Endocrine Abstracts

Introduction: Different forms of brain damages in endocrine disease are relatively common. Recently the Hashimoto encephalopathy is more frequent recognised and successfully treated. The diagnosis criteria and treatment options however are still under discussion. On the other hand in neurology are described new pathologic entities, which can occurred also by endocrine patients.

Case: In September 2009 by the 66 years old women with type 2 diabetes and metabolic syndrome was diagnosed hypothyroidism in course of autoimmune thyroiditis with moderately elevated antithyroid antibodies. The hypothyroidism was successfully treated with levothyroxine, but in December 2012 patient was admitted with cognitive decline and impaired mobility. In CT brain metastases are described but the primary focus are not founded. In brain biopsy was found inflammatory infiltration from the T and B lymphocytes and macrophages, reactive gliosis and loss of myelin. After steroids, initially as pulses of 1 g methylprednisolone and then oral prednisonum (60 mg with subsequent reduction) clinical status was improved and in MRI we observed brain damage regressions until almost complete in November 2013. In May 2014 when attempting to further reduce the dose of steroids visual loss occurred on the right eye. The vision returned after pulses of methylprednisolone, which we have repeated in subsequent months. The patient is currently in a stable condition on oral 25 mg prednisone. Diabetes and hypothyroidism are treated effectively. She sees and moves quite well, although she had a depressed mood.

Comments: We have serious doubts regarding the diagnosis. The clinics including a strong dependence on steroids would speak rather for Clippers syndrome, but we cannot exclude pathology associated with thyroiditis, despite the relatively low titre of antibodies. Therefore, we would like to introduce our problem, to the European Endocrinologists in hope for comments and advice.