Emergency Medicine and Endocrinology
Astra Clinical Library
Endocrinology
Practical endocrinology guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
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Endocrinology and Emergency Medicine
Hyperosmolar Hyperglycemic Syndrome
Hyperosmolar hyperglycemic syndrome is a life-threatening hyperglycemic emergency requiring prompt recognition, volume resuscitation, electrolyte-directed insulin therapy, and evaluation for precipitating illness. The supplied search results do not contain HHS-specific diagnostic thresholds or treatment protocols; current emergency guidance should be consulted.Endocrinology
Diabetes Mellitus Screening
Screen adults and selected youth for dysglycemia using validated plasma glucose or A1C testing, confirm abnormal results when hyperglycemia is not unequivocal, and recognize settings—including HIV and pediatric risk—in which test selection and interpretation require modification.Endocrinology and critical care
Thyroid Storm
Thyroid storm is a clinical diagnosis of decompensated thyrotoxicosis with acute organ dysfunction. Immediate ICU-level multimodal therapy, treatment of the precipitant, and cautious cardiovascular management are required; thyroid hormone concentrations do not distinguish storm from uncomplicated thyrotoxicosis.[8]Endocrinology
Obesity and Type 2 Diabetes
Excess adiposity is a central, modifiable driver of insulin resistance and type 2 diabetes progression. Management should integrate weight-directed treatment with complication-focused glucose-lowering therapy, prioritizing cardiometabolic outcomes, safety, treatment burden, and durable access.Pediatric endocrinology and emergency medicine
Pediatric Diabetic Ketoacidosis
Pediatric diabetic ketoacidosis requires rapid confirmation of hyperglycemia, ketonemia, and acidosis; protocolized isotonic fluid resuscitation, potassium replacement, and delayed low-dose intravenous insulin; and intensive neurologic surveillance for cerebral edema while treating the precipitant and preventing recurrence.[21]Endocrinology
Type 1 Diabetes
Type 1 diabetes requires lifelong physiologic insulin replacement, early continuous glucose monitoring, and structured prevention of hypoglycemia and ketoacidosis. Accurate classification—including adult-onset autoimmune disease—guides urgent insulin initiation, technology selection, sick-day planning, and referral for disease-modifying or beta-cell replacement options.Endocrinology
Type 2 Diabetes
Type 2 diabetes management should pair individualized glycemic targets with early selection of therapies that reduce cardiovascular, heart failure, kidney, weight, and hypoglycemia risk—not simply A1C. Reassess medication effectiveness, safety, affordability, and treatment burden every 3–6 months.Endocrinology
Adrenal Insufficiency
Adrenal insufficiency requires rapid recognition of crisis, physiologic glucocorticoid replacement, etiologic localization with ACTH, and assay-aware cortisol interpretation. Distinguish primary disease from central and glucocorticoid-induced suppression because mineralocorticoid replacement, testing strategy, and long-term management differ.Endocrinology
Hypoglycemia
Hypoglycemia requires immediate reversal, identification of medication- and illness-related drivers, and prevention of recurrence. Management differs for an alert patient, a patient requiring assistance, and prolonged events from insulin secretagogues or depleted hepatic glycogen.Endocrinology
Hyperthyroidism
Confirm biochemical thyrotoxicosis, rapidly identify thyroid storm, then distinguish hormone overproduction from destructive or exogenous hormone exposure to select thionamides, definitive therapy, or non-antithyroid management.Endocrinology
Cushing Disease
Confirm persistent endogenous hypercortisolism before localization, then distinguish pituitary ACTH secretion from ectopic ACTH production with pituitary MRI and selective inferior petrosal sinus sampling. Transsphenoidal resection is first-line; recurrent or persistent disease requires individualized multimodal cortisol control.Endocrinology
Cushing Syndrome
