2012 Volume 55 Issue 8 Pages 614-620
A 47-year-old man who had undergone hypothalamic meningioma surgery one year earlier and postoperative hormone replacement therapy for panhypopituitarism and diabetes insipidus was seen for general fatigue and lethargy. Laboratory examination showed markedly elevated plasma glucose with few ketone bodies. Chest computed tomography (CT) showed ground-glass opacity of the lung. He was admitted in an emergency and diagnosed with hyperglycemic hyperosmolar state and pneumonia, for which he was administered continuous intravenous insulin infusion and antibiotics. Although his general condition improved immediately as plasma glucose decreased, laboratory examination showed severely elevated creatine phosphokinase and serum and urine myoglobin, indicating rhabdomyolysis. Early volume loading was started and rhabdomyolysis was cured without severe acute kidney injury. On day 7, he suffered sudden chest pain with hypoxemia. Emergency CT with contrast medium showed multiple bilateral perfusion defects consistent with pulmonary emboli and underlying deep vein thrombosis of the lower left leg. Anticoagulation therapy with heparin and warfarin was conducted immediately. His respiratory status improved gradually as pulmonary emoboli decreased. This report is a rare case of hypothalamic syndrome complicated by rhabdomyolysis and pulmonary embolism on subsequent hyperglycemic hyperosmolar syndrome.
