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A Clinician’s Guide

Edited by

Glenn Matfin, BSc (Hons), MSc (Oxon), MB ChB, DGM, FACE, FACP, FRCP

Consultant in Acute and General Medicine, Diabetes and Endocrinology
Honorary Professor of Medicine
National Health Service, UK

Professor of Medicine
MBRU College of Medicine
Dubai Healthcare City
Dubai, UAE

Second Edition

This Work is a co-publication between the Endocrine Society and John Wiley & Sons, Ltd.

This first published 2018
© 2018 John Wiley & Sons Ltd

This Work is a co-publication between the Endocrine Society and John Wiley & Sons, Ltd.

Edition History
Endocrine Society/Endocrine Press (1e, 2014)

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Library of Congress Cataloging-in-Publication Data

Cover images: ©donskarpo / Getty Images-Thyroid level conceptual meter
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Cover design by Wiley

1 2018

Contents

Notes on Contributors

Foreword

Preface

List of Abbreviations

Part I General Aspects of Acute Medical Emergencies

Introduction Acute Medical Care: A Crisis with Solutions
1. Introduction
2. What Is the Impact of the Acute Medical Crisis on Diabetes and Endocrinology Speciality Delivery?
3. Solutions/Opportunities
4. Acknowledgments
5. References
1 Early Management of Acute Medical Emergencies
1. Introduction
2. Recognition of Medical Emergencies
3. The ABCDE Approach
4. Definitive Diagnosis and Treatment
5. Conclusions
6. References

Part II General Endocrine and Metabolic Aspects of Acute and Critical Illness

Introduction Endocrine Testing and Responses in Acute and Critical Illness
1. Acknowledgments
2. References
2 Endocrine Testing in Acute and Critical Illness
1. Introduction
2. Factors Influencing Laboratory Hormone Results or Their Interpretation in Acute Illness
3. Examples of Endocrine System Testing in Acute and Critical Illness
4. Hypothalamic-Pituitary-Thyroid (HPT) Axis
5. The Hypothalamic-Pituitary-Adrenal (HPA) Axis
6. Catecholamines
7. Hypothalamic-Pituitary Gonadal (HPG) Axis
8. Growth Hormone and Insulin-Like Growth Factor-1
9. Vitamin D
10. Conclusions
11. References
3 Endocrine Responses to Critical Illness
1. Introduction
2. Hypothalamic-Pituitary-Thyroid Axis
3. Hypothalamic-Pituitary-Adrenal Axis
4. The Hyperglycemic Response to Critical Illness: To Treat or Not to Treat?
5. Conclusions
6. Acknowledgments
7. References

Part III Special Populations

4 Endocrine and Metabolic Emergencies in Pregnancy
1. Introduction
2. Diabetes Mellitus
3. Pituitary Disease
4. Adrenal Disease
5. Thyroid Disease in Pregnancy
6. Parathyroid Disease in Pregnancy
7. Conclusions
8. References
5 Endocrine and Metabolic Emergencies in Inherited Metabolic Diseases
1. Introduction
2. Rhabdomyolysis
3. Encephalopathy
4. Acute Adrenal Crisis
5. Stroke
6. Cardiac Disease
7. Psychiatric Presentations
8. Pregnancy
9. Conclusions
10. References
6 Endocrine and Metabolic Emergencies in Transitional Care
1. Introduction
2. Type 1 Diabetes Mellitus
3. Hyperglycemic Hyperosmolar State (HHS)
4. Autoimmune Polyglandular Syndromes (APS)
5. Adrenal Insufficiency
6. Endocrine Hypertension
7. Traumatic Brain Injury (TBI)
8. Growth Hormone Deficiency (GHD)
9. Diabetes Insipidus (DI)
10. Hypothyroidism
11. Conclusions
12. References
7 Emergency Perioperative Diabetes and Endocrine Management
1. Introduction
2. Emergency Perioperative Diabetes and/or Hyperglycemia Management
3. Approaches to Management of Perioperative Diabetes and/or Hyperglycemia
4. Emergency Perioperative Endocrine and Metabolic Management
5. Pituitary
6. Thyroid
7. Adrenal Crisis
8. Sodium Level
9. Calcium
10. Neuroendocrine Tumors (NETs)
11. Conclusions
12. References
8 Endocrine and Metabolic Emergencies in HIV/AIDS
1. Introduction
2. Hypoadrenalism
3. Lactic Acidosis and Mitochondrial Toxicity
4. Hyperglycemia
5. Hypertriglyceridemia
6. Thyrotoxicosis
7. Hypercalcemia
8. Conclusions
9. References
9 Endocrine and Metabolic Emergencies in Late-Effects Patients
1. Introduction
2. Organization of Care for Cancer Survivors
3. Adrenal Insufficiency
4. Radiation Affecting the Hypothalamic Pituitary Axis
5. Adrenal Suppression Following Glucocorticoids
6. Immune Checkpoint Inhibitors and Endocrine Dysfunction
7. Thyroid Dysfunction
8. Diabetes Insipidus
9. Metabolic Disorders
10. Other Non-Endocrine Consequences
11. Conclusions
12. References
10 Endocrine and Metabolic Emergencies in Transplantation
1. Introduction
2. Hyperglycemia
3. Hypoglycemia
4. Dyslipidemia
5. Pituitary Disease
6. Adrenal Disease
7. Thyroid Disease
8. Calcium and Phosphate Disorders
9. Hypercalcemia
10. Hypocalcemia
11. Hypophosphatemia
12. Conclusions
13. References
11 Endocrine and Metabolic Changes with Aging: Endocrin-Aging: Recognizing and Managing Care in Older Frail Persons
1. Introduction
2. Pituitary Dysfunction in the Elderly
3. Hypothyroidism
4. Hyperthyroidism
5. Primary Adrenal Insufficiency (Addison's Disease)
6. Type 2 Diabetes Mellitus
7. Hyperglycemic Crisis
8. Hypoglycemia
9. Hypercalcemia
10. Sarcopenia and Hormones
11. Conclusions
12. References

