Endocrinology Pathways

Step-up pharmacotherapy for T2DM — NICE NG28 individualised approach with HbA1c targets

Diagnosis and treatment of hyperthyroidism — Graves', toxic nodule, thyroiditis

Diagnosis and management of adrenal insufficiency including sick-day rules and adrenal crisis

Emergency management of pituitary apoplexy — haemorrhage or infarction of pituitary adenoma

Diagnosis and treatment of hypercalcaemia — PTH-mediated vs malignancy

Hyperosmolar Hyperglycaemic State (HHS) clinical pathway.

Thyroid Storm clinical pathway.

Decompensated severe hypothyroidism — hypothermia, hypotension, hypoventilation, ALOC. IV levothyroxine + hydrocortisone, supportive care.

Workup with metanephrines, alpha-blockade BEFORE beta-blocker, surgery; manage crisis with phentolamine.

Confirm hypercortisolism (LDDST, urinary cortisol, late-night salivary), distinguish ACTH-dependent vs independent, localise source.

Common cause of resistant hypertension — screen aldosterone:renin ratio, confirm with saline suppression, lateralise with adrenal vein sampling.

Anterior + posterior pituitary deficiencies — prioritise cortisol replacement first, then thyroid, sex steroids, GH, ADH; sick-day rules.

Confirm true hyperprolactinaemia, exclude drug/secondary, MRI, dopamine agonist (cabergoline) first-line.

Recognise tetany, ECG changes, IV calcium gluconate, identify cause (vitamin D, hypoparathyroidism, hyperphosphataemia, drugs).

Diagnosis (IGF-1, OGTT GH suppression), pituitary MRI, transsphenoidal surgery first-line, somatostatin analogues / pegvisomant, comorbidity management.

Schwartz-Bartter criteria, identify cause (CNS, pulmonary, drugs, malignancy), fluid restriction, salt + urea, tolvaptan.

Polyuria + polydipsia with low urine osmolality — water deprivation test, distinguish central vs nephrogenic, desmopressin (central) or thiazide (nephrogenic).

Rotterdam criteria, exclude differentials, lifestyle + metformin / OCP / clomiphene / letrozole, screen for cardiometabolic risk.

Confirm with TSH + fT4 + TPO antibody, levothyroxine titration, special situations (pregnancy, elderly, ischaemic heart disease).