Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism.

Autor:	Díaz-Fontenla F; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Castillo-Pradillo M; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Díaz-Gómez A; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Ibañez-Samaniego L; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Gancedo P; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Guzmán-de-Villoria JA; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Fernández-García P; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., Bañares-Cañizares R; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain., García-Martínez R; Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Rafael Bañares-Cañizares, Rita García-Martínez, Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2017 Jul 28; Vol. 23 (28), pp. 5246-5252.
DOI:	10.3748/wjg.v23.i28.5246
Abstrakt:	Hepatic encephalopathy (HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events ( i.e ., portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here, we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment, hyperammonaemia, electroencephalograph alterations, impaired neuropsychological performance, and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE, paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE. Competing Interests: Conflict-of-interest statement: The authors do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Databáze:	MEDLINE
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