Part IV Pituitary Disorders

Introduction Emergency Management of Pituitary Disorders
1. Conclusions
2. References
12 Hypopituitarism
1. Introduction
2. Etiology
3. Pathophysiology
4. Clinical Features and Findings
5. Conclusions
6. References
13 Pituitary Apoplexy
1. Introduction
2. Predisposing and Precipitating Factors
3. Pathophysiology
4. Clinical Presentation
5. Endocrine Dysfunction
6. Diagnostic Evaluation
7. Management of Pituitary Apoplexy
8. Conclusions
9. References
14 Macroprolactinomas
1. Introduction
2. Visual Field Defect at Presentation
3. Cerebrospinal Fluid (CSF) Rhinorrhea
4. Pituitary Apoplexy
5. Tumor Enlargement during Pregnancy
6. Conclusions
7. References

Part V Thyroid Disorders

Introduction Emergency Management of Thyroid Disorders
1. Introduction
2. Thyroid Emergencies
3. Conclusions
4. References
15 Myxedema Coma
1. Introduction
2. Pathophysiology
3. Clinical Manifestations
4. Prognosis
5. Conclusions
6. References
16 Life-Threatening Thyrotoxicosis: Thyroid Storm and Adverse Effects of Antithyroid Drugs
1. Introduction
2. Clinical Presentation
3. Treatment
4. After the Storm: Definitive Treatment
5. Prevention of Thyroid Storm
6. Adverse Effects of Antithyroid Drugs
7. Conclusions
8. Acknowledgments
9. References
17 Amiodarone-Induced Thyrotoxicosis
1. Introduction
2. Pathophysiology
3. Amiodarone-Induced Thyroid Disease
4. Conclusions
5. References
18 Thyrotoxic Periodic Paralysis
1. Introduction
2. Pathophysiology
3. Clinical Features
4. Conclusions
5. Acknowledgments
6. References
19 Sight-Threatening Graves’ Orbitopathy
1. Introduction
2. Pathophysiology
3. Dysthyroid Optic Neuropathy (DON)
4. Corneal Breakdown
5. Subluxation of the Globe
6. Conclusions
7. References

