URGÊNCIAS ENDOCRINOLÓGICAS: DIAGNÓSTICO DIFERENCIAL, MANEJO HOSPITALAR E PREVENÇÃO DE COMPLICAÇÕES SISTÊMICAS
DOI:
https://doi.org/10.71248/6arjc189Palavras-chave:
Cetoacidose Diabética, Crise Tireoidiana, Diagnóstico Diferencial, Emergências, Insuficiência AdrenalResumo
As urgências endocrinológicas, como a cetoacidose diabética, o estado hiperglicêmico hiperosmolar, a crise tireotóxica, o coma mixedematoso, a crise adrenal e a apoplexia hipofisária, são condições potencialmente fatais que exigem reconhecimento rápido e manejo hospitalar qualificado. Este estudo teve como objetivo mapear as evidências recentes sobre diagnóstico diferencial, manejo hospitalar e prevenção de complicações sistêmicas nessas condições em adultos. Trata-se de revisão de escopo conduzida segundo o método do Joanna Briggs Institute e o checklist PRISMA-ScR, com busca em outubro de 2026 na PubMed/MEDLINE e na Biblioteca Virtual em Saúde (LILACS e BDENF), abrangendo publicações de 2026. Dos 873 registros identificados, 17 estudos primários foram incluídos, de 13 países, com predomínio de coortes retrospectivas. As crises hiperglicêmicas concentraram a maior parte das evidências. Os achados indicaram que o atraso diagnóstico se associou a maior necessidade de suporte intensivo, que escores clínicos e biomarcadores simples auxiliam a estratificação de risco e que choque, sepse, lesão renal aguda, doença cardiovascular e infecções concomitantes determinaram a mortalidade. Conclui-se que protocolos individualizados, vigilância metabólica e estratégias de prevenção baseadas em educação e continuidade do cuidado são centrais para reduzir complicações.
Referências
ABUJLAMBO, Abdallah et al. Impact of Early Subcutaneous Basal Insulin With Intravenous Insulin Infusion for Diabetic Ketoacidosis and Glycaemic Outcomes: A Systematic Review and Meta-Analysis. Endocrinology, Diabetes & Metabolism, v. 9, n. 4, art. e70277, 2026. DOI: https://doi.org/10.1002/edm2.70277.
AL-RASHEEDI, Mabrouk et al. Knowledge, attitude, and practice of physicians toward the management of diabetic ketoacidosis. Frontiers in Clinical Diabetes and Healthcare, v. 7, art. 1723632, 2026. DOI: https://doi.org/10.3389/fcdhc.2026.1723632.
BABY, Naveen et al. Early use of neutral Protamine Hagedorn (NPH) insulin in the management of diabetic ketoacidosis: an open-label randomized controlled trial in a resource-limited setting. BMC Research Notes, v. 18, n. 1, art. 471, 2025. DOI: https://doi.org/10.1186/s13104-025-07508-5.
BADDOCK, Stephanie et al. Management of diabetic ketoacidosis in adult inpatients: A retrospective analysis of rates of hypoglycaemia with variable-rate and fixed-rate intravenous insulin infusion protocols. Diabetic Medicine, v. 42, n. 7, art. e70063, 2025. DOI: https://doi.org/10.1111/dme.70063.
BHAT, Adnan et al. Electronic Glycemic Management Systems Versus Conventional Insulin Infusion Protocols in Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Non-Randomized Studies. Medicina, v. 62, n. 7, art. 1287, 2026. DOI: https://doi.org/10.3390/medicina62071287.
BIAGETTI, Betina et al. Pituitary Apoplexy: Comorbidities, Management, and Outcomes-A Spanish Observational Multicenter Study. The Journal of Clinical Endocrinology and Metabolism, v. 110, n. 6, p. e1811-e1820, 2025. DOI: https://doi.org/10.1210/clinem/dgae649.
BRITO, Matheus Oliveira; GONÇALVES, Nathalia Santos; BORGES, Viviane Gomes Paixão. Uso prolongado de corticosteroides e supressão adrenal. Nursing (São Paulo), v. 32, n. 340, p. 21796-21800, 2026. Disponível em: https://www.revistanursing.com.br/index.php/revistanursing/article/view/5103/6356.
CHANDRABALAN, Vishnu et al. Diabetic ketoacidosis in patients with type 2 diabetes: Risk factors for mortality and adverse outcomes. World Journal of Experimental Medicine, v. 16, n. 1, art. 117464, 2026. DOI: https://doi.org/10.5493/wjem.v16.i1.117464.
CHANTRAPITAK, Pakpoom et al. Prognostic factors and prognostic risk score of 30-day all-cause mortality in thyroid storm. BMC Endocrine Disorders, v. 26, n. 1, art. 290, 2026. DOI: https://doi.org/10.1186/s12902-026-02348-1.
