Clinical meaning
DKA: absolute/relative insulin deficiency causing lipolysis, ketogenesis. Triad: glucose >250, pH <7.3, bicarb <18, ketonemia. HHS: extreme hyperglycemia (>600), hyperosmolality (>320) without significant ketosis. DKA treatment: NS 15-20 mL/kg/hr, insulin drip 0.1-0.14 U/kg/hr, K+ replacement when <5.3. Transition to SC insulin when glucose <200, bicarb >=15, pH >7.3, AG closed.
Diagnosis & workup
Diagnostics & workup: - Fine needle aspiration biopsy of thyroid nodules (Bethesda classification) - Prolactin level for pituitary evaluation - IGF-1 for growth hormone excess or deficiency screening - TSH (most sensitive for primary thyroid dysfunction) - Plasma metanephrines for pheochromocytoma screening - HbA1c for 3-month glycemic control (target <7% for most adults) - Pituitary MRI for sellar/suprasellar mass evaluation
Risk factors: - Pituitary adenoma causing hormonal hypersecretion or deficiency - Metabolic syndrome (waist circumference, triglycerides, HDL, BP, glucose) - Pregnancy altering hormonal milieu (gestational DM, thyroiditis) - Family history of endocrine disorders (autoimmune thyroid, T2DM) - Eating disorders with hypothalamic amenorrhea - Autoimmune disease predisposition (Type 1 DM, Hashimoto's, Addison's) - Sleep deprivation disrupting cortisol and growth hormone secretion