Endokrine Krisen, postoperative endokrine Störungen

  • A. Lorentz


Bei Störungen des Kohlenhydratstoffwechsels können folgende Komaforrnen auftreten
  • hypoglykämische Krise

  • alkoholische Ketoazidose

  • diabetische Ketoazidose

  • hyperosmolares nichtketoazidotisches Koma

  • biguanidinduzierte Laktatazidose.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


Komata bei Störungen des Kohlenhydratstoffwechsels

  1. Albrink MJ, Hold PM, Man EB et al. (1955) The displacement of serum water by the lipids and hyperlipemic serum; a new method for the rapid determination of serum water. J Clin Invest 34:1483PubMedCrossRefGoogle Scholar
  2. Arieff AI, Carroll HJ (1974) Cerebral edema and depression of sensorium in nonketotic hyperosmolar coma. Diabetes 23:525PubMedGoogle Scholar
  3. Arieff AI, Kleeman CR (1974) Cerebral edema in diabetic comas: II. Effects of hyperosmolality, hyperglycemia and insulin in diabetic rabbits. J Clin Endocrinol Metab 38:1057PubMedCrossRefGoogle Scholar
  4. Arky RA, Freinkel N (1969) Hypoglycemic action of alcohol. In: Sardesai VM (ed) Biochemical and clinical aspects of alcohol metabolism. Thomas, Springfield/IllGoogle Scholar
  5. Berger W, Gries FA, Koschinsky TH, Toeller M (1984) Diabetes mellitus. In: Siegenthaler W, Kaufmann W, Hornbostel H, Waller HD (Hrsg) Lehrbuch der inneren Medizin. Thieme, Stuttgart New YorkGoogle Scholar
  6. Bradley RF (1965) Treatment of diabetic ketoacidosis and coma. Med Clin North Am 49:961Google Scholar
  7. Bradley RF, Bryfogle JW (1956) Survival of diabetic patients after myocardial infarction. Am J Med 20:207PubMedCrossRefGoogle Scholar
  8. Bradley RF, Rees SB (1963) Water, electrolytes and hydrogen ion abnormalities in diabetes mellitus. In: Bland JH (ed) Clinical metabolism of body water and electrolytes. Saunders, Philadelphia, pp 431Google Scholar
  9. Chernow B (1984) Hormonal and metabolic considerations in critical care medicine. In: Shoemaker W, Thompson WL, Holbrook PR (eds) Textbook of critical care. Saunders, Philadelphia London Toronto Mexiko City Rio de Janeiro Sydney TokyoGoogle Scholar
  10. Clements RS Jr, Vourganti B (1978) Fatal diabetic ketoacidosis: Major causes and approaches to their prevention. Diabetes Care 1:314PubMedGoogle Scholar
  11. Cohen AS, Vance VK, Runyan JW Jr et al. (1960) Diabetic acidosis: an evaluation of the cause, course and therapy of 73 cases. Ann Intern Med 52:55PubMedGoogle Scholar
  12. Daniels JC, Chakroverty S, Barron KD (1969) Anacidotic hyperglycemia and focal seizures. Arch Intern Med 124:701PubMedCrossRefGoogle Scholar
  13. Foster DW, McGarry JD (1983) The metabolic derangements and treatment of diabetic ketoacidosis. N Engl J Med 309:159PubMedCrossRefGoogle Scholar
  14. Gries FA, Berchtold P, Puyn U et al. (1987) Diabetes mellitus. In: Krück F, Kaufmann W, Bünte H, Gladtke E, Tölle R (Hrsg) Therapie-Handbuch. Urban & Schwarzenberg, München Wien BaltimoreGoogle Scholar
  15. Katz MA (1973) Hyperglycemia-induced hyponatremia: calculations of expected serum sodium depression. N Engl J Med 289:843PubMedCrossRefGoogle Scholar
  16. Keller U, Berger W (1980) Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetes 29:87PubMedGoogle Scholar
  17. Kleinberger G (1982) Intensivtherapie bei schweren endogenen Stoffwechselstorungen. In: Benzer H, Frey R, Hügin W, Mayrhofer O (Hrsg) Anästhesiologie, Intensivrnedizin und Reanimation. Springer, Berlin Heidelberg New YorkGoogle Scholar
  18. Maccario M, Messis CP (1969) Cerebral edema complicating treated nonketotic hyperglycemia. Lancet II:352CrossRefGoogle Scholar
  19. Miles JM, Rizza RA, Haymond MW et al. (1980) Effects of acute insulin deficiency on glucose and ketone body turnover in man: evidence for the primacy of overproduction of glucose and ketone bodies in the genesis of diabetic ketoacidosis. Diabetes 29:926PubMedGoogle Scholar
  20. Morris L, Murphy M, Kitabchi A (1986) Bicarbonate therapy in severe diabetic ketoacidosis. Ann Int Med 105:836PubMedGoogle Scholar
  21. Paton RC (1981) Haemostatic changes in diabetic coma. Diabetologia 21:172PubMedCrossRefGoogle Scholar
  22. Petrides P, Weiss L, Lömer G, Wieland OH (1985) Diabetis mellitus. Urban & Schwarzenberg, München Wien BaltimoreGoogle Scholar
  23. Rossini AA, Mordes JP (1985) The diabetic comas. In: Rippe JM, Irwin RS, Alpert JS, Dalen JE (eds) Intensive care medicine. Little, Brown, Boston TorontoGoogle Scholar
  24. Wilson HK, Keuer SP, Lea AS et al. (1982) Phosphate therapy in diabetic ketoacidosis. Arch Intern Med 142:517PubMedCrossRefGoogle Scholar