Confirm autonomous hypercortisolism before localization, then use ACTH to separate adrenal from pituitary or ectopic disease. Surgical cure is preferred, but urgent cortisol control, source-directed imaging, petrosal sampling, and medical bridging are essential when disease is severe or surgery is not curative.Endocrinology
Hypothyroidism
Use TSH and free T4 to distinguish primary from central hypothyroidism, identify myxedema coma immediately, individualize levothyroxine initiation for cardiovascular risk, and avoid routine treatment of mild persistent subclinical disease in older adults.Endocrinology
Pituitary Hyperplasia in Primary Hypothyroidism
In a patient with pituitary enlargement, markedly elevated TSH with low free thyroxine should redirect management toward primary hypothyroidism. Recognize diffuse thyrotroph hyperplasia, assess mass effect and pituitary axes, replace thyroid hormone, and document regression before considering pituitary surgery.Pediatric Endocrinology
Congenital Hypothyroidism
Manage an abnormal newborn screen as a time-critical thyroid hormone deficiency: confirm with serum testing, begin levothyroxine promptly, monitor free T4 and TSH intensively, and use thyroid imaging to clarify permanence without delaying treatment.Obesity Medicine
Weight Loss Plateau
A weight-loss plateau usually reflects a new energy-balance equilibrium, adaptive reductions in expenditure, increased appetite, or relaxed adherence. Reassess trajectory, intake, activity, medications, body composition, and treatment intensity before changing therapy; use chronic disease escalation when clinically indicated.Endocrinology and Surgical Oncology
Thyroid Cancer
Management hinges on histology, anatomic extent, iodine avidity, and recurrence risk. Use ultrasound-directed staging and pathology to select lobectomy versus total thyroidectomy, reserve radioiodine for appropriate differentiated cancers, and avoid DTC algorithms in medullary disease.Pediatric endocrinology
Androgen Insensitivity Syndrome
Diagnose androgen insensitivity syndrome by confirming a 46,XY DSD, excluding impaired testosterone synthesis, and identifying androgen receptor dysfunction. Management requires phenotype-specific counseling, coordinated DSD expertise, individualized gonadal decision-making, hormone planning, and lifelong attention to bone, sexual, reproductive, and psychosocial health.Endocrinology
Graves Disease
Confirm Graves disease with TSH-receptor antibodies or characteristic diffuse uptake, distinguish it from destructive and nodular thyrotoxicosis, control adrenergic symptoms, then select antithyroid drugs, radioactive iodine, or thyroidectomy according to reproductive plans, orbitopathy, relapse risk, and treatment goals.Endocrinology
Klinefelter Syndrome
Confirm suspected Klinefelter syndrome with chromosome analysis, distinguish primary testicular failure from other hypogonadal states, address fertility before testosterone when relevant, and longitudinally manage hypogonadism alongside metabolic, bone, cardiovascular, reproductive, and psychosocial comorbidity.Medical Genetics and Endocrinology
Turner Syndrome
Confirm suspected Turner syndrome with appropriately extensive cytogenetic analysis, define mosaicism and Y-chromosome material, then initiate phenotype-directed cardiovascular, renal, endocrine, growth, reproductive, hearing, and neurodevelopmental surveillance across the lifespan.Endocrinology
Osteoporosis in Females
A fracture-focused approach to osteoporosis in postmenopausal females: establish treatment eligibility from fragility fracture, DXA, and FRAX; exclude remediable secondary causes; select antiresorptive or bone-forming therapy by fracture risk; and prevent treatment gaps that accelerate bone loss.Endocrinology
17-Hydroxylase Deficiency
Suspect 17-hydroxylase/17,20-lyase deficiency in a patient with hypertension, hypokalemia, absent or incomplete puberty, and deficient sex-steroid production; confirm the CYP17A1-related steroidogenic disorder with targeted biochemical and genetic evaluation.Endocrinology
21-Hydroxylase Deficiency
Diagnose suspected 21-hydroxylase deficiency with properly timed 17-hydroxyprogesterone testing, urgently identify salt-wasting risk in newborns, and use cosyntropin steroid profiling and genotyping to resolve equivocal cases while guiding endocrine management and family counseling.Endocrinology
