Case Report


A case of acute areflexic, flaccid quadriplegia resulting from acute hypophysitis

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1 Lecturer, Arthur Lok Jack Graduate School of Business and School of Medicine, University of the West Indies Trinidad and Tobago

2 House Officer, Department of Medicine, San Fernando General Hospital Trinidad and Tobago

3 Consultant, Department of Medicine San Fernando Teaching Hospital Trinidad and Tobago

Address correspondence to:

Mandreker Bahall

House #57 LP 62, Calcutta Road Number 3, McBean, Couva, Trinidad,

Trinidad and Tobago

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Article ID: 100953Z01MB2018

doi: 10.5348/100953Z01MB2018CR

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How to cite this article

Bahall M, Bahall K, Teelucksingh JD. A case of acute areflexic, flaccid quadriplegia resulting from acute hypophysitis. Int J Case Rep Images 2018;9:100953Z01MB2018.

ABSTRACT


Introduction: Acute flaccid paralysis, though relatively common, can pose a diagnostic challenge because of its varied etiology.

Case Report: We report a 42-year-old Afro-Caribbean woman whose third and final admission over a 3-week period was because of acute onset quadriparesis. At the final admission, she had flaccid paralysis, no ankle and knee reflexes, and equivocal plantar responses. Investigations revealed severe hypokalemia and hypernatremia, increased creatinine, and low adrenocorticotropic hormone, cortisol, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone. She had marked polyuria and increased plasma osmolality. Atrial natriuretic factor was detected and chest computed tomography showed a dilated esophagus and bilateral acute pulmonary emboli. Magnetic resonance imaging revealed an enlarged 1.2x1.4x1.8 cm pituitary gland showing enhancement, indicating hypophysitis. She was diagnosed with quadriparesis secondary to hypokalemia and neurogenic diabetes insipidus secondary to panhypopituitarism involving the stalk, which is postulated to have resulted from acute hypophysitis. She made a complete recovery following treatment with intravenous potassium, fluids and hormone replacement.

Conclusion: Hypophysitis-induced panhypo-pituitarism with diabetes insipidus remains a rare cause of quadriparesis.

Keywords: Diabetes insipidus, Hypokalemia, Hypophysitis, Quadriplegia

SUPPORTING INFORMATION


Author Contributions:

Mandreker Bahall - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Krishni Bahall - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Joel David Teelucksingh - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Source Of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this case report.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Ethics Approval:

The corresponding author is the guarantor of submission.

Open Access Statement:

© 2018 Mandreker Bahall et al. This article is distributed under the terms of Creative Commons Attrits unrestricted use, distribution andibution License which perm reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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