Trauma und cbirurgischer Eingriff bei chronischer Steroidtherapie

  1. Amatruda TT Jr, Hollingsworth DR, D’Espo ND et al. (1960) A study of the mechanism of the steroid withdrawal syndrome. Evidence for integrity of the hypothalamic-pituitary-adrenal-system. J Clin Endocrinol Metab 20:339PubMedCrossRefGoogle Scholar
  2. Aronin N (1985) Approach to the acutely ill patient on chronic steroid therapy. In: Rippe JM, Irwin RS, Alpert JS, Dalen JE (eds) Intensive care medicine. Little, Brown, Boston TorontoGoogle Scholar
  3. Graber AJ, Ney RJ, Nicholson WE et al. (1965) Natural history of pituitary-adrenal recovery following long-term suppression with corticosteroids. J Clin Endocrinol Metab 25:11PubMedCrossRefGoogle Scholar
  4. Hayduk K (1987) Steroidtherapie. In: Krück F, Kaufmann W, Bünte H, Gladtke E, Tolle R (Hrsg) Therapiehandbuch. Urban & Schwarzenberg, München Wien BaltimoreGoogle Scholar
  5. Kaiser H (1977) Cortisonderivate in der Klinik und Praxis. Thieme, StuttgartGoogle Scholar
  6. Kaufmann W, Winkelmann W (1982) Erkrankungen der Nebennieren und Therapie mit Kortikosteroiden. In: Losse H, Gerlach V, Wetzel E (Hrsg) Rationelle Therapie in der inneren Medizin. Thieme, StuttgartGoogle Scholar
  7. Kehlet H, Binder C (1973 a) Value of an ACTH test in assessing hypothalamic-pituitary-adrenocortical function in glucocorticoidtreated patients. Br J Med 1:147CrossRefGoogle Scholar
  8. Kehlet H, Binder C (1973 b) Alteration in distribution volume and biological half-life of cortisol during major surgery. J Clin Endocrinol Metab 36:330PubMedCrossRefGoogle Scholar
  9. Kehlet H, Binder C (1973 c) Adrenocortical function and clinical course during and after surgery in unsupplemented glucocorticoid-treated patients. Br J Anaesth 45:1043PubMedCrossRefGoogle Scholar
  10. Millar RA (1985) Pituitary and adrenal glands in relation to anaesthesia. In: Gray TC, Nunn JF, Utting JE (eds) General anaesthesia. Butterworths, London Boston Singapore Sidney Wollington Duban TorontoGoogle Scholar
  11. Oyama T (1973) Anesthetic management of endocrine disease. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  12. Plumpton FS, Besser GM, Cole PV (1969) Corticosteroid treatment and surgery. 2. The management of steroid cover. Anästhesia 24: 12CrossRefGoogle Scholar
  13. Streck WF, Lockwood DH (1979) Pituitary-adrenal recovery following short term suppression with corticosteroids. Am J Med 66:910PubMedCrossRefGoogle Scholar