Part VI Adrenal Disorders

Introduction Emergency Management of Adrenal Disorders
1. Introduction
2. Pheochromocytoma and Paraganglioma
3. Primary Aldosteronism
4. Incidentally Discovered Adrenal Tumors
5. Conclusions
6. References
20 Acute Adrenal Insufficiency
1. Introduction
2. Pathophysiology
3. Etiology of Adrenal Insufficiency
4. Clinical Assessment
5. Diagnostic Testing of Adrenal Insufficiency
6. Treatment
7. Treatment of Precipitating Illness
8. Special Populations
9. Prevention of Adrenal Crisis
10. Conclusions
11. References
21 Acute Medical Aspects Related to Florid Cushing's Syndrome
1. Introduction
2. Etiology
3. Florid Cushing's Syndrome Investigation
4. Clinical Signs and Features
5. Management
6. Diagnostic Considerations
7. Conclusions
8. References
22 Endocrine Hypertensive Emergencies
1. Introduction
2. Hypertensive Emergencies
3. Pathogenesis
4. Hypertensive Emergencies Associated with Pheochromocytoma
5. Other Endocrine Causes of Hypertensive Emergencies
6. Diagnostic Considerations
7. Clues to Endocrine Causes of Hypertensive Emergencies
8. Treatment of Hypertensive Emergencies
9. Treatment of Pheochromocytoma-Related Hypertensive Emergencies
10. Treatment of Other Endocrine Hypertensive Emergencies
11. Conclusions
12. References

Part VII Calcium, Phosphate, and Metabolic Bone Diseases

Introduction Emergency Management of Calcium, Phosphate, and Metabolic Bone Diseases
23 Hypocalcemia
1. Introduction
2. Pathophysiology
3. Etiology
4. Diagnostic Considerations
5. Clinical Assessment
6. Acute Intervention
7. Permanent Hypoparathyroidism
8. Emerging Therapies
9. Conclusions
10. Acknowledgments
11. References
24 Hypercalcemia
1. Introduction
2. Pathophysiology
3. Etiology
4. Diagnostic Considerations
5. Clinical Signs and Features
6. Management of Severe Hypercalcemia
7. Treatment of Precipitating Illness
8. Emerging Treatments
9. Hypercalcemia in Pregnancy
10. Conclusions
11. References
25 Acute Medical Aspects Related to Phosphate Disorders
1. Introduction
2. Pathophysiology of Phosphate Homeostasis
3. Hypophosphatemia as a Metabolic Emergency
4. Hyperphosphatemia as a Metabolic Emergency
5. Conclusions
6. Acknowledgments
7. References
26 Acute Medical Aspects Related to Osteoporosis and Its Therapy
1. Introduction
2. Safety Concerns with Osteoporosis Therapy
3. Work-Up and Management of the Acute Fragility Fracture
4. Conclusions
5. References
27 Acute Medical Aspects Related to Paget's Disease of Bone
1. Introduction
2. Severe Bone Pain in Persons with Paget's Disease
3. Neurological Complications of Paget's Disease
4. Hypercalcemia
5. High Output Cardiac Failure
6. Conclusions
7. References
28 Acute Medical Aspects Related to Kidney Stones
1. Introduction
2. Epidemiology
3. Pathophysiology
4. Pathology
5. Differential Diagnosis
6. Risk Factors
7. Emergency Care Evaluation
8. Management
9. Prevention of Recurrence
10. Conclusions
11. References

Part VIII Neuroendocrine Tumors

Introduction Emergency Management of Neuroendocrine Tumors
1. Introduction
2. Small Intestinal NETs
3. Pancreatic NETs
4. Syndromes Related to Ectopic Hormonal Secretion
5. Conclusions
6. References
29 Acute Endocrine and Metabolic Emergencies Related to Neuroendocrine Tumors
1. Introduction
2. Specific Tumors and Situations
3. Syndromes Related to Ectopic Hormonal Secretion
4. Conclusions
5. References

