A life-saving initiative: Endocrine Emergency Guidance
Marie Freel | Society News
Endocrine emergencies are potentially life-threatening clinical problems, and are compounded by a lack of recognition, leading to delays in therapy. Every endocrinologist is aware of patients, attending their outpatient clinic, with tales of suboptimal care in a non-endocrine clinical environment, because of a failure to understand their chronic condition and its possible complications. This is particularly relevant in adrenal insufficiency, and has led to potentially avoidable excess morbidity and mortality.
To address this issue, the Society’s Clinical Committee has launched a new initiative to introduce succinct and straightforward clinical guidance documents for use by the non-endocrinologist within an emergency setting. Five ‘Emergency Guidance’ documents have been developed, often in conjunction with more comprehensive European, American or national guidelines. All five have been published together in Endocrine Connections.1–5 Each covers the most common endocrine-themed medical emergencies.
This is often under-recognised and, in particular, there is a lack of understanding of ‘sick day rules’ amongst non-endocrine health professionals. This Emergency Guidance document clearly outlines key points in the recognition and management of a new presentation of adrenal insufficiency, as well as clarifying how to alter glucocorticoid therapy in the event of intercurrent illness or medical procedures. The lead author, Wiebke Arlt, was also an author of the Endocrine Society clinical practice guideline on the diagnosis and treatment of primary adrenal insufficiency published in 2016.6
'The Society wishes to distribute these document widely to a non-endocrine audience, most notably emergency departments and acute general medical and surgical wards'
This Emergency Guidance document has principally been written by Stephen Ball, who was also an author of the European Society of Endocrinology clinical practice guideline on hyponatraemia in 2014.7 The particular strength of this guidance is that it emphasises the importance of assessing the severity of acute hyponatraemia and treating it accordingly in the first instance. Evaluation of volume status and confirming the exact cause of hyponatraemia, whilst important, are often done poorly by nonspecialist clinicians, and delay the appropriate treatment of this common and potentially life-threatening condition.
Disorders of calcium regulation are the second-most common electrolyte disorder requiring endocrine input. In these Emergency Guidance documents, Jeremy Turner, Jennifer Walsh and colleagues provide a concise summary of the key causes of hypocalcaemia and hypercalcaemia and their immediate management, based upon biochemical severity and underlying cause. In the case of hypercalcaemia, the first step is rehydration with normal saline, and intravenous zoledronic acid is now the bisphosphonate of choice.
In this condition, recognition and prompt treatment with intravenous hydrocortisone may be life-saving and prevent long term visual complications. In this Emergency Guidance document, Stephanie Baldeweg and colleagues emphasise that this condition must be considered in patients with acute severe headache, visual defects and/or impairment of consciousness. Authors of this document were also authors of the Society for Endocrinology’s UK guidelines for the management of pituitary apoplexy, published in 2011 and reviewed with no necessary changes in 2014.8
Each Emergency Guidance document has been principally written by authors with extensive experience and expertise in the relevant condition with consideration of the most up to date evidence available, and has been peer-reviewed by the Society for Endocrinology Clinical Committee.
The Society wishes to distribute these important documents as widely as possible to a non-endocrine audience, most notably emergency departments and acute general medical and surgical wards. Publication of all documents in Endocrine Connections and subsequent availability on the Society for Endocrinology website will allow endocrinologists to provide a single point of reference to non-specialist colleagues to guide the management of these extremely common and important conditions.
On behalf of the Society for Endocrinology Clinical Committee
This article has been reproduced in amended form from Endocrine Connections 2016 5 E1–E2. doi:10.1530/EC-16-0068.
- Arlt W et al. 2016 Endocrine Connections 5 G1–G3.
- Ball S et al. 2016 Endocrine Connections 5 G4–G6.
- Turner J et al. 2016 Endocrine Connections 5 G7–G8.
- Walsh J et al. 2016 Endocrine Connections 5 G9–G11.
- Baldeweg S et al. 2016 Endocrine Connections 5 G12–G14.
- Bornstein AR et al. 2016 Journal of Clinical Endocrinology & Metabolism 101 364–389.
- Spasovski G et al. 2014 European Journal of Endocrinology 170 G1–G47.
- Rajasekaran S et al. 2011 Clinical Endocrinology 74 9–20.