Endocrine Emergencies Answers 531triggered by infection, trauma, myocardial infarction, stroke, or noncompli-
ance with anti-hyperthyroid medications. Thyroid storm is a clinical diagno-
sis. The signs and symptoms of this disorder reflect an overactive sympathetic
system and include fever, tachycardia out of the proportion to the fever, GI
symptoms, and altered mental status. Patients may also develop high-output
heart failure. The clue to the diagnosis in this case is the patient’s known
hyperthyroidism.
Pheochromocytoma (a)presents with a similar hyperadrenergic state
caused by a catecholamine-secreting tumor but does not result in altered
mentation. The hallmark of this disease is hypertension associated with
headache, palpitations, and diaphoresis. Cocaine (b)acts as a CNS stimu-
lant by blocking reuptake of excitatory neurotransmitters norepinephrine,
dopamine, and serotonin. It is, however, less likely than thyroid storm in
this patient given her underlying hyperthyroidism and pulmonary infec-
tion. Heat stroke (c)should be suspected in patients with core body tem-
perature > 104°F (> 40°C) and altered mental status. Neuroleptic malignant
syndrome (e) is a rare life-threatening reaction to a medication with
dopamine receptor antagonism. Such medications include neuroleptics,
such as haloperidol, clozapine, and risperidone, lithium and many antiemetics,
such as prochlorperazine, promethazine, and metoclopramide. The syndrome
presents as fever, altered mental status, and muscular rigidity.