attributable to other causes, such as the precipitating illness. Consequently, the underlying endocrine disorder may easily be overlooked. This article will outline the presentation, investigation, and acute management of adult endocrine emergencies. Diabetic emergencies and glycaemic control in critical illness are discussed in the accompanying article, ‘Endocrine problems in the critically ill 1: diabetes and glycaemic control’.¹

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