  1. Besser GM, Cullen DR, Irvine WJ et al. (1971) Immunoreactive corticotropin levels in adrenocortical insufficiency. Br Med J I:374CrossRefGoogle Scholar
  2. Blizzard RM, Chee D, Davis E (1967) The incidence of adrenal and other antibodies in sera of patients with idiopathic adrenal insufficiency (Addison’s disease). Clin Exp Immunol 2:19PubMedGoogle Scholar
  3. Dluhy RG, Himathongkam T, Greenfield M (1974) Rapid ACTH-test with plasmaaldosteron levels: improved diagnostic discrimination. Ann Intern Med 80:693PubMedGoogle Scholar
  4. Irvine WJ, Barnes EW (1975) Addison’s disease, ovarian failure and hypoparathyroidism. Clin Endocrinol Metab 4:379CrossRefGoogle Scholar
  5. Longcope C (1985) Hypoadrenal crisis. In: Rippe JM, Irwin RS, Alpert JS, Dalen IE (eds) Intensive care medicine. Little, Brown, Boston TorontoGoogle Scholar
  6. Nerup J (1974) Addison’s disease – serological studies. Acta Endocrinol 76:142PubMedGoogle Scholar
  7. Sheridan P, Mattingly D (1975) Simultaneous investigations and treatment of suspected adrenal insufficiency. Lancet II:676CrossRefGoogle Scholar
  8. Stumpe KO (1987) Nebennierenrindeninsuffizienz. In: Krück F, Kaufmann W, Bünte H, Gladtke E, Tölle R (Hrsg) THerapie-Handbuch. Urban & Schwarzenberg, Munchen Wien BaltimoreGoogle Scholar
  9. Vetter H (1984) Nebennieren. In: Siegenthaler W, Kaufmann W, Hornborstel H, Waller HD (Hrsg) Lehrbuch der inneren Medizin. Thieme, Stuttgart New YorkGoogle Scholar

