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

Autor: Rafael Bañares-Cañizares, Arantxa Díaz-Gómez, Luis Ibáñez-Samaniego, Juan A Guzmán-De-Villoria, Rita García-Martínez, Pilar Fernández-García, Marta Castillo-Pradillo, Fernando Diaz-Fontenla, Pilar Gancedo
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Cirrhosis
endocrine system diseases
Carbimazole
Vascular Malformations
Drug Resistance
Thyrotropin
Case Report
Gastroenterology
Renal Veins
0302 clinical medicine
Liver Cirrhosis
Alcoholic
Medicine
Hyperammonemia
Hepatic encephalopathy
medicine.diagnostic_test
Portal Vein
Thyroid
Brain
Electroencephalography
General Medicine
Middle Aged
Embolization
Therapeutic
Magnetic Resonance Imaging
Propranolol
Diagnosis of exclusion
Alcoholism
medicine.anatomical_structure
Cognitive impairment
030211 gastroenterology & hepatology
Female
Goiter
Nodular
medicine.medical_specialty
endocrine system
Adrenergic beta-Antagonists
Disorders of Excessive Somnolence
Diagnosis
Differential
03 medical and health sciences
Refractory
Hypothyroidism
Antithyroid Agents
Ammonia
Internal medicine
Magnetic resonance spectroscopy
Humans
Intensive care medicine
business.industry
Dysarthria
Magnetic resonance imaging
Portosystemic shunt
medicine.disease
Thyroxine
Differential diagnosis
Portasystemic Shunt
Transjugular Intrahepatic
business
Tomography
X-Ray Computed
030217 neurology & neurosurgery
Zdroj: World Journal of Gastroenterology
Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid
Consejería de Sanidad de la Comunidad de Madrid
ISSN: 2219-2840
1007-9327
Popis: 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.
Databáze: OpenAIRE
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