Recognising and Managing Endocrine Emergencies

Table of Contents

1. What Are Endocrine Emergencies?
2. What Are Some Common Endocrine Emergencies?
3. Diabetic ketoacidosis (DKA)
4. Hyperosmolar hyperglycaemic state (HHS)
5. Adrenal crisis
6. Thyroid storm
7. Myxoedema coma
8. Hypoglycaemia

A middle-aged patient arrives in the ER with confusion, low blood pressure, and severe vomiting. The usual culprits are ruled out. But could this be an adrenal crisis?

Endocrine emergencies are less known and even less understood. But without prompt action, they can be lethal. They present subtly and cause severe damage to the body. Read on to find out what causes endocrine emergencies, the signs to look out for and how to manage them.

Why Do Endocrine Glands Matter?

Endocrine glands are specialised organs that are responsible for hormone production. The hormones released directly into the bloodstream act as chemical messengers regulating essential body functions like metabolism, growth, reproduction, and stress response.

Major endocrine glands include the pituitary gland, thyroid gland, adrenal glands, pancreas and ovaries and testes.

What Are Endocrine Emergencies?

When hormones go out of balance, that has a damaging effect on the body. When the amounts of various hormones increase or decrease beyond an optimal level in the blood, it causes emergencies which require prompt recognition and treatment.

What Are Some Common Endocrine Emergencies?

Diabetic ketoacidosis (DKA)

DKA is a serious complication of diabetes, characterised by high blood sugar, and is most commonly seen in those who are suffering from type1diabetes. A prolonged deficiency of insulin causes this. As the body breaks down fat to release energy, ketones are formed as byproducts, the high amounts of which lead to complications in metabolism and acid buildup.

Triggers: Missed insulin doses, infection, stress or trauma.

Symptoms: Excessive thirst and urination, abdominal pain and vomiting, rapid and fruit-scented breath, drowsiness and confusion.

Potential Risks:  Cerebral Oedema, shock.

Management: Fluid replacement, Insulin Therapy, and Electrolyte Correction.

Hyperosmolar hyperglycaemic state (HHS)

This is a severe complication of diabetes that can even be life-threatening, commonly seen in type 2 diabetes patients. The patients develop an extremely high level of sugar (often >600 mg/dL) over days to weeks, severely impairing bodily functions if not addressed promptly. Blood shows minimal to no ketones, and there is a significant absence of acidosis.

Triggers: Infection, poorly controlled diabetes, stroke, or certain medications.

Symptoms: Extreme thirst, dry mouth and skin, visual disturbance, confusion, and tiredness.

Potential Risks:  Severe dehydration, seizures, or coma in advanced cases.

Management: Aggressive Fluid Replacement, Insulin Therapy, and Correction.

Remember, HHS is more lethal than DKA, especially in the case of older adults. Early recognition and prompt medical help are mandatory for avoiding danger.

Adrenal crisis

This is a condition caused by a sudden, severe deficiency of adrenal hormones. Adrenal hormones produced by the adrenal glands on top of the kidneys are responsible for several major bodily functions, like metabolism and salt-water balance. Usually affects individuals with Addison’s disease or adrenal insufficiency.

Triggers: Infection, surgery, sudden steroid withdrawal, severe stress.

Symptoms: Severely low blood pressure and sugar, dehydration, low sodium and potassium, fatigue and nausea, and confusion.

Potential Risks:  loss of consciousness and organ failure.

Management: An immediate IV hydrocortisone, fluid replenishment with isotonic saline, and correction of electrolyte imbalance. 

Thyroid storm

Also called thyroid crisis, this is a rare and life-threatening endocrine emergency caused by excessive thyroid hormones. Extreme levels of thyroid hormones cause sudden and intense increases in metabolic activities in the body.

Triggers: Infection, surgery, trauma. Stress, radiation therapy, and withdrawal of antithyroid medication.

Symptoms: High fever (> 38.5°C or 101.3°F), tachycardia/ very high heart rate (>140 bpm), nausea, diarrhoea, agitation, and delirium.

Potential Risks:  heart failure, coma.

Management: Inhibit hormone synthesis and release through medication, and provide supportive care through IV fluids, oxygen supply, and electrolyte correction.

The mortality rate of thyroid storms is up to 20 to 30 %. Early recognition and aggressive treatment are critical.

Myxoedema coma

This is the opposite of a thyroid storm. Myxoedema coma is an extreme form of hypothyroidism. Prolonged and unmanaged hypothyroidism causes this condition. The patients are usually severely metabolically decompensated, but not always comatose, as indicated by the name.

Triggers: Exposure to very low temperatures, infection, trauma, sedatives, and stopping thyroid medication.

Symptoms: low body temperature (< 35°C), low heart rate, hypotension, hypoventilation, dry skin, puffy face, and myxoedema (swelling)

Potential Risks:  heart failure, respiratory failure, seizures, coma.

Management: Thyroid hormone replacement, supportive therapy through gradual rewarming using warm blankets, mechanical ventilation and treating metabolic issues.  

This condition is most commonly found in elderly women with untreated hypothyroidism.

Hypoglycaemia

This is a condition characterised by abnormally low blood sugar levels in the body due to excessive insulin. It is also affected by hormonal deficiencies, such as low cortisol levels and imbalances in pituitary hormones.

Triggers: Too much insulin intake, delayed or missed meals, adrenal insufficiency, severe liver disease.

Symptoms: sweating. Tremors, palpitations, anxiety, hunger, slurred speech, and visual disturbances.

Potential Risks:  seizures, loss of consciousness, coma.

Management: Patients able to swallow are given 15–20 g of fast-acting carbohydrate; IV dextrose and glucagon injection are also effective.

To Keep in Mind

Endocrine emergencies are uncommon but highly fatal and require immediate attention. Conditions like thyroid storm, myxoedema coma, adrenal crisis, and severe hypoglycaemia require urgent intervention, multidisciplinary care, and often ICU support. Outcomes can be improved only through early detection, looking out for warning signs and timely medical attention.

If you or a loved one experiences sudden, unexplained symptoms like altered consciousness, severe weakness, or abnormal vital signs, do not delay seeking help. The specialised Endocrinology department at STAR Hospitals offers world-class diagnostic options, treatment plans and long-term wellness programmes. Excellence, care, and precision come together to ensure that each patient receives the care they deserve.

Book an appointment with STAR Hospitals today for expert evaluation and timely treatment.