Post-thyroidectomy development of posterior reversible encephalopathy syndrome (PRES) due to over-replacement of hypocalcemia

Olga Papalou; Nikolaos Katechakis; Chrysoula Koukoula; Aikaterini Beka; Dimitra Baikousi; Kyriaki Gkoufa; Angeliki Mandrapylia; Theodora Stratigou; Dimitra Vassiliadi; Stylianos Tsagarakis

doi:10.1530/endoabs.90.P590

P590

Prev Next

Section Contents Cite

Endocrine Abstracts (2023) 90 P590 | DOI: 10.1530/endoabs.90.P590

ECE2023 Poster Presentations Calcium and Bone (83 abstracts)

Post-thyroidectomy development of posterior reversible encephalopathy syndrome (PRES) due to over-replacement of hypocalcemia

Olga Papalou , Nikolaos Katechakis , Chrysoula Koukoula , Aikaterini Beka , Dimitra Baikousi , Kyriaki Gkoufa , Angeliki Mandrapylia , Theodora Stratigou , Dimitra Vassiliadi & Stylianos Tsagarakis

Err

Author affiliations

Evangelismos Hospital, Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Athens, Greece

A 61-year-old woman was admitted to the Emergency Department with generalized seizures. She reported general malaise, anorexia, headache and multiple episodes of vomiting that started about 12 h before admission. She had a history of recent thyroidectomy, and she was on oral calcium carbonate (3 gr/day) and alpha calcidol (3 mg/day). Non-contrast head CT scan was negative for major findings. Laboratory work up revealed hypercalcemia (corrected calcium 14,4 mg/dl), renal impairment (creatinine 2.9 mg/dl) and compensated metabolic alkalosis. Further neurological workup with brain MRI revealed cortical swelling and FLAIR signal abnormalities of both occipital, parietal and right frontal lobes, consistent with posterior reversible encephalopathy syndrome (PRES). The patient’s encephalopathy resolved after resolution of hypercalcemia and she had no neurological deficits on discharge. She was restarted on lower doses of calcium for hypoparathyroidism and is on close follow-up. This case illustrates the difficulties in managing postoperative hypoparathyroidism and highlights a rare but serious complication of iatrogenic hypercalcemia.