Endocrine Abstracts

Introduction: Sulphonylureas (SU) are an effective therapy for type 2 diabetes (T2DM). As insulin secretagogues, hypoglycemia is a potencial adverse effect. Hypoglycemia may cause neuroglycopenic brain injury, which can mimetize stroke and infections of the central nervous system. Case ReportThe authors report the case of an autonomous 71 year-old woman, with medical history of hypertension and T2DM, treated with enalapril and gliclazide, that was admitted in the Emergency Room after being found unresponsive at home. The first medical evaluation revealed: GCS 14, hypertension (172/85mmHg) and capillary blood glucose of 28 mg/dl. Complete neurological exam showed left hemiparesis and aphasia, being stroke the most probable diagnosis.Patient was admitted to the Neurology floor. No ischemic lesion or hemorrhage were found in two separate cerebral MRIs. All other exams were normal, including: holter, cardiac ultrasound, carotid doppler, EEG and lumbar puncture. Blood workup was unremarkable, without signs of infection or inflammatory disease. A1C hemoglobin was 5.7%. All symptoms and deficits remitted after SU discontinuation. After excluding differential diagnosis, it was assumed the diagnosis of neuroglycopenia with focal neurological deficits caused by treatment with SU. ConclusionNowadays, with the development of new antidiabetic drugs, the use of SU has been reduced. The risk of SU induced hypoglycemia is relevant, mainly in the elderly. Cognitive and mental impairment are the most frequent symptoms of hypoglycemia. In rare cases, hypoglycemic encephalopathy with focal deficts may occur. Being a reversible cause of injury, its peremptory diagnosis is relevant.