Endocrine Abstracts

Central pontine myelinolysis (CPM) is a neurological disorder typically caused by rapid correction of severe chronic hyponatremia. Conditions causing a hyperosmolar state can also cause CPM, but it is rarely seen in diabetes. We report the case of a 33-year-old woman with personal history of Type 1 Diabetes since she was 9 years old with very poor metabolic control (A1hbC 15%) and microvascular complications, who attended the emergency department due to left hemicranial headache for the past 2 days that subsided with the analgesia prescribed in the emergency room. As an incidence laboratory result showed a glycemia of 676mg/dl without ketoacidosis, increased serum osmolality, and normal sodium, so insulin therapy was started in the emergency room and she was discharged the next day asymptomatic with a glycemia of 183mg/dl. She went back to the emergency room 24 h later due to language impairment with difficulty in issuing words. MRI brain demonstrated a symmetric lesion in the central pons with increased signal intensity on T2- and diffusion-weighted images. After neurological consultation and MRI confirmation, the patient was diagnosed with CPM secondary to hyperosmolar hyperglycemia. Twelve-week-follow up with neurology was notable for near-complete resolution of symptoms and MRI alterations. The patient is currently undergoing Endocrinology check-ups with good metabolic control (A1HbC 6.7%) This is a case report of central pontine myelinolysis (CPM) associated with hyperglycemia, which is unique in several aspects: CPM occurred in the setting of uncontrolled hyperglycemia with normal corrected serum sodium and no other electrolyte abnormalities. The presentation was atypical with intermittent symptoms and patient remained alert without corticospinal involvement. Despite the pronounced fluctuations in serum osmolality, central pontine myelinolysis (CPM) is rarely seen in diabetics. This case report of CPM associated with hyperglycemia highlights the importance of adequate blood glucose control in diabetics. CPM can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.