Endocrine Crises

An endocrine crisis is a sudden failure of hormonal control that threatens perfusion, ventilation, temperature regulation, glucose balance, or neurologic function. The main patterns are diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), thyroid storm, myxedema coma, and adrenal crisis. At the bedside, first identify the dominant direction of illness: severe dehydration with ketones or hyperosmolality; excessive thyroid activity with heat and tachycardia; deficient thyroid activity with hypothermia and hypoventilation; or cortisol deficiency with hypotension, electrolyte disturbance, and possible hypoglycemia. These patterns overlap with sepsis, toxicologic emergencies, and cardiac disease, so an apparently plausible alternative must not delay stabilization. The safest sequence is consistent: assess airway, breathing, circulation, mental status, glucose, and temperature; obtain vascular access and urgent investigations; begin syndrome-directed treatment; then reassess the trajectory rather than relying on a single value.