Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review

[helvella]

A frequent suggestion here on Thyroid UK forum is that exercise depletes T3. Seems quite reasonable and there is some evidence - even if much of it would be dismissed as being anecdotal.

Here, however, they have a case of rhabdomyolysis, which they pin on hypothyroidism (among others). Yet the treatment chosen was "continuous renal replacement therapy (CRRT), glucocorticoid hormone replacement therapy and aggressive hydration". Where was the T3 (liothyronine)? Why wasn't T3 given?

Of course, they might have considered it but decided that the other issues precluded its use. Would be good to know more.

Am J Emerg Med. 2018 Jun 7. pii: S0735-6757(18)30481-9. doi: 10.1016/j.ajem.2018.06.019. [Epub ahead of print]

Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review.

Zhou C1, Lai S2, Xie Y2, Zhang S3, Lu Y4.

Author information

1 Department of Urology/Institute of Urology, West China Hospital, Sichuan University, 37 Guo Xue Rd., Chengdu, 610041, Sichuan Province, China.

2 Department of Emergency Medicine, West China Hospital, Sichuan University, 37 Guo Xue Rd., Chengdu, 610041, Sichuan Province, China.

3 Department of Emergency Medicine, West China Hospital, Sichuan University, 37 Guo Xue Rd., Chengdu, 610041, Sichuan Province, China. Electronic address: [e-mail].

4 Department of Urology/Institute of Urology, West China Hospital, Sichuan University, 37 Guo Xue Rd., Chengdu, 610041, Sichuan Province, China. Electronic address: [e-mail].

Abstract

INTRODUCTION:

Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with hypopituitarism, adrenal insufficiency and hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified.

CASE REPORT:

We report the case of a 23-year-old male with primary hypopituitarism who developed acute renal impairment (AKI) with rhabdomyolysis after strenuous physical activity (push-ups). His blood test confirmed marked hypopituitarism. Severe elevation of serum CK consistent with rhabdomyolysis was noted and an elevated creatinine indicated AKI and multiple organ dysfunction syndrome (MODS). Patient's condition improved significantly after continuous renal replacement therapy (CRRT), glucocorticoid hormone replacement therapy and aggressive hydration. MODS with rhabdomyolysis in patients with hypothyroidism is quite rare and we expect that this case report adds to the existing literature on this subject. We also emphasize that thyroid and adrenal gland status should be evaluated in patients with unexplained AKI, MODS and presenting with the symptoms of muscle involvement.

LITERATURE REVIEW:

We respectively reviewed 23 patients with hypopituitarism, adrenal Insufficiency and hypothyroidism induced rhabdomyolysis who were involved in the past 40 years relevant literatures.

CONCLUSION:

We report a successfully treated case of rhabdomyolysis, which is a rare but potentially serious complication of hypopituitarism. Screening for endocrine abnormality in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment is essential to prevent rhabdomyolysis and its consequences.

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS:

AKI; Hypopituitarism; MODS; Rhabdomyolysis

PMID: 29910183

DOI: 10.1016/j.ajem.2018.06.019

ncbi.nlm.nih.gov/pubmed/299...

Rhabdomyolysis is the breakdown of damaged skeletal muscle.

[silverfox7]

Thank you for posting. I have a relative in my husband's side with this and I asked HU if a relevant group. All comments were on Thyroid pages but very little advice out there but will pass this on.

Have now sent the other as well