Endocrinology

A

• Acute Adrenal Crisis — Hydrocortisone First, Aggressive Fluids, and Precipitant Control

  Life-threatening hypotension, hyponatremia, hyperkalemia, and hypoglycemia in patients with adrenal insufficiency or chronic steroid use. Give hydrocortisone immediately with large-volume isotonic fluids and dextrose; treat triggers such as infection or withdrawal; do not delay steroids for labs.
• Acute Adrenal Crisis — Stress-Dose Steroids, Fluids, and Precipitant Control

  Life-threatening cortisol deficiency with hypotension, hyponatremia, hyperkalemia, and hypoglycemia. Treat immediately with hydrocortisone 100 mg IV, aggressive isotonic fluids, and dextrose as needed; do not delay for labs. Identify precipitating illness or medication nonadherence.
• Adrenal Crisis — Immediate Hydrocortisone and Fluids

  Life-threatening adrenal insufficiency with hypotension and shock; give hydrocortisone immediately, aggressive fluids, dextrose as needed, and treat precipitating cause.
• Adrenal Crisis — Recognition & Treatment

  Acute glucocorticoid deficiency causing shock and electrolyte derangements; treat immediately with stress dose hydrocortisone and fluids; do not delay for tests.
• Adrenal Crisis — Stress‑Dose Steroids, Triggers, and Disposition

  Life‑threatening cortisol deficiency with hypotension, abdominal pain, hyponatremia/hyperkalemia, and shock. Treat immediately with IV hydrocortisone and isotonic fluids; do not delay for labs. Identify precipitants (infection, missed doses, surgery) and provide sick‑day education.

C

• Cushing Syndrome — Screening & Localization

  Evaluate endogenous hypercortisolism with high‑specificity screening tests, then localize by ACTH and imaging; IPSS for equivocal pituitary cases; treat with surgery or medical therapy.

D

• Diabetes in CKD — Medication Choice & Dose Adjustments

  Combine glycemic control with kidney and CV protection. Use SGLT2 inhibitors and GLP‑1 RA, continue ACEi/ARB, and adjust drug doses to eGFR.
• Diabetic Ketoacidosis — Adult

  Diagnose with hyperglycemia, ketonemia, and anion gap metabolic acidosis; resuscitate with fluids, start insulin infusion when K ≥3.3, replete potassium, add dextrose as glucose falls, and treat precipitating cause.
• Diabetic Ketoacidosis — Adult ED Management

  Fluid resuscitation, insulin infusion with careful potassium management, and identification of precipitating cause; transition to subcutaneous insulin after resolution criteria met.
• Diabetic Ketoacidosis — Fluids, Insulin Protocol, and Potassium Strategy

  DKA presents with hyperglycemia, anion gap metabolic acidosis, and ketonemia/ketonuria. Begin isotonic fluids, correct potassium before insulin if K+ <3.3, start insulin infusion when safe, and transition to subcutaneous insulin once gap closes. Identify and treat precipitants.
• Diabetic Ketoacidosis — Fluids, Insulin, Potassium, and Anion Gap Closure

  DKA presents with hyperglycemia, ketosis, and metabolic acidosis. Begin balanced crystalloids, correct potassium, and start insulin infusion after K+ ≥3.3 mEq/L. Add dextrose as glucose approaches 200 mg/dL and continue insulin until ketoacidosis resolves (anion gap closes). Search for precipitants.
• Diabetic Ketoacidosis — Fluids, Insulin-Dextrose Pairing, and Electrolytes

  Hyperglycemia, ketonemia, and anion-gap metabolic acidosis. Start isotonic fluids, initiate insulin with potassium-safe thresholds, add dextrose when glucose ~200–250 mg/dL to continue ketone clearance, and correct electrolytes; search for triggers.
• DKA in Adults — Fluid, Insulin, and Electrolytes

  Hyperglycemic crisis with anion gap metabolic acidosis and ketonemia. Manage with fluids, insulin, and potassium; add dextrose when glucose <200 mg/dL until anion gap closes; search for precipitant.

G

• Graves Disease — Antithyroid Drugs, RAI, and Surgery

  Autoimmune hyperthyroidism. Choose antithyroid drugs, radioactive iodine, or surgery based on patient factors; beta‑blockers for symptoms; monitor for agranulocytosis and hepatotoxicity.

