Endocrine Abstracts

Introduction: The hypothalamus plays a pivotal role in maintaining body temperature.

Insults to the hypothalamus can result in life threatening temperature disturbance.

We describe a case of hypothalamic dysfunction presenting with poikilothermia that was managed with a special portable external heating vest.

Case report: A 31 year old man presented in July 1992 with a subarachnoid hemorrhage which was managed surgically and complicated by secondary hydrocephalus. Other sequelae included cognitive impairment, adipsic diabetes insipidus, hypersomnolence and epilepsy.

He presented with multiple admissions in 1997 with confusion and lethargy. On these admissions, he was noted to have profound hypothermia (30–34  °C).These episodes were complicated by severe electrolyte imbalance due to altered sensorium and reduced fluid intake.

His recurrent admissions correlated with seasonal temperature changes with more frequent admissions during winter months particularly during cold snaps. He was noted to be poikilothermic and his body temperature reflected the surrounding ambient temperature. His conscious level was labile at extremes of temperature (<33 and >35  °C). Endocrine testing revealed adipsic diabetes insipidus and partial anterior pituitary insufficiency.

He was managed with a lightweight electric thermal vest with variable heat adjustment (Chilli Heated Motorcycle Vest). This helped in maintaining his body temperature within a fixed range and reduced the frequency of hospital admissions.

Conclusion: The management of hypothalamic syndromes is challenging. Temperature dysregulation and poikilothermia are rare complications of hypothalamic damage. This case highlights the efficacy of a novel external heating device in achieving and maintaining stable core body temperature and reducing the severity and frequency of hypothermic episodes.