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Endocrine emergencies

¹ Diabetes Unit, Royal Hallamshire Hospital, Sheffield, UK
² Endocrine Unit, Northern General Hospital and Royal Hallamshire Hospital, Division of Clinical Sciences North, Northern General Campus, University of Sheffield, Sheffield, UK

Correspondence to:
Correspondence to:
Dr Mark W Savage
Diabetes Centre, North Manchester General Hospital, Delauneys Road, Manchester M8 5RB, UK; mark.savage{at}pat.nhs.uk

Diabetic and endocrine emergencies are traditionally treated by the acute medical admitting team or accident and emergency department staff. Most will see diabetic emergencies on a regular basis, as they are common and both type 1 and type 2 disease are increasing in prevalence. Diabetic emergencies are usually easily treated and the patients discharged. However, it is vital not to become complacent as these disorders can lead to death. It is particularly important to follow local guidance and to involve the diabetes team both during and after each episode. Recently it has become clear that about 30% of patients admitted with acute coronary syndrome (including infarction) have either diabetes or "stress hyperglycaemia"; evidence suggests that these patients should be treated not only as a cardiac emergency but also as a diabetic one. Thus, every patient with acute coronary syndrome or acute myocardial infarction needs diabetes to be excluded. The other endocrine emergencies are less common, but in some ways more important simply because of their rarity. A high level of suspicion is often required to make a diagnosis, although some, such as myxoedema coma, are usually obvious. Treatment must be started before the diagnosis can be confirmed. Guidance on making the diagnosis and initiating treatment should be made available on the local NHS intranet for non-endocrinologists to access; and where possible expert advice made available by telephone. The basic management steps in the common diabetic and endocrine emergencies are outlined; this is not a complete list, but rather an insight for those involved in non-selected emergency admissions.

Abbreviations: ACTH, adrenocorticotrophic hormone; DKA, diabetic ketoacidosis; ECG, electrocardiogram; HDU, high dependency unit; HONK, hyperosmolar non-ketotic coma; PAI, primary adrenal insufficiency; PTH, parathyroid hormone; SAI, secondary adrenal insufficiency

Keywords: diabetes; hypercalcaemia; myxoedema coma; pituitary apoplexy; thyroid storm