Thyroid, Adrenal & Dysglycemic Emergencies

ABPN Neurocritical Care Study Guide Exam

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1 Chapter 1: Neurologic Examination & Coma Assessment in the ICU

Current Examination, Blueprint & Preparation Neurologic Examination in Critically Ill Patients Coma Evaluation & Consciousness Alterations Delirium & Toxic-Metabolic Encephalopathy in the ICU

2 Chapter 2: Cerebral Physiology & Intracranial Dynamics

Cerebral Blood Flow, Metabolism & Autoregulation Intracranial Pressure & Compliance Cerebral Edema & Herniation Syndromes

3 Chapter 3: Intracranial Hypertension & Cerebral Perfusion Management

Tiered ICP Management Protocols Hyperosmolar Therapy & Fluid Management Advanced & Refractory ICP Interventions

4 Chapter 4: Airway, Mechanical Ventilation & Pulmonary ICU Management

Emergency Airway Management & Neuro-Intubation Mechanical Ventilation Strategies in Acute Brain Injury Tracheostomy & Ventilator Weaning in Neurocritical Care Pulmonary Complications in the Neuro-ICU Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy

5 Chapter 5: Hemodynamics, Shock & Cardiovascular Management

Hemodynamic Monitoring & Blood Pressure Targets Vasoactive Agents: Inotropes, Vasopressors & Antihypertensives Cardiac Complications of Brain Injury

6 Chapter 6: Neuropharmacology, Analgesia & Sedation

ICU Sedation & Analgesia Neuromuscular Blockade & Monitoring Propofol Infusion Syndrome & Drug Toxicities Antiseizure Drug Pharmacology in the ICU

7 Bleeding, Thrombosis & Hematologic Emergencies

Warfarin & Heparin Reversal Direct Oral Anticoagulant (DOAC) Reversal Antiplatelet Management & Platelet Dysfunction Venous Thromboembolism Prophylaxis & Management Transfusion, Coagulopathy, TMA & Cellular-Therapy Neurotoxicity

8 Chapter 8: Systemic ICU Care, Fluids, Electrolytes & Endocrine

Hyponatremia & Osmoregulation: SIADH vs Cerebral Salt Wasting Diabetes Insipidus, Hypernatremia & Endocrine Crises Critical Care Prophylaxis, Nutrition & Infection Prevention

9 Systemic Trauma & Environmental Injury

Polytrauma, Chest Injury & Abdominal Hemorrhage Burns, Electrical Injury & Hanging

10 Cardiac Emergencies & Mechanical Support

IABP, Ventricular Devices & ECMO Acute Coronary, Valvular, Rhythm & Aortic Emergencies

11 Kidney Injury, Acid–Base & Renal Replacement

Acute Kidney Injury & Renal Drug Clearance Acid–Base Disorders, Electrolytes & Renal Replacement

12 Systemic Infection & Endocrine Emergencies

Sepsis, Endocarditis & Antimicrobial Principles Thyroid, Adrenal & Dysglycemic Emergencies

13 Gastrointestinal & Hepatic Emergencies

Acute Abdomen, GI Bleeding & Abdominal Compartment Syndrome Acute Liver Failure, Cirrhosis & Hepatic Drug Effects

14 Chapter 9: Neuroimaging in the Neuro-ICU

Non-Contrast CT & CT Angiography CT Perfusion & Advanced Perfusion Imaging Magnetic Resonance Imaging in Critical Illness

15 Chapter 10: Electrophysiology & Neuromonitoring

Continuous EEG & ACNS Standardized Critical Care Terminology Invasive Neuromonitoring: ICP & External Ventricular Drains Multimodal Monitoring: PbtO2, Microdialysis & Transcranial Doppler

16 Angiography, Electrodiagnosis & CSF Analysis

Conventional Angiography & Cranial–Spinal Shunts EMG, Nerve Conduction & Acute Muscle Disease CSF Analysis: Infection, Inflammation & Hemorrhage

17 Chapter 11: Bedside Procedures, Ultrasound & Death by Neurologic Criteria

Critical Care Procedural Skills Critical Care Ultrasound & Echocardiography Determination of Death by Neurologic Criteria

