Endocrine Abstracts

Introduction: Acute hemichorea due to hyperglycemia has been reported in subjects with type 2 diabetes, type 1 diabetes, and a rare type of diabetes, maternally inherited diabetes and deafness. This condition was generally subsided after adequate glycemic control, and the recurrence of hemichorea was rarely reported.

Case report: We comprehensively reviewed clinical presentation and course of hemichorea in five elderly patients with type 2 diabetes (four women and one men). Age was 69–84 years and duration of diabetes was 1–35 years. Initial HbA1c levels were 9.3–13%. They had multiple comorbidities, hypertension (n = 4), dyslipidemia (n = 4), and chronic kidney disease (n = 4). Three patients were previously prescribed insulin but had poor compliance. Four patients undertook brain MRI and one of them performed brain FDG–PET. Three out of four brain MRI showed high signal intensities of putamen in T1–weighted images. FDG–PET scan showed hypometaboism in the corresponding lesions. Metabolic derangement or vascular insufficiency might be the pathophysiology of hemichorea in this case. Duration of hemichorea was various from 10 days to 5 months. All of them were treated with multiple daily insulin injection, and four patients were treated with dopamine–receptor blockers. One patient’s hemichorea was recurred after 2 months from the time when the first event was resolved. This patient was finally diagnosed with vasculitis and followed a grave course after treatment of immunosuppressant.

Discussion and conclusion: The prognosis of hemichorea due to hyperglycemia seemed to be good, and we can easily detect typical brain MRI findings. However, we should consider other cause of hemichorea such as vasculitis when the symptom was recurred after adequate glycemic control.