Vitamin D Deficiency
Use serum 25-hydroxyvitamin D to identify clinically meaningful deficiency, then distinguish low intake or sun exposure from malabsorption, CKD-related mineral disease, phosphate-wasting disorders, and toxicity-prone treatment settings before selecting replacement and monitoring calcium-phosphate physiology.Endocrinology
Acute Hypercalcemia Management
Manage acute hypercalcemia by confirming biologically relevant calcium elevation, assessing severity and volume status, restoring euvolemia, initiating rapid calcium-lowering therapy when indicated, and directing definitive treatment by the PTH-dependent or PTH-independent mechanism.Hospital Medicine and Endocrinology
Inpatient Insulin Regimen Selection
Select insulin by acuity, nutritional reliability, prior diabetes treatment, and glucose trajectory. Use IV insulin for critical illness, scheduled subcutaneous insulin for sustained ward hyperglycemia, and correction-only therapy selectively for new, mild stress hyperglycemia while preventing hypoglycemia during changing intake.Endocrinology
Steroid-Induced Hyperglycemia
Adjust insulin to the glucocorticoid’s timing and glucose pattern, prioritize postprandial surveillance, treat persistent hyperglycemia with scheduled insulin, and reduce insulin promptly as steroid exposure falls to prevent hypoglycemia.Endocrinology
SGLT2 Inhibitor Associated Ketoacidosis
Suspect ketoacidosis—not merely gastrointestinal illness or postoperative stress—in any SGLT2 inhibitor user with nausea, vomiting, abdominal pain, dyspnea, or malaise, regardless of glucose. Confirm with beta-hydroxybutyrate and acid-base testing, stop the drug, and treat as diabetic ketoacidosis with early carbohydrate replacement.Endocrinology and Hospital Medicine
HHS Fluid Management
Manage HHS by restoring intravascular volume before insulin, tracking osmolality and sodium to prevent overly rapid tonicity shifts, replacing potassium as needed, and individualizing crystalloid rate for cardiac or renal vulnerability.Endocrinology
GLP-1 Therapy Adverse Effects
Manage GLP-1 receptor agonist adverse effects by distinguishing expected dose-related gastrointestinal intolerance from pancreatitis, obstruction, gastroparesis, biliary disease, and perioperative aspiration risk. Escalation phase, severe persistent symptoms, and planned anesthesia require targeted medication and procedural decisions.Endocrinology
Thyrotoxicosis Diagnostic Testing
Confirm biochemical thyrotoxicosis with TSH and free thyroid hormones, then distinguish hormone overproduction from destructive or exogenous release using TRAb and uptake-pattern testing to direct definitive management.Endocrinology and Critical Care Medicine
Thyroid Storm Treatment Sequence
Treat suspected thyroid storm as an ICU emergency: resuscitate and treat the trigger while rapidly blocking adrenergic effects, hormone synthesis, hormone release, peripheral conversion, and enterohepatic recirculation in a timed sequence.Endocrinology and Emergency Medicine
Adrenal Crisis
Treat suspected adrenal crisis immediately with parenteral hydrocortisone and isotonic saline; obtain diagnostic blood samples first only if this does not delay therapy. Continue stress-dose glucocorticoid replacement, correct hypoglycemia and electrolyte abnormalities, identify the precipitant, and transition only after hemodynamic and clinical stabilization.Endocrinology
Primary Aldosteronism Screening Interpretation
Interpret primary aldosteronism screening by assessing aldosterone and renin together, accounting for potassium status and medications, then selecting confirmatory testing or direct subtype evaluation when the biochemical phenotype is unequivocal.Endocrinology and Emergency Medicine
Diabetic Ketoacidosis Insulin and Potassium Management
In DKA, insulin reverses ketogenesis but can precipitate fatal hypokalemia. Use beta-hydroxybutyrate and acid-base criteria to guide therapy, withhold insulin when potassium is below 3.5 mEq/L, continue treatment through ketoacidotic resolution, and overlap intravenous with subcutaneous insulin.Endocrinology
