Endocrine Causes of Altered Mental Status
Single Most Likely Diagnosis
- Diabetic Ketoacidosis (DKA): This condition is a common and serious complication of diabetes that can lead to altered mental status due to severe hyperglycemia, metabolic acidosis, and dehydration. The altered mental status can range from mild confusion to coma.
Other Likely Diagnoses
- Hypothyroidism: Severe, untreated hypothyroidism can lead to myxedema coma, a life-threatening condition characterized by altered mental status, hypothermia, and respiratory depression.
- Hyperthyroidism: Thyrotoxic crisis, a severe form of hyperthyroidism, can cause altered mental status, including confusion, agitation, and even coma, due to the excessive levels of thyroid hormones.
- Adrenal Insufficiency: Addisonian crisis, a severe form of adrenal insufficiency, can lead to altered mental status, hypotension, and shock due to the lack of cortisol and aldosterone.
- Hyperparathyroidism: Severe hypercalcemia caused by hyperparathyroidism can lead to altered mental status, including confusion, lethargy, and coma.
Do Not Miss Diagnoses
- Pheochromocytoma: Although rare, pheochromocytoma can cause episodic hypertension, tachycardia, and altered mental status due to the excessive release of catecholamines. Missing this diagnosis can be fatal.
- Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, thyroid storm can cause altered mental status, fever, tachycardia, and cardiac arrhythmias.
- Adrenal Crisis: Missing an adrenal crisis can be fatal, as it requires immediate treatment with corticosteroids to prevent shock and death.
Rare Diagnoses
- Hypoparathyroidism: Severe hypocalcemia caused by hypoparathyroidism can lead to altered mental status, including confusion, seizures, and tetany.
- Multiple Endocrine Neoplasia (MEN) Syndromes: Although rare, MEN syndromes can cause a variety of endocrine disorders, including hyperparathyroidism, pheochromocytoma, and pancreatic neuroendocrine tumors, which can lead to altered mental status.
- Cushing's Syndrome: Endogenous Cushing's syndrome, caused by excessive cortisol production, can lead to altered mental status, including depression, anxiety, and cognitive impairment.