ECE2023 Eposter Presentations Calcium and Bone (99 abstracts)
Gayet Wernicke’s encephalopathy: An exceptional complication of primary hyperparathyroidism
Mouna Elleuch 1 , Siddiqa Soomauroo 1 , Dhouha Ben Salah 1 , Abdel Mouhaymen Missaoui 1 , Souhir Maalej 1 , Nadia Charfi 1 , Fatma Hamza 2 , Khadijah Moalla 3 , Mouna Mnif 1 , Fatma Mnif 1 , Nabila Rekik Majdoub 1 , Mariem Dammak 3 , Fadhel Guermazi 2 , Faten Hadj Kacem 1 & Mohamed Abid 1
1Hedi Chaker University Hospital, Department of Endocrinology, Sfax, Tunisia; 2Habib Bourguiba University Hospital, Department of Nuclear Medicine, Sfax, Tunisia; 3Habib Bourguiba University Hospital, Department of Neurology, Sfax, Tunisia
Introduction: Gayet Wernicke’s encephalopathy (GWE) is a severe encephalopathy secondary to acute thiamine (vitamin B1) deficiency which may lead to severe sequelae or death if the diagnosis is delayed. We report the first case in the literature of an association between GWE and primary hyperparathyroidism (PHP) in a man.
Observation: He was a 57 years old man, with a personal history of hypertension and primary infertility, who presented with incoercible vomiting, asthenia and fever. Biological finding revealed hypokalaemia (2.7 mmol/l), renal failure (creatinine clearance=29 ml/min), hypophosphaemia (0.45 mmol/l), hypercalcaemia (4.02 mmol/l) with electrical findings on the elctrocardiogram (QT shortening) requiring an emergency haemodialysis session. PHP was diagnosed with a serum parathyroid hormone (PTH) level of 570 pg/ml (8.7 times upper limit of the range). Cervical ultrasound showed a plunging cystic mass with some parietal calcifications, measuring 40×56×90 mm and largely necrotic. Parathyroid MIBI scan showed fixation in the periphery of the mass. Parathyroid carcinoma is the most likely diagnosis. The evolution was marked by the appearance of epileptic seizures, followed by an alteration in his state of consciousness. Cerebral MRI showed bilateral and symmetrical signal abnormalities of the mamillary, hypothalamic, medial thalamic bodies and the periaqueductal white matter and around the third and the fourth ventricule (V3 and V4) in FLAIR hypersignal, moderate Diffusion hypersignal in accordance with an EGW. The patient was treated with intraveinous thiamine followed by oral thiamine 100 mg once daily as maintenance dose with favourable outcome.
Conclusion: Although EGW is a known complication of alcoholism, it should be noted that it can occur regardless of this addiction so as to avoid delaying the diagnosis of a curable cause of hypercalcaemia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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