DKA Transition to Subcutaneous Insulin
Transition from intravenous to subcutaneous insulin only after ketoacidosis has resolved, oral intake is adequate, and basal insulin timing prevents an interruption in insulin activity. Use a structured overlap, meal-linked prandial dosing, and post-transition glucose surveillance to limit rebound hyperglycemia and recurrent DKA.Endocrinology
Thyroid Nodule Biopsy Thresholds
Use ultrasound risk stratification plus nodule size—not size alone—to select thyroid nodules for ultrasound-guided FNA. ACR TI-RADS reduces biopsy recommendations relative to ATA-based approaches; discordant imaging and cytology should prompt repeat sampling, molecular risk stratification, or diagnostic surgery rather than reassurance.Endocrinology
Adrenal Insufficiency Diagnostic Testing
Test promptly when otherwise unexplained hypotension, volume depletion, hyponatremia, hyperkalemia, abdominal pain, fever, or hypoglycemia raises concern. Draw cortisol and ACTH when feasible, but treat suspected crisis immediately, then use cosyntropin testing and ACTH-directed classification to define primary versus central disease.Endocrinology
Acromegaly
Diagnose acromegaly with age-adjusted IGF-1, resolve equivocal biochemistry selectively with oral glucose testing, localize the source by pituitary MRI, and tailor surgery, medical therapy, radiotherapy, and longitudinal surveillance to tumor anatomy and biochemical control.Endocrinology
Congenital Adrenal Hyperplasia
Evaluate suspected congenital adrenal hyperplasia by urgency and steroid pattern: immediately protect infants at risk for salt-wasting crisis, confirm 21-hydroxylase deficiency with serum 17-hydroxyprogesterone and targeted cosyntropin testing, then use mineralocorticoid replacement, glucocorticoid coverage during physiologic stress, and CYP21A2 testing selectively.Pediatric Endocrinology
Delayed Puberty
Evaluate delayed puberty by separating constitutional and functional delay from central hypogonadism and primary gonadal failure. Growth trajectory, bone age, pubertal examination, LH/FSH, and sex steroids direct targeted evaluation, timed observation, puberty induction, and long-term replacement planning.Endocrinology
Glucagonoma
Suspect glucagonoma when necrolytic migratory erythema, weight loss, diabetes, anemia, or thrombosis coexists with marked fasting hyperglucagonemia. Confirm biochemical syndrome, stage with pancreas-protocol imaging and somatostatin receptor PET, obtain graded tissue diagnosis, and prioritize resection when feasible.Endocrinology
Gynecomastia
Evaluate gynecomastia by separating typical pubertal or drug-related disease from hypogonadism, systemic illness, hormone-secreting tumors, and male breast cancer. Focus testing on atypical, progressive, or unexplained presentations; withdraw reversible exposures and reserve surgery for persistent, consequential disease.Endocrinology
Hashimoto Thyroiditis
Diagnose Hashimoto thyroiditis by integrating TSH/free T4 status with TPO or thyroglobulin antibodies and, when needed, ultrasound; treat thyroid hormone deficiency rather than antibody positivity, optimize levothyroxine administration before escalating dose, and intensify surveillance during pregnancy and postpartum.Endocrinology
Hirsutism
Evaluate hirsutism by tempo, virilization, menstrual pattern, and objective androgen testing. Most cases reflect PCOS or idiopathic hyperandrogenism, but rapid progression, later onset, or marked biochemical androgen excess requires urgent exclusion of adrenal or ovarian neoplasia.Endocrinology
Hyperprolactinemia
Evaluate confirmed prolactin elevation by first excluding pregnancy, medication effects, hypothyroidism, renal or hepatic failure, and assay interference; then use symptom burden, prolactin magnitude, and pituitary MRI findings to distinguish prolactinoma from stalk effect and guide definitive management.Cardiology and Endocrinology
Hypertriglyceridemia
Manage hypertriglyceridemia by separating pancreatitis-risk chylomicronemia from ASCVD-risk elevations, confirming fasting severity, correcting secondary drivers, and applying a triglyceride-specific diet and selected pharmacotherapy while maintaining LDL-C–directed risk reduction.Endocrinology