18 Chapter 12: Acute Ischemic Stroke & Reperfusion Therapies

Acute Ischemic Stroke Management & Thrombolysis Endovascular Thrombectomy & Large Vessel Occlusion Malignant Hemispheric & Cerebellar Infarction

19 Chapter 13: Spontaneous Intracerebral Hemorrhage & Intraventricular Hemorrhage

Acute Intraparenchymal Hemorrhage Management Intraventricular Hemorrhage & Hydrocephalus Surgical Evacuation & Minimally Invasive Surgery in ICH

20 Chapter 14: Aneurysmal Subarachnoid Hemorrhage & Delayed Cerebral Ischemia

Aneurysmal Subarachnoid Hemorrhage: Acute Resuscitation & Securing Delayed Cerebral Ischemia & Cerebral Vasospasm Non-Aneurysmal Subarachnoid Hemorrhage & Vascular Malformations

21 Venous, Spinal & Traumatic Vascular Disease

Cerebral Venous Thrombosis & Spinal Cord Infarction Traumatic Dissection, Carotid–Cavernous Fistula & Penetrating Injury

22 Chapter 15: Traumatic Brain & Spinal Cord Injury

Severe Traumatic Brain Injury & Contusions Acute Traumatic Spinal Cord Injury & Neurogenic Shock Spine Trauma, Fractures & Cord Syndromes

23 Chapter 16: Status Epilepticus, Seizures & Neuromuscular Emergencies

Status Epilepticus: Convulsive & Non-Convulsive Refractory & Super-Refractory Status Epilepticus Acute Neuromuscular Respiratory Failure

24 Chapter 17: Post-Cardiac Arrest Care, CNS Infections & Encephalitis

Targeted Temperature Management & Post-Cardiac Arrest Care Post-Cardiac Arrest Neuroprognostication Acute CNS Infections, Encephalitis & Inflammatory Emergencies

25 Neuroinflammation & Neurooncology

Fulminant Demyelination & Autoimmune Encephalitis Brain, Spinal & Leptomeningeal Cancer Emergencies

26 Pregnancy, Transplantation & Pediatric Care

Pregnancy, Postpartum & Post-Transplant Neurologic Care Pediatric Neurocritical Care

27 Chapter 18: Neurosurgical & Perioperative Emergencies

Postoperative Neurosurgical Complications Device Complications: EVDs, Shunts & ICP Monitors Cerebral Hyperperfusion Syndrome & Post-Interventional Emergencies

28 Chapter 19: Ethics, Palliative Care & Organ Donation in the Neuro-ICU

Communication, Surrogate Decision-Making & Conflict Resolution Neuroprognostication Ethics, Withdrawal of Life Support & Palliative Care Organ Donation & Management of the Deceased Donor

Thyroid, Adrenal & Dysglycemic Emergencies

Key Takeaways Explain This Topic AI

In suspected adrenal crisis, obtain cortisol and ACTH if feasible but do not delay hydrocortisone and resuscitation.

Thyroid storm is clinical decompensation; the height of the thyroid hormone level alone does not establish severity.

Myxedema coma requires supportive care, thyroid hormone, and assessment or empirical treatment of adrenal insufficiency.

DKA can occur with modest glucose elevation, especially with SGLT2 inhibitors; ketones and acid–base findings matter.

Last updated: October 2026

Endocrine Mimics of Neurologic Catastrophe

The outline includes thyrotoxicosis, myxedema, adrenal failure, dysglycemia, and pituitary disease. These disorders can produce altered consciousness without a new structural lesion. Temperature, heart rate, blood pressure, sodium, glucose, medication history, and the time course help identify the syndrome. More than one process may coexist: an infection can precipitate adrenal crisis or DKA, and pituitary injury can cause both cortisol deficiency and disordered water balance.

A single reassuring result must not terminate assessment. A normal-range TSH may be inappropriate when free T4 is low in central hypothyroidism. A moderately elevated glucose does not exclude ketoacidosis. Cortisol interpretation is affected by illness and preceding glucocorticoids; obtain samples when practical, but treatment of an unstable suspected crisis should not await the laboratory.

Acute Adrenal Insufficiency

Adrenal crisis can cause hypotension, volume depletion, hyponatremia, hypoglycemia, gastrointestinal symptoms, and encephalopathy. Primary adrenal failure may also cause hyperkalemia because mineralocorticoid secretion is impaired. Secondary failure after pituitary injury often preserves aldosterone, so absence of hyperkalemia does not exclude it. Chronic glucocorticoid exposure with abrupt interruption is another important mechanism.