Hyperthyreote Krise

  1. Althoff PH, Neubauer M, Schöffling K (1977) Die hyperthyreoten Krisen – Klinik und Therapie. Notfallmedizin 3:11Google Scholar
  2. Anaissie E, Tohme JF (1985) Reserpine in propranolol-resistant thyroid storm. Arch Intern Med 145:2248PubMedCrossRefGoogle Scholar
  3. Bay V, Engel U (1980) Komplikationen bei Schilddrüsenoperationen. Chirurg 51:91PubMedGoogle Scholar
  4. Bhasin S, Wallace W, Lawrence JB et al. (1981) Sudden death associated with thyroid hormon abuse. Am J Med 71:887PubMedCrossRefGoogle Scholar
  5. Bolte HD (1979) Herzrhythmusstörungen. In: Bolte HD (Hrsg) Therapie mit Beta-Rezeptoren-blockern. Springer, Berlin Heidelberg New YorkGoogle Scholar
  6. Braverman LE, Chiovato L (1985) Thyroid storm. In: Rippe JM, Irwin RS, Alpert JS, Dalen JE (eds) Intensiv care medicine. Little, Brown, Boston TorontoGoogle Scholar
  7. Brooks MH, Waldstein SS (1980) Free thyroxine concentrations in thyroid storm. Ann Intern Med 93:694PubMedGoogle Scholar
  8. Brooks MH, Waldstein SS, Bronsky D et al. (1975) Serum triiodothyronine concentrations in thyroid storm. J Clin Endocrinol Metab 40:339PubMedCrossRefGoogle Scholar
  9. Chopra IJ, Solomon DH, Teco GNC et al. (1980) Inhibition of hepatic outer ring monodeiodination of thyroxine and 3,3’,5’-triiodothyronine by sodium salicylate. Endocrinology 106:1728PubMedCrossRefGoogle Scholar
  10. Croxon MS, Hall TD, Nicoloff JT et al. (1977) Combination drug therapy for treatment of hyperthyroid Graves’ disease. J Clin Endocrinol Metab 45:623CrossRefGoogle Scholar
  11. Derksen RH, van de Wiel A, Poortman J, der Kinderen PJ, Kater L (1984) Plasma-exchange in the treatment of severe thyrotoxicosis in pregnancy. Eur J Obstet Gynecol Reprod Biol 18:139PubMedCrossRefGoogle Scholar
  12. Emrich D, Freyschmidt P, Bay et al. (1977) Therapie der diffusen Schilddrüsenüberfunktion. Ergebnisse der Arbeitstagung der Sektion Schilddrüse der Deutschen Gesellschaft für Endokrinologie (am 2. u. 3.12.1976, Göttingen). Dtsch Med Wochenschr 102:1261PubMedGoogle Scholar
  13. Feely J, Forrest A, Gunn A et al. (1980) Propranolol dosage in thyrotoxicosis. J Clin Endocrinol Metab 51:658PubMedCrossRefGoogle Scholar
  14. Fradkin JE, Wolff J (1983) Jodine-induced thyreotoxicosis. Medicine 62:1PubMedCrossRefGoogle Scholar
  15. Gallagher TF, Hellmann L, Findelstein J, Yoshida K, Waitzmann ED (1972) Hyperthyroidism and cortisol secretion in man. J Clin Endocrinol 34:919CrossRefGoogle Scholar
  16. Geffner DL, Azukizawa M, Hershman JM (1975) Propylthiouracil blocks extrathyroidal conversion of thyroxine to triiodothyronine. J Clin Invest 55:224PubMedCrossRefGoogle Scholar
  17. Heberling HJ, Heilman W, Heintze M, Gauer J, Lohmann D (1981) Erste Erfahrungen mit der Lithiumkurzzeittherapie bei schwerer Thyreotoxikose. Z Gesamte Inn Med 36:704PubMedGoogle Scholar
  18. Hedman I, Tisell LE (1985) Life-threatening hypercalcemia in a case of thyrotoxicosis: clinical features and management. A case report. Acta Chir Scand 151:487PubMedGoogle Scholar
  19. Herrmann J, Kruskemper HL, Grosser KD et al. (1971) Peritonealdialyse in der Behandlung der thyreotoxischen Krise. Dtsch Med Wochenschr 96:742PubMedCrossRefGoogle Scholar
  20. Hintze G, Lepsien G, Becker HD, Koebberling J (1985) Die subtotale Schilddrüsenresektion bei schwerer, jodinduzierter Hyperthyreose. Chirurg 56:594PubMedGoogle Scholar
  21. Ikram H (1977) Haemodynamic effects of beta-adrenergic blockade in hyperthyroid patients with and without heart failure. Br Med J I:1505CrossRefGoogle Scholar
  22. Larsen PR (1972) Salicylate-induced increases in free triiodothyronine in human serum. J Clin Invest 51:1125PubMedCrossRefGoogle Scholar
  23. McDermott MT, Kidd GS, Dodson LE Jr, Hofeldt FD (1983) Radioiodine-induced thyroid storm. Case report and literature review. Am J Med 75:353PubMedCrossRefGoogle Scholar
  24. Mackin JF, Canary JJ, Pittman CS (1974) Thyroid storm and its management. N Engl J Med 291:1396PubMedCrossRefGoogle Scholar
  25. McCallum GT (1971) Thyroid crisis today. Ann Surg 37:521Google Scholar
  26. Ogriseg M, Fill H, Kirchmair W, Stuehlinger W (1981) Plasmafiltrationsbehandlung einer thyreotoxischen Krise. Schweiz Med Wochenschr 111:592PubMedGoogle Scholar
  27. Perrild H, Molholm-Hansen J, Skovsted L et al. (1983) Different effects of propranolol, alprenolol, sotalol, atenolol and metoprolol on serum T3 and serum rT3 in hyperthyroidism. Clin Endocrinol 18:139CrossRefGoogle Scholar
  28. Peterson RF (1958) The influence of the thyroid on adrenal cortical function. J Clin Invest 37:736PubMedCrossRefGoogle Scholar
  29. Schulz F, Schifferdecker E, Althoff PH (1987) Jodinduzierte hyperthyreote Krisen. Fortschr Med 105:48PubMedGoogle Scholar
  30. Tajiri J, Katsuya H, Kiyokawa T, Urata K, Okamoto K, Shimada T (1984) Successful treatment of thyrotoxic crisis with plasma exchange. Crit Care Med 12:536PubMedCrossRefGoogle Scholar
  31. Urbanic RC, Mazzaferri EL (1978) Thyrotoxic crisis and myxedema coma. Heart Lung 7:435PubMedGoogle Scholar
  32. Usadel KH (1985) Zur Problematik jodinduzierter Hyperthyreose. Langenbecks Arch Chir 365:75PubMedCrossRefGoogle Scholar
  33. Verhoeven RP, Visser TJ, Docter R et al. (1977) Plasma thyroxine and 3,3’,5’-triiodothyronine during beta-adrenergic blockade in hyperthyroidism. J Clin Endocrinol Metab 44:1002PubMedCrossRefGoogle Scholar
  34. Wartowsky L, Ransil HJ, Ingbar SH (1970) Inhibition by iodine of the release of thyroxine from the thyroid glands of patients with thyrotoxicosis. J Clin Invest 49:78CrossRefGoogle Scholar
  35. Wünsch C, Heberling HJ (1984) Ergebnisse der Lithiumbehandlung bei schwerer Hyperthyreose. Dtsch Z Verdau Stoffwechselkr 44:26PubMedGoogle Scholar

