Endocrine Abstracts

Introduction/aim: Neurological symptoms are rarely related to decompensated type 2 diabetes mellitus. However, thanks to complementary tests, we can identify this association more easily.

Material and method: Review of the patient’s clinical record and the relevant literature.

Results: A 76-year old man complained in the last year of a progressive, involuntary and disabling movement disorder consisting in hemichorea of the left upper and lower limbs. He presented psychotic thoughts, cognitive impairment, as well as moderate weight loss. He had a clinical history for more than 10 years of a poorly controlled type 2 diabetes mellitus (haemoglobin A1c 14.4%) treated only with 20 units of glargine insulin daily, moreover with irregular adherence. No diabetic complications had been described. He also suffered from dyslipidaemia without pharmacological treatment, anxiety and depressive disorder, subclinical hypothyroidism, a lack of self-care, and a smoking habit. His medication included omeprazole 20 mg per day and atenolol 50 mg per day. In the lab test there was nothing remarkable, apart from high glucose levels (around 200–300 mg/dl), and low total plasmatic protein concentration (5.67 g/dl). Tests for HIV and drugs were negative. An MRI of the brain showed high signal intensity of right-basal ganglia on T1-weighted images, in particular on putamen, which could be associated with a case of non-ketotic hyperglycemia-induced hemichorea. Once the right treatment for his diabetes was established (20 UI glargine insulin, plus 12 units in total of insulin aspart daily) and his capillary glucose levels were in range, the choreiform movements gradually improved until they were completely absent.

Conclusions: When considering neurological disorders, we rarely associate those with diabetes mellitus; however, sometimes we must think out of the box to reach the correct diagnosis. Although there haven’t been many confirmed cases until now, we should include non-ketotic hyperglycemia in the differential diagnosis of acute movement disorders such as chorea.