Endokrine Funktionsstörungen können sowohl durch eine Autonomie als auch eine Insuffizienz
der glandulären Hormonproduktion oder durch hormonelle Wechselwirkungen zu Elektrolytentgleisungen
führen. Im Folgenden werden die häufigsten Elektrolytstörungen in der internistischen
Notfallmedizin im Kontext von endokrinologischen Krankheitsbildern vorgestellt.
Abstract
Background Electrolyte disorders are among the most frequent presentations in emergency internal
medicine and may represent initial manifestations of underlying endocrine disease.
This review highlights the pathophysiological background, diagnostic strategies and
therapeutic recommendations for electrolyte imbalances in endocrine emergencies.
Content Hyponatremia still marks the most prevalent electrolyte disorder and may indicate
underlying adrenal insufficiency, hypopituitarism, the syndrome of inappropriate antidiuresis
(SIAD), or immunotherapy-induced endocrinopathies. The diagnostic evaluation includes
clinical volume assessment and paired measurements of serum and urine sodium and osmolality.
Acute symptomatic hyponatremia requires immediate correction using hypertonic saline,
overcorrection can be avoided by using proactive or reactive desmopressin protocols.
SIAD remains a diagnosis of exclusion, with fluid restriction remaining first-line
therapy and osmotic agents and tolvaptan as second-line options. Hypernatremia may
occur in the context of diabetes insipidus and requires careful fluid management and,
in central forms, desmopressin substitution. Hypokalemia can result from hyperaldosteronism
or hypercortisolism and should prompt endocrine evaluation, especially in patients
with hypertension. Hypercalcemia is frequently caused by hyperparathyroidism but may
also be present in thyrotoxicosis, adrenal insufficiency or due to excessive intake
of cholecalciferol or lithium.
Conclusion Electrolyte disturbances may serve as important clinical indicators and red flags
of endocrine disorders. Early recognition and targeted diagnostic and therapeutic
strategies are essential to prevent life-threatening complications. This review provides
a structured approach for clinicians to evaluate and manage electrolyte disorders
with a focus on endocrine etiologies in acute care settings.
Schlüsselwörter
endokrinologische Notfälle - Elektrolytstörungen - Hyponatriämie - SIAD - Hyperkalzämie
Keywords
endocrine emergencies - electrolyte disorders - hyponatremia - SIAD - hypercalcemia