CHIA, Jia Ee et al. Age and sex differences in diabetic ketoacidosis outcomes in type 1 diabetes: a national cohort study. BMJ Open Diabetes Research & Care, v. 14, n. 1, art. e005817, 2026. DOI: https://doi.org/10.1136/bmjdrc-2025-005817.
CHIA, Jia Ee et al. COVID-19 and diabetic ketoacidosis: National outcomes, predictors, and resource utilization in the United States. Journal of Diabetes Investigation, v. 17, n. 3, p. 535-541, 2026. DOI: https://doi.org/10.1111/jdi.70217.
CHO, Eunae et al. Incidence and Predictors of Acute Pancreatitis in Patients With Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS): A Multicenter Retrospective Study. Endocrine Practice, v. 32, n. 9, p. 1369-1377, 2026. DOI: https://doi.org/10.1016/j.eprac.2026.04.015.
CIAFARDINI, A et al. Diabetic Ketoacidosis: Considerations and Residual Controversies in Management After the 2024 ADA, EASD, JBDS, AACE, and DST Joint Consensus. Endocrine, Metabolic & Immune Disorders – Drug Targets, v. 26, art. e18715303374972, 2026. DOI: https://doi.org/10.2174/0118715303374972250407065308.
FATIMA, Samar et al. Threshold-based compliance with diabetic ketoacidosis management protocols and its association with inpatient mortality: a retrospective single-centre study in a tertiary hospital in Karachi, Pakistan. BMJ Open, v. 15, n. 7, art. e102173, 2025. DOI: https://doi.org/10.1136/bmjopen-2025-102173.
GRANADINO POZO, Juan Osvaldo; SOLAR POBLETE, María Paz del. Perfil epidemiológico, distribución geográfica y tendencias de hospitalización por coma mixedematoso en Chile: estudio nacional 2015-2024. Revista Chilena de Endocrinología y Diabetes, v. 19, n. 3, p. 124-129, 2026. Disponível em: https://www.revistasoched.cl/3_2026/3.pdf.
HASHMI, Mariam et al. Navigating Thyroid Crises: A Nationwide Analysis of the Weekend Effect and Mortality Trends in Myxedema Coma (2016-2020). Journal of Community Hospital Internal Medicine Perspectives, v. 15, n. 2, p. 6-13, 2025. DOI: https://doi.org/10.55729/2000-9666.1423.
HOSHIYAMA, Ayako et al. Disseminated intravascular coagulation as a frequent and critical complication of thyroid storm: a single-center retrospective survey. Endocrine Journal, v. 72, n. 6, p. 719-726, 2025. DOI: https://doi.org/10.1507/endocrj.EJ24-0542.
KAWAHARA, Tetsuya et al. Determinants of diagnostic delay in thyroid storm: a 12-year single-center cohort study. Journal of the Endocrine Society, v. 10, n. 5, art. bvag088, 2026. DOI: https://doi.org/10.1210/jendso/bvag088.
KEW, Tania M et al. Identifying interhospital variation in hyperosmolar hyperglycemic syndrome (HHS) care: development and outcomes of the DEKODE HHS model. BMJ Open Diabetes Research & Care, v. 13, n. 6, art. e005489, 2025. DOI: https://doi.org/10.1136/bmjdrc-2025-005489.
LIAN, Zi Yang et al. Metabolic Complications During the Initial Management of Diabetic Ketoacidosis According to Diabetes Type in a Single Tertiary Centre in Malaysia. Cureus, v. 18, n. 1, art. e101129, 2026. DOI: https://doi.org/10.7759/cureus.101129.
MASOOD, Ubair et al. Management of Diabetic Ketoacidosis in Remote and Resource-constrained Settings in India. Annals of African Medicine, 2026. DOI: https://doi.org/10.4103/aam.aam_834_26.
MATSUO, Yuichiro et al. Potassium Iodide Use and Patient Outcomes for Thyroid Storm: An Observational Study. The Journal of Clinical Endocrinology and Metabolism, v. 110, n. 2, p. e310-e320, 2025. DOI: https://doi.org/10.1210/clinem/dgae187.
MIYAZAKI, Reina et al. Severity and Clinical Outcomes Among ICU Patients With Diabetic Ketoacidosis: An Analysis of the Japanese Intensive Care Patient Database. Critical Care Explorations, v. 8, n. 8, art. e1449, 2026. DOI: https://doi.org/10.1097/CCE.0000000000001449.
MOHAMED, Rania Al Sayed Abd Albaky et al. Clinical characteristics and outcomes of diabetic ketoacidosis in patients with type 2 diabetes during acute systemic stress. Cardiovascular Diabetology – Endocrinology Reports, v. 12, n. 1, art. 28, 2026. DOI: https://doi.org/10.1186/s40842-026-00293-5.
