Endocrine emergencies. Adrenal crisis, myxedema coma, and thyroid storm

Each of the endocrine emergencies discussed here--adrenal crisis, myxedema coma, and thyroid storm--represents decompensation of a long-standing endocrine disorder and is precipitated in most cases by some stressful event. Each necessitates immediate, aggressive therapy. Even with such therapy, the mortality rate remains 30% to 50% for myxedema coma and 30% to 40% for thyroid storm. Therapy must be instituted on the basis of strong clinical suspicion, without delay for results of specific hormone assays to confirm the diagnosis. Although some risks may be inherent in this approach, they are minimal compared with the risks of delaying therapy until laboratory confirmation can be obtained. Immediate therapy consists of specific measures to correct the hormone deficit or excess; the precipitating cause should then be sought and treated.