If suspected in an adult, the Endocrine Society recommends immediate parenteral hydrocortisone 100 mg, appropriate fluid resuscitation, and approximately 200 mg over the next 24 hours, given continuously or in divided doses. Correct hypoglycemia and treat the trigger. Draw cortisol and ACTH first when feasible without delaying treatment. Long-term steroid replacement, tapering, mineralocorticoid needs, and diagnostic testing are subsequent individualized decisions.

In panhypopituitarism , assess adrenal, thyroid, gonadal, and water-balance axes. Replace glucocorticoids before thyroid hormone when adrenal insufficiency is possible because increasing metabolic demand can worsen an untreated cortisol deficit. In pituitary apoplexy, severe visual compromise or deteriorating consciousness also requires urgent endocrine and neurosurgical assessment.

Thyroid Storm

Thyroid storm is acute systemic decompensation associated with thyrotoxicosis. Fever, severe tachycardia or atrial fibrillation, agitation or coma, gastrointestinal dysfunction, and cardiac failure are typical clues. It is a clinical diagnosis supported by thyroid tests; hormone concentrations overlap with uncomplicated hyperthyroidism. Infection, surgery, medication interruption, and other stressors can precipitate it.

Management addresses supportive care, the trigger, adrenergic symptoms, hormone synthesis, hormone release, and peripheral conversion. Use a thionamide and give iodine after synthesis blockade when indicated by the protocol. Glucocorticoids provide additional support. Beta-blockade requires particular caution in decompensated heart failure or shock; suppressing compensatory adrenergic tone can precipitate collapse. Do not assume that a rapid heart rate always justifies a large long-acting beta-blocker dose.

Severe Hypothyroidism

Myxedema coma may present with hypothermia, bradycardia, hypoventilation, hyponatremia, and depressed consciousness, sometimes without literal coma. Sedatives and opioids can have amplified effects. Look for a precipitating infection, cold exposure, medication problem, or cardiovascular event. Support ventilation and circulation, use cautious warming, and give thyroid hormone under an appropriate protocol with cardiac risk assessment. Evaluate or cover adrenal insufficiency before thyroid replacement.

Syndrome Distinguishing clues Immediate priority

Adrenal crisis Shock, hyponatremia, hypoglycemia, steroid or pituitary history Hydrocortisone, fluids, glucose when needed

Thyroid storm Fever, marked tachycardia, CNS and systemic decompensation Multimodal thyroid therapy and circulatory stabilization

Myxedema coma Hypothermia, bradycardia, hypoventilation Support, glucocorticoid assessment, thyroid replacement

DKA/HHS Dehydration, ketones or hyperosmolality, metabolic disturbance Fluids, electrolyte-guided insulin, trigger treatment

Hypoglycemia, DKA, and HHS

Treat symptomatic hypoglycemia promptly with appropriate glucose and recheck. Give thiamine promptly when deficiency is possible, but do not delay life-saving dextrose while waiting for it. Long-acting insulin, sulfonylureas, organ dysfunction, or interrupted nutrition can cause recurrence. Continued monitoring and a cause-specific plan are needed after an initial improvement.

Diabetic ketoacidosis (DKA) requires diabetes or hyperglycemia together with significant ketonemia and metabolic acidosis. SGLT2 inhibitor-associated DKA can occur with relatively modest glucose elevation. Measure beta-hydroxybutyrate when available rather than relying solely on urine ketones. Hyperosmolar hyperglycemic state (HHS) features marked hyperglycemia and hyperosmolality with less prominent ketoacidosis, although mixed presentations occur.

Both require fluid, electrolyte, and insulin management with frequent reassessment. Total-body potassium is often depleted even when the initial serum concentration is high. The 2024 consensus advises delaying insulin in hypokalemia until potassium is above 3.5 mmol/L while replacing it appropriately. Monitor sodium, glucose, potassium, osmolality, and acid–base recovery; avoid abrupt osmotic changes. New neurologic deterioration during treatment requires immediate evaluation for cerebral complications and other causes.

Sources checked October 17, 2026: Endocrine Society adrenal guideline and 2024 hyperglycemic crisis consensus .