Endocrine Crises in Acutely and Critically Ill Patients

Abstract

Endocrine disorders are complex syndromes that can cause serious complications in an acute medical illness, trauma, or surgical event. In 1872, Claude Bernard found that a regulated internal milieu in a changing and challenging environment was important, as cells and tissues emitted signals in an effort to coordinate physiological functions. Today, we know that this communication between tissues is done by chemical mediators known as hormones, interacting with receptors, resulting in physiological responses. A delicate and interwoven network exists within the endocrine, nervous, and immune systems. This network requires care providers to look beyond the obvious conclusions at times to identify underlying causes of symptoms and signs associated with major organ systems, such as cardiovascular or gastrointestinal systems, to find an endocrine disorder in crisis mode.The 3 major pathological mechanisms of endocrine disease are excessive hormone production, insufficient hormone production, and resistance to hormone use. Nurses caring for acutely and critically ill patients with an endocrine disorder must consider the profound effects the stress cascade has on neuroendocrine control. Recognition of subtle and substantial alterations in homeostasis can vastly improve clinical outcomes for those who experience endocrine crises.This symposium, authored by endocrine and diabetes clinical nurse specialists with backgrounds in adult health, reviews 3 different disorders or syndromes of glandular tissue that can be exacerbated in critical illness or progress to an acute event. The article on multiple endocrine neoplasia provides an overview of this rare syndrome that puzzles so many care providers and highlights the glands and hormones associated with each type, clinical manifestations, and nursing implications in critical care. The article on acute diabetes management and adult hyperglycemic crises and hypoglycemia addresses a more common endocrine disease, focusing on the crises that can develop in the presence of precipitating factors or less than optimal self-management. The author has addressed the standard of practice for diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia, identifying the goals of therapy to resolve or prevent the crisis. The final article in the series is on thyroid gland disorder emergencies, thyroid storm, and myxedema coma. Individuals at risk for these emergent developments are identified, and pharmacological therapies in addition to supportive care are reviewed.This series of articles is intended to inform acute and critical care nurses alike, challenging each person to expand his or her knowledge of endocrine disease. The assessment of individuals in crisis is complex and multifactorial. The astute and inquisitive nurse will integrate this new knowledge into practice, enhancing the quality of care delivered to persons with endocrinopathies and improving clinical outcomes of those in his or her care.