The Curbsiders Internal Medicine Podcast REBOOT: #372 Endocrine Emergencies featuring Dr. Sara Markley Webster
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Aug 7, 2023 Dr. Sara Markley Webster from Emory University discusses inpatient management of can't miss endo emergencies including adrenal crisis, myxedema coma, and thyroid storm. The topics covered include dosage and tapering of hydrocortisone, diagnostic options for adrenal insufficiency, resolving electrolyte abnormalities, clinical aids for diagnosing myxedema coma, thyroid hormone replacement, and the use of steroids in endocrine emergencies.
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Treat Suspected Adrenal Crisis Early
- If adrenal crisis is possible, give stress‑dose hydrocortisone promptly rather than delay for testing.
- Typical regimen: 100 mg IV load then 50 mg IV q6h, taper as patient improves.
Primary Vs Secondary Less Relevant Acutely
- In the acute hospital setting it often doesn't matter whether adrenal failure is primary or secondary.
- High‑dose hydrocortisone given acutely usually covers both glucocorticoid and mineralocorticoid needs.
Sick‑Day Rules For Adrenal Insufficiency
- In known adrenal insufficiency counsel patients on sick‑day rules: double for mild illness, triple for fever >38°C.
- Advise urgent care or IV steroids if vomiting prevents oral intake.