Hypothyreotes Koma

  1. Ayns JC, Olivero JJ, Fromer JP (1982) Rapid correction of severe hyponatremia with intravenous hypertonic saline solution. Am J Med 72:43CrossRefGoogle Scholar
  2. Catz B, Russell S (1961) Myxedema, shock and coma: seven survival cases. Arch Intern Med 108:407PubMedGoogle Scholar
  3. Chopra IJ, Solom DH, Hepner GW et al. (1979) Misleading low free thyroxine index and usefulness of reverse triiodothyronine measurement in nonthyroidal illnesses. Ann Intern Med 90:905PubMedGoogle Scholar
  4. Emerson C (1985) Myxedema coma. In: Rippe JM, Irwin RS, Alpert JS, Dalen JE (eds) Intensive care medicine. Little, Brown, Boston TorontoGoogle Scholar
  5. Holvey DN, Goodner CJ, Nicoloff JT et al. (1964) Treatment of myxedema coma with intravenous thyroxine. Arch Intern Med 113:89PubMedGoogle Scholar
  6. Kaplan MM, Larsen RP, Crantz FR et al. (1982) Prevalence of abnormal thyroid function test results in patients with acute medical illnesses. Am J Med 72:9PubMedCrossRefGoogle Scholar
  7. Nickerson JF, Hill SR, McNeil JH et al. (1960) Fatal myxedema, with and without coma. Ann Intern Med 53:475PubMedGoogle Scholar
  8. Renler JB (1978) Hypothermia: pathophysiology, clinical settings and management. Ann Intern Med 89:519Google Scholar
  9. Slag MF, Morley JE, Elson MK et al. (1981) Hypothyroxinemia in critical patients as a predictor of high mortality. JAMA 245:43PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • A. Lorentz

There are no affiliations available

Personalised recommendations