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Critical Care Endocrinology

  • Kecha A. LynShue
  • Mark A. Sperling
Chapter

Abstract

Endocrine emergencies may present as isolated occurrences, as the initial manifestation of an endocrine disorder or as an acute decompensation in the condition of a child with a known endocrine disease, the result of non-compliance with medication or stress of intercurrent illness. Signs and symptoms of endocrine disorders are non-specific and may include altered level of consciousness, respiratory changes and alterations in muscle tone. A history of poor feeding, vomiting, weight loss or lethargy may also be elicited. When evaluating a child with a suspected endocrinologic abnormality, it is imperative to obtain baseline laboratory samples prior to treatment such that the proper diagnosis and treatment can ultimately be determined.

Keywords

Thyroid Hormone Thyroid Stimulate Hormone Cerebral Edema Adrenal Insufficiency Congenital Adrenal Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work is supported in part by NIH training grants, DK97729 and 5 T32DK063686 and by the Renziehausen Foundation

Suggested Readings

  1. Albert SG, DeLeon MJ, Silverberg AB. Possible association between high-dose fluconazole and adrenal insufficiency in critically ill patients. Crit Care Med. 2001;29:668–70.PubMedCrossRefGoogle Scholar
  2. Bone M, Diver, M Selby A, et al. Assessment of adrenal function in the initial phase of meningococcal disease. 2002;110:563–9.PubMedCrossRefGoogle Scholar
  3. Bravo EL. Pheochromocytoma: an approach to antihypertensive ­management. Ann N Y Acad Sci. 2002;970:1–10.CrossRefGoogle Scholar
  4. Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev. 2003;24:539–53.PubMedCrossRefGoogle Scholar
  5. Casartelli CH, Garcia PC, Piva JP, Branco RG. Adrenal insufficiency in children with septic shock. J Pediatr. 2003;79:S169–76.CrossRefGoogle Scholar
  6. Chugani HT. A critical period of brain development: studies of cerebral glucose utilization with PET. Prev Med. 1998;27:184–8.PubMedCrossRefGoogle Scholar
  7. Duck SC, Wyatt DT. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr. 1988;113:10–4.PubMedCrossRefGoogle Scholar
  8. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics. 2004;113:e133–40.PubMedCrossRefGoogle Scholar
  9. Egi M, Bellomo R, Stachowski E, et al. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc. 2010;85:217–24.PubMedCrossRefGoogle Scholar
  10. Ein SH, Pullerits J, Creighton R, Balfe JW. Pediatric pheochromocytoma. A 36-year review. Pediatr Surg Int. 1997;12:595–8.PubMedGoogle Scholar
  11. Finfer S, Chittock DR, Su SY, NICE-SUGAR Study Investigators, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.PubMedCrossRefGoogle Scholar
  12. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264–9.PubMedCrossRefGoogle Scholar
  13. Hale PM, Rezvani I, Braunstein AW, Lipman TH, Martinez N, Garibaldi L. Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes. Acta Paediatr. 1997;86:626–31.PubMedCrossRefGoogle Scholar
  14. Hansen TK, Thiel S, Wouters PJ, et al. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels. J Clin Endocrinol Metab. 2003;88:1082–8.PubMedCrossRefGoogle Scholar
  15. Harris GD, Fiordalisi I, Harris WL, Mosovich LL, Finberg L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study. J Pediatr. 1990;117:22–31.PubMedCrossRefGoogle Scholar
  16. Hatherill M, Tibby SM, Hilliard T, Turner C, Murdoch IA. Adrenal insufficiency in septic shock. Arch Dis Child. 1999;80:51–5.PubMedCrossRefGoogle Scholar
  17. Hussain K, Cosgrove K. From congenital hyperinsulinism to diabetes mellitus: the role of pancreatic beta-cell K-ATP channels. Pediatr Diabetes. 2005;6:103–13.PubMedCrossRefGoogle Scholar
  18. Mahoney CP, Vlcek BW, DelAguila M. Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol. 1999;21:721–7.PubMedCrossRefGoogle Scholar
  19. Menon K, Clarson C. Adrenal function in pediatric critical illness. Pediatr Crit Care Med. 2002;3:112–6.PubMedCrossRefGoogle Scholar
  20. Miller W. The adrenal cortex. In: Sperling M, editor. Pediatric endocrinology. 2nd ed. Philadelphia: Saunders; 2002.Google Scholar
  21. Mittendorf EA, McHenry CR. Complications and sequelae of thyroidectomy and an analysis of surgeon experience and outcome. Surg Technol Int. 2004;12:152–7.PubMedGoogle Scholar
  22. Muglia L, Majzoub J. Disorders of the posterior pituitary. In: Sperling M, editor. Pediatric endocrinology. 2nd ed. Philadelphia: Saunders; 2002. p. 289–322.Google Scholar
  23. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.PubMedCrossRefGoogle Scholar
  24. Reid S, McQuillan S, Losek J. Hypoglycemia complicating dehydration due to acute gastroenteritis. Clin Pediatr. 2003;42:641–6.CrossRefGoogle Scholar
  25. Rickert CH, Paulus W. Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Childs Nerv Syst. 2001;17:503–11.PubMedCrossRefGoogle Scholar
  26. Rivkees S. Radioactive iodine use in childhood Graves’ disease: time to wake up and smell the I-131. J Clin Endocrinol Metab. 2004;89:4227–8.PubMedCrossRefGoogle Scholar
  27. Rivkees SA, Sklar C, Freemark M. Clinical review 99: the management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab. 1998;83:3767–76.PubMedCrossRefGoogle Scholar
  28. Shoback D, Marcus R, Bikle D. Metabolic bone disease. In: Greenspan F, Gardner D, editors. Basic & clinical endocrinology. 7th ed. Lange Medical Books/McGraw-Hill: New York; 2004. p. 295–359.Google Scholar
  29. Sperling MA. Pediatric endocrinology. 2nd ed. Philadelphia: Saunders; 2002.Google Scholar
  30. Sperling MA, Menon RK. Hyperinsulinemic hypoglycemia of infancy. Recent insights into ATP-sensitive potassium channels, sulfonylurea receptors, molecular mechanisms, and treatment. Endocrinol Metab Clin North Am. 1999;28:695–708, vii.PubMedCrossRefGoogle Scholar
  31. Sperling M, Menon R. Differential diagnosis and management of neonatal hypoglycemia. Pediatr Clin North Am. 2004;51:703–23.PubMedCrossRefGoogle Scholar
  32. Srinivasan V, Spinella PC, Drott HR, et al. Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med. 2004;5:329–36.PubMedCrossRefGoogle Scholar
  33. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.PubMedCrossRefGoogle Scholar
  34. Van den Berghe G, Wilmer A, Milants I, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006a;55:3151–9.PubMedCrossRefGoogle Scholar
  35. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006b;354:449–61.PubMedCrossRefGoogle Scholar
  36. Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373:547–56.PubMedCrossRefGoogle Scholar
  37. Weise M, Merke D, Pacak K, et al. Utility of plasma free metanephrines for detecting childhood pheochromocytoma. J Clin Endocrinol Metab. 2002;87:1955–60.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Kecha A. LynShue
    • 1
  • Mark A. Sperling
    • 2
  1. 1.Pediatric Endocrinology, Department of Pediatrics, Carolinas Medical Center-NortheastJeff Gordon Children’s HospitalConcordUSA
  2. 2.Endocrinology, Metabolism and Diabetes Mellitus, Department of PediatricsUniversity of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMCPittsburghUSA

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