PEAMYAO, Wanwisa et al. Predictive Factors for Diagnosing Diabetic Ketoacidosis or Simple Hyperglycemia in Adults With High Blood Glucose: The "1-DKA Alert" Study. Journal of Clinical Medicine Research, v. 17, n. 3, p. 164-173, 2025. DOI: https://doi.org/10.14740/jocmr6180.
RESNICK, Ortal; MATALKA, Leen; FOSTER, Christy. Bridging the gap in adrenal crisis management: a pilot simulation-based pre post educational intervention to improve resident knowledge. BMC Medical Education, v. 26, n. 1, art. 1633, 2026. DOI: https://doi.org/10.1186/s12909-026-09924-y.
SEBASTIAN-VALLES, Fernando et al. Pre- and in-hospital lactate ratio as a predictor of mortality in severe diabetic ketoacidosis: a multicenter prospective cohort study. European Journal of Internal Medicine, v. 146, art. 106706, 2026. DOI: https://doi.org/10.1016/j.ejim.2026.106706.
SHEGENE, Birhanu et al. Predictors of hyperosmolar hyperglycemic state among adult type 1 and type 2 diabetes mellitus patients at public hospitals in Harari region, Eastern Ethiopia: A survival analysis. Journal of Public Health Research, v. 15, n. 2, art. 22799036261456356, 2026. DOI: https://doi.org/10.1177/22799036261456356.
SOTHORNWIT, Jin et al. Epidemiology and mortality rate of thyroid storm in Thailand: Analysis using a national in-patient database. PLOS ONE, v. 21, n. 8, art. e0357142, 2026. DOI: https://doi.org/10.1371/journal.pone.0357142.
STOKLAND, Ann-Elin Meling et al. Risk and outcomes of adrenal crisis in primary adrenal insufficiency: Evidence from a 24-year nationwide cohort study. Journal of Internal Medicine, v. 300, n. 5, p. 675-688, 2026. DOI: https://doi.org/10.1111/joim.70153.
TAYLOR, Peter et al. Management of endocrine emergencies: joint consensus statement for management of myxoedema coma. European Thyroid Journal, v. 15, n. 4, art. ETJ260044, 2026. DOI: https://doi.org/10.1530/ETJ-26-0044.
TAYLOR, Peter et al. Management of thyroid emergencies: joint consensus statement on management of thyroid storm. European Thyroid Journal, v. 15, n. 4, art. ETJ260043, 2026. DOI: https://doi.org/10.1530/ETJ-26-0043.
THAKUR, Rahul et al. Diabetic and Nondiabetic Endocrine Emergencies: Clinical Spectrum and Outcomes From a Tertiary Care Center in North India. AACE Endocrinology and Diabetes, v. 13, n. 1, p. 46-54, 2026. DOI: https://doi.org/10.1016/j.aed.2025.09.003.
THAMMAKOSOL, Kitti et al. Early insulin degludec with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial. Diabetes, Obesity and Metabolism, v. 27, n. 12, p. 7020-7029, 2025. DOI: https://doi.org/10.1111/dom.70101.
TIAN, Binbin et al. Aspiration pneumonia in diabetic ketoacidosis: a decade-long analysis of occurrence , associated risk factors and clinical outcomes in 530,700 US hospitalizations. Diabetology & Metabolic Syndrome, v. 17, n. 1, art. 395, 2025. DOI: https://doi.org/10.1186/s13098-025-01972-6.
UWUMIRO, Fidelis et al. National Trends in US Hospitalizations and Outcomes of Thyrotoxicosis With and Without Thyrotoxic Storm, 2016 to 2020. The Journal of Clinical Endocrinology and Metabolism, v. 110, n. 11, p. 3084-3096, 2025. DOI: https://doi.org/10.1210/clinem/dgaf150.
XU, Rui et al. Metabolomics identifies candidate diagnostic biomarkers for pituitary apoplexy. Frontiers in Endocrinology, v. 17, art. 1879303, 2026. DOI: https://doi.org/10.3389/fendo.2026.1879303.
ZHANG, Yue et al. Real-world insights from acute management of potassium disorders in diabetic ketoacidosis. Frontiers in Endocrinology, v. 16, art. 1669400, 2025. DOI: https://doi.org/10.3389/fendo.2025.1669400.
ZHU, Xianying et al. Association of cerebrovascular disease with adverse outcomes in patients with diabetic ketoacidosis. Endocrine Connections, v. 15, n. 1, art. e250870, 2026. DOI: https://doi.org/10.1530/EC-25-0870.
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