Part IX Glucose Disorders

Introduction Emergency Management of Glucose Disorders
1. Introduction
2. References
30 Management of Diabetes and/or Hyperglycemia in Non-Critical Care Hospital Settings
1. Introduction
2. Inpatient Hyperglycemia and Hypoglycemia: A Brief Definition
3. Prevalence of Hyperglycemia and Hypoglycemia in Non-Critical Care Settings
4. Hyperglycemia and Outcomes in Non-Critical Care Settings
5. Hypoglycemia and Outcomes in Non-Critical Care Hospital Settings
6. Glycemic Variability
7. Management of Inpatient Hyperglycemia in Non-Critically Ill Hospitalized Patients
8. Personalized Hyperglycemia Management in Non-Critical Care Settings: A New Paradigm
9. Hospital Use of Incretin Therapy in Non-Critical Care Settings
10. Recommendations After Hospital Discharge
11. Conclusions
12. References
31 Hypoglycemia
1. Introduction
2. Definition of Hypoglycemia
3. Epidemiology
4. Glucose Measurements
5. Physiology of Glucose Metabolism
6. Management of Hypoglycemia
7. Etiology
8. Conclusions
9. Acknowledgments
10. References
32 Severe Hyperglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar State
1. Introduction
2. Pathophysiology
3. Etiology
4. Diagnostic Considerations
5. Clinical Signs and Features
6. Management of Severe Hyperglycemia, DKA, and HHS
7. Treatment of Precipitating Illness
8. DKA in Pregnancy
9. Conclusions
10. References
33 Short-Term Intensive Insulin Therapy in Patients with Newly Presenting Type 2 Diabetes
1. Introduction
2. Clinical Evidence of STII Therapy in Newly Presenting T2DM
3. Clinical Practice of STII Therapy in Newly Presenting T2DM
4. Conclusions
5. References
34 Management of Concentrated Insulins in Acute Care Settings
1. Introduction
2. Background to Concentrated Insulins
3. Admission
4. During Hospitalization
5. Discharge
6. Conclusions
7. References
35 Management of Insulin Pumps in Hospitalized Patients
1. Introduction
2. Contexts of Inpatient CSII Therapy
3. General Considerations
4. Contraindications to Inpatient CSII Self-Management
5. Patient Agreement
6. Admission/Post-admission Procedures
7. Practical Experience with Inpatient CSII Self-Management
8. Continuous Glucose Monitoring Systems
9. Specific Scenarios
10. Use of CSII in the Perioperative Period
11. Limitations of Guidelines
12. Conclusions
13. References
36 Management of Diabetes and/or Hyperglycemia during Enteral and Parenteral Nutrition
1. Introduction
2. Glycemic Goals in Patients Receiving Enteral and Parenteral Nutrition
3. Managing Hyperglycemia in Patients During Specialized Nutrition Support
4. Lipid Management Issues Unique to PN
5. Hospital Discharge Diabetes Management Options for Patients Receiving Specialized Nutrition Support
6. Hypoglycemia in Patients Receiving Specialized Nutrition Support
7. Conclusions
8. Acknowledgments
9. References
37 Management of Diabetes and/or Hyperglycemia in Hospitalized Patients with Renal Insufficiency
1. Introduction
2. Diabetes, Hypoglycemia, and Chronic Kidney Disease
3. Insulin Therapy in Patients with Diabetes and/or Hyperglycemia in CKD/ESRD
4. Non-Insulin Therapies in Patients with Diabetes and/or Hyperglycemia in CKD/ESRD
5. Diagnosis and Management of Diabetic Ketoacidosis in Advanced CKD/ESRD
6. Practical Management of Diabetes and/or Hyperglycemia in CKD/ESRD
7. Conclusions
8. Acknowledgments
9. References
38 Management of Glucocorticoid-Induced Diabetes and/or Hyperglycemia
1. Introduction
2. Definition
3. Prevalence
4. Risk Factors for the Development of GID
5. Common Glucocorticoid Regimens
6. Pathophysiology and Pattern of GIH
7. Diagnosis
8. Associated Adverse Outcomes
9. Treatment Options
10. General Management Approach
11. Conclusions
12. References
39 Management of Diabetes and/or Hyperglycemia in Acute Coronary Syndrome, Acute Stroke, and Acute Heart Failure
1. Introduction
2. Acute Coronary Syndromes
3. Strokes and TIAs
4. Heart Failure
5. Conclusions
6. References
40 Acute Diabetic Foot
1. Introduction
2. Prevention of Diabetes Foot Complications
3. Classification and Diagnosis
4. Management of Diabetic Foot Infections
5. Osteomyelitis
6. Necrotizing Fasciitis
7. Charcot Neuroarthropathy
8. Peripheral Arterial Disease (PAD)
9. Discharge Planning
10. Conclusions
11. Acknowledgments
12. References

Part X Sodium Disorders

Introduction Emergency Management of Sodium Disorders
1. References
41 Emergency Management of Acute and Chronic Hyponatremia
1. Introduction
2. Classification of Hyponatremia by Plasma Tonicity, Extracellular Fluid Volume Status, and Severity
3. Hyponatremia Symptoms, Morbidity, and Mortality
4. Treatment of Symptomatic Hyponatremia: General Principles
5. Currently Available Therapies for Treatment of Symptomatic Hyponatremia
6. Hyponatremia Treatment Guidelines Based on Symptom Severity
7. Monitoring the Serum [Na⁺] in Hyponatremic Patients
8. Common Clinical Questions about the Therapy of Symptomatic Hyponatremia
9. References
42 Emergency Management of Acute and Chronic Hypernatremia
1. Introduction
2. The Physiological Control of Water Balance
3. Causes of Hypernatremia
4. Consequences of Hypernatremia
5. Management of Acute Hypernatremia
6. Management of Chronic Hypernatremia
7. Conclusions
8. References