H

• Hashimoto Thyroiditis — Diagnosis & Hypothyroid Transition

  Autoimmune thyroiditis causing hypothyroidism. Treat with levothyroxine; dose by weight and adjust by TSH. Address subclinical cases based on TSH level, symptoms, and pregnancy plans.
• HHS — Diagnosis & Management

  Marked hyperglycemia, hyperosmolality, and dehydration with minimal ketosis. Treat with aggressive fluids, insulin after initial resuscitation, and careful electrolyte/osmolality monitoring; identify precipitant.
• Hypercalcemia of Malignancy — Acute Management

  Vigorous IV fluids, temporary calcitonin, and definitive antiresorptive therapy with bisphosphonate or denosumab; treat the malignancy and contributors.
• Hyperosmolar Hyperglycemic State — Adult

  Severe hyperglycemia with hyperosmolarity and minimal ketosis; treat with fluids first, then insulin once volume repleted and K is safe; correct electrolytes and identify precipitating cause.
• Hyperosmolar Hyperglycemic State — Adult Management

  Severe hyperglycemia with hyperosmolality and minimal ketosis; prioritize fluids, correct electrolytes, then insulin; search for triggers and prevent complications.
• Hyperosmolar Hyperglycemic State — Fluid Strategy, Insulin, and Electrolyte Targets

  Profound hyperglycemia with hyperosmolality and minimal ketosis; prioritize isotonic fluids with careful correction of osmolality, low-dose insulin infusion once volume is restored, and aggressive potassium and phosphate management.
• Hypocalcemia — Acute Management

  Treat symptomatic or severe cases with IV calcium; correct hypomagnesemia; identify causes such as hypoparathyroidism, vitamin D deficiency, pancreatitis, and renal failure.
• Hypocalcemia — Emergency Management & Long‑Term Care

  Treat symptomatic or severe hypocalcemia urgently with IV calcium and correct magnesium; identify and address the cause (hypoparathyroidism, vitamin D deficiency, CKD, pancreatitis, drugs).
• Hypoglycemia — Adult Emergency Management

  Treat promptly when symptomatic or glucose <70 mg/dL; use oral glucose if able; IV dextrose or IM glucagon if altered; prevent recurrent hypoglycemia (octreotide for sulfonylurea).
• Hypopituitarism — Recognition & Hormone Replacement

  Recognize hormone deficiencies and replace in physiologic order. Always replace glucocorticoids before starting levothyroxine to avoid adrenal crisis.

M

• Male Hypogonadism — Workup & Treatment

  Confirm low morning testosterone on two occasions with symptoms; differentiate primary vs secondary; treat with testosterone when indicated while addressing fertility and contraindications.
• Myxedema Coma — Recognition and Treatment

  Severe decompensated hypothyroidism with hypothermia and altered mental status; treat immediately with IV thyroid hormone, stress-dose steroids, passive rewarming, and supportive care.
• Myxedema Coma — Steroids First, IV Thyroid Hormone, and Passive Rewarming

  Severe decompensated hypothyroidism with hypothermia, bradycardia, hypotension, hyponatremia, and altered mental status. Treat empirically with stress‑dose glucocorticoids, IV levothyroxine loading (± liothyronine), passive rewarming, careful ventilation, and aggressive search for precipitants (infection, MI, sedatives).

P

• Primary Hyperparathyroidism — Evaluation & Indications for Surgery

  PHPT: hypercalcemia with inappropriately elevated PTH. Evaluate renal/bone complications and criteria for parathyroidectomy; otherwise monitor with risk reduction.

S

• Severe Hypoglycemia — Immediate Treatment and Prevention of Rebound

  Treat with IV dextrose or IM glucagon when IV access is not available; for sulfonylurea toxicity add octreotide and prolonged observation.

T

• Thyroid Storm — Beta-Blockade, Thionamides, Iodine, and Steroids

  Life-threatening hyperthyroidism precipitated by infection, surgery, or withdrawal of antithyroid drugs. Start beta-blockade, administer thionamides (PTU preferred initially), give iodine at least 1 hour later to block release, add glucocorticoids, and treat precipitants; ICU monitoring and active cooling as needed.
• Thyroid Storm — Burch–Wartofsky Score, Stepwise Block-and-Replace

  Life-threatening thyrotoxicosis with fever, delirium, and cardiovascular instability; treat with beta blockade, high-dose thionamides, iodide given after thionamide, stress-dose glucocorticoids, and supportive ICU care.
• Thyroid Storm — Emergency Management

  Life threatening thyrotoxicosis with fever, tachyarrhythmia, CNS and GI symptoms; give beta blockade, thionamide, iodine (after thionamide), steroids, and supportive care.
• Thyroid Storm — Emergency Treatment

  Life-threatening thyrotoxicosis: block adrenergic effects, inhibit hormone synthesis, block hormone release with iodine (after thionamide), reduce T4→T3 conversion with steroids, and give supportive care.
• Thyroid Storm — Recognition & Treatment

  Life threatening thyrotoxicosis; treat with sequence therapy: beta blocker, thionamide, iodine one hour later, and glucocorticoid; manage triggers and supportive care.
• Thyroid Storm — Thionamides, Iodine Timing, β-Blockade, and Steroids

  Severe thyrotoxicosis with multiorgan dysfunction. Start β-blockade; give PTU 500–1000 mg load then 250 mg q4h (or Methimazole 20 mg q4–6h), followed by iodine (SSKI) 1–2 h later to block release. Add hydrocortisone 100 mg IV q8h and supportive care including cooling and fluids.