Dear Colleagues,
Endocrine emergencies are a collection of rare and extreme manifestations of common endocrine disorders that are often triggered by an inciting event, such as an acute infection. An endocrine emergency may be the first presentation of an underlying endocrine disorder. The neurologic and systemic complications of endocrine disorders generally worsen with increasing severity of the endocrine dysfunction. The systemic effects of hormones extend to the nervous system. As a consequence, these conditions can present with neurological complications that manifest in the majority of cases with delirium, seizures, and coma, or as specific and peculiar syndromes such as hemichorea, hemiballism, and epilepsia partialis continua. The severity of these conditions often necessitates management in the intensive care unit. They require substantial supportive care in addition to specific targeted therapy to correct the hormonal metabolic abnormalities, while at the same time blocking hormonal activity in cases of excessive function, or supplementing hormonal deficiencies. Endocrine emergencies and their neurological complications are rare. Prompt diagnosis is very important in order to quickly start treatment and thus avoid morbidity and mortality, which can be very high. One of the neuroendocrine disorders is pituitary apoplexy, a rare endocrine emergency that can occur due to infarction or haemorrhage of the pituitary gland. This disorder often involves a pituitary adenoma and may be the first manifestation of an underlying adenoma. Adrenal crisis, also termed acute adrenal insufficiency, is an acute life-threatening condition that remains a significant cause of death in patients with adrenal insufficiency. This condition is an endocrine emergency precipitated by an internal or external process. It occurs in the setting of a known or unknown lack of production of the adrenal hormone cortisol. Myxedema coma represents the extreme degree of severity of hypothyroidism. It has a high incidence of mortality and is therefore a true medical emergency. In general, the development of myxedema coma is associated with the presence of a triggering factor in a controlled hypothyroid patient and manifests with multisystem alterations. Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis. The aim of this special issue is to help clinicians in the setting of emergency medicine to promptly recognize, diagnose and treat endocrine emergencies and their neurological manifestations. Timely and appropriate therapy based on current guidelines can prevent the need for intensive care, as well as reducing mortality and long-term complications.
MARIA SOFIA COTELLI
Guest Editor
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