Part XI Obesity and Clinical Lipidology

Introduction Emergency Management Related to Obesity and Clinical Lipidology
1. Obesity
2. Clinical Lipidology
3. References
43 Acute Emergencies Related to Bariatric Surgery
1. Introduction
2. Bariatric Procedures
3. Bariatric Surgery-Related Issues
4. Conclusions
5. References
44 Chylomicronemia Syndrome: Very Severe Hypertriglyceridemia and Acute Pancreatitis
1. Introduction
2. History
3. Epidemiology
4. Pathophysiology
5. Etiology
6. Clinical Features
7. Investigations
8. Treatment
9. Conclusions
10. Acknowledgments
11. References
45 Statin-Related Myopathy and Rhabdomyolysis
1. Introduction
2. Definition of Terms
3. Historical Background
4. Risk Factors and Prevention of Myopathy/Rhabdomyolysis
5. Statin-Associated Muscle Symptoms (SAMS)
6. Muscle Symptoms with CK ≥ 5 to 10 × ULN
7. Myopathy
8. Rhabdomyolysis
9. Conclusions
10. References

Index

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List of Table

Chapter 1

Table 1.1
Table 1.2
Table 1.3

Chapter 2

Table 2.1

Chapter 3

Table 3.1

Chapter 4

Table 4.1

Chapter 5

Table 5.1
Table 5.2
Table 5.3

Chapter 6

Table 6.1
Table 6.2

Chapter 8

Table 8.1

Chapter 9

Table 9.1

Chapter 10

Table 10.1
Table 10.2

Chapter 11

Table 11.1
Table 11.2
Table 11.3
Table 11.4

Chapter 12

Table 12.1
Table 12.2
Table 12.3

Chapter 13

Table 13.1

Chapter 14

Table 14.1

Chapter 15

Table 15.1
Table 15.2
Table 15.3
Table 15.4

Chapter 16

Table 16.1
Table 16.2
Table 16.3
Table 16.4
Table 16.5
Table 16.6

Chapter 17

Table 17.1
Table 17.2

Chapter 18

Table 18.1
Table 18.2

Chapter 3

Table 19.1

Chapter 20

Table 20.1
Table 20.2
Table 20.3
Table 20.4

Chapter 22

Table 22.1
Table 22.2
Table 22.3
Table 22.4

Chapter 23

Table 23.1
Table 23.2
Table 23.3
Table 23.4

Chapter 24

Table 24.1
Table 24.2
Table 24.3
Table 24.4

Chapter 25

Table 25.1
Table 25.2
Table 25.3

Chapter 26

Table 26.1
Table 26.2

Chapter 27

Table 27.1
Table 27.2

Chapter 28

Table 28.1

Chapter 29

Table 29.1

Chapter 30

Table 30.1

Chapter 31

Table 31.1
Table 31.2
Table 31.3
Table 31.4

Chapter 32

Table 32.1
Table 32.2
Table 32.3

Chapter 33

Table 33.1

Chapter 34

Table 34.1
Table 34.2
Table 34.3
Table 34.4
Table 34.5
Table 34.6
Table 34.7

Chapter 35

Table 35.1
Table 35.2

Chapter 36

Table 36.1
Table 36.2
Table 36.3
Table 36.4

Chapter 37

Table 37.1
Table 37.2
Table 37.3
Table 37.4

Chapter 38

Table 38.1
Table 38.2

Chapter 39

Table 39.1
Table 39.2
Table 39.3
Table 39.4
Table 39.5

Chapter 40

Table 40.1
Table 40.2
Table 40.3
Table 40.4
Table 40.5
Table 40.6
Table 40.7

Chapter 41

Table 41.1
Table 41.2
Table 41.3
Table 41.4
Table 41.5

Chapter 42

Table 42.1
Table 42.2
Table 42.3

Chapter 43

Table 43.1
Table 43.2
Table 43.3

Chapter 44

Table 44.1
Table 44.2
Table 44.3
Table 44.4

Chapter 45

Table 45.1
Table 45.2
Table 45.3
Table 45.4