Ishii Makoto
Continuum (Minneap Minn). 2017 Jun;23(3, Neurology of Systemic Disease):778-801. doi: 10.1212/CON.0000000000000467.
This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities.
To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. A 2015 prospective study in patients with adrenal insufficiency found a significant number of adrenal crisis-related deaths despite all study patients receiving standard care and being educated on crisis prevention strategies, highlighting that current prevention strategies and medical management remain suboptimal.
Early diagnosis and prompt treatment of endocrine emergencies are essential but remain challenging because of a lack of objective diagnostic tools. The optimal management is also unclear as prospective and randomized studies are lacking. Additional research is needed for these clinical syndromes that can be fatal despite intensive medical intervention.
本文概述了具有潜在毁灭性神经表现的内分泌急症，若不治疗可能会致命。文中讨论了垂体卒中、肾上腺危象、黏液性水肿昏迷、甲状腺风暴、急性高钙血症和低钙血症、高血糖急症（糖尿病酮症酸中毒和高血糖高渗状态）以及急性低血糖症，重点在于识别其体征和症状以及对这些临床病症进行诊断和管理。
为确定内分泌急症的最佳管理方法，在未来的前瞻性研究中，使用正式的临床诊断标准和分级量表（如最近针对垂体卒中提出的那些）将是有益的。2015年一项针对肾上腺功能不全患者的前瞻性研究发现，尽管所有研究患者都接受了标准治疗并接受了危机预防策略教育，但仍有相当数量与肾上腺危象相关的死亡病例，这突出表明当前的预防策略和医疗管理仍不尽人意。
内分泌急症的早期诊断和及时治疗至关重要，但由于缺乏客观的诊断工具，仍然具有挑战性。由于缺乏前瞻性和随机研究，最佳管理方法也不明确。对于这些尽管经过强化医疗干预仍可能致命的临床综合征，还需要进行更多研究。