Hypoparathyroidism
Confirm true hypocalcemia with an inappropriately low PTH, correct reversible magnesium or vitamin D abnormalities, stabilize symptomatic patients promptly, and manage chronic disease to control symptoms without creating hypercalciuria, renal injury, or calcium-phosphate complications.Endocrinology
Hypopituitarism
Evaluate suspected hypopituitarism with paired pituitary-target hormone testing, prioritize central adrenal insufficiency, image structural disease, and replace deficient axes in an order that avoids precipitating adrenal crisis.Endocrinology
Insulinoma
Confirm endogenous hyperinsulinemic hypoglycemia before imaging, then localize and stage for parenchyma-sparing cure when feasible. Persistent or metastatic disease requires continuous hypoglycemia prevention and multidisciplinary tumor-directed therapy selected by resectability and receptor imaging.Endocrinology
Male Hypogonadism
Diagnose male hypogonadism only when compatible clinical features coexist with repeatedly low early-morning testosterone, then use gonadotropins to separate testicular failure from central disease, protect fertility, identify reversible causes, and select monitored testosterone replacement when indicated.Endocrinology
Osteomalacia
Evaluate suspected osteomalacia by separating vitamin D or calcium deficiency from renal phosphate wasting. A low phosphate value requires assessment of renal phosphate handling, vitamin D metabolites, alkaline phosphatase, parathyroid hormone, and targeted evaluation for FGF23-mediated disease or acquired malabsorption.Endocrinology
Pheochromocytoma
Evaluate patients with paroxysmal or resistant hypertension, catecholamine spells, adrenal incidentaloma, or relevant family history using properly collected fractionated metanephrines; localize only after biochemical evidence, then provide alpha blockade, volume expansion, and expert surgical planning for functional disease.Endocrinology
Pituitary Adenoma
Pituitary adenoma management begins by identifying visual or adrenal emergencies, defining hormone secretion and hypopituitarism, and obtaining dedicated sellar imaging. Treatment diverges sharply: dopamine agonist therapy for prolactinoma, transsphenoidal surgery for most other clinically significant tumors, and selective radiation or medical therapy for persistent disease.Endocrinology and Neurosurgery
Pituitary Apoplexy
Pituitary apoplexy requires immediate glucocorticoid coverage, MRI-based confirmation, formal neuro-ophthalmic and endocrine assessment, and urgent transsphenoidal decompression for deteriorating vision, consciousness, or hypothalamic dysfunction. Stable patients without progressive neuro-ophthalmic deficits may undergo closely monitored conservative management.Endocrinology
Postpartum Thyroiditis
Evaluate new postpartum thyroid dysfunction with TSH and free T4, distinguish destructive thyroiditis from Graves disease before prescribing antithyroid drugs, treat symptoms selectively, and reassess hypothyroidism for recovery while planning long-term surveillance and future-pregnancy monitoring.Pediatric Endocrinology
Precocious Puberty
Evaluate early pubertal signs by separating transient or isolated variants from progressive hypothalamic-pituitary-gonadal activation and gonadotropin-independent disease. Age, tempo, growth, bone maturation, gonadotropin testing, and targeted imaging determine who needs observation, etiologic investigation, or GnRH-agonist suppression.Endocrinology
Prediabetes
Identify prediabetes with fasting glucose, HbA1c, or oral glucose tolerance testing; then stratify progression risk by glycemic burden and prioritize structured weight-loss and activity intervention, adding metformin selectively for patients at highest risk of type 2 diabetes.Endocrinology
Primary Hyperparathyroidism
Confirm PTH-dependent hypercalcemia biochemically, exclude familial hypocalciuric hypercalcemia before an operation, assess skeletal and renal involvement, and offer parathyroidectomy as definitive treatment. Use localization imaging for operative planning rather than diagnosis, with medical therapy or surveillance reserved for selected patients.Endocrinology