Senthilnathan Subbiah, Reddy Keesari Sai Sandeep, Ravipati Chakradhar
Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2024 Sep 1;16(9):e68395. doi: 10.7759/cureus.68395. eCollection 2024 Sep.
Acute quadriparesis is caused by severe and sudden weakness of all four limbs, which is a distressing clinical presentation that demands immediate and comprehensive investigation. This case report presents a unique instance of acute quadriparesis secondary to an adrenal tumor. A 54-year-old female presented with acute weakness in her upper and lower limbs over six hours without a prior history of fever, convulsions, or other systemic symptoms. Laboratory evaluations revealed significant hypokalemia, prompting further investigation. Differential diagnoses such as Guillain-Barré syndrome, demyelinating lesions, and myopathy were systematically ruled out through clinical evaluation and diagnostic testing. The patient's hypokalemia was aggressively managed with intravenous potassium replacement, leading to significant improvement in muscle strength. Radiological imaging revealed a hyperenhancing lesion in the left adrenal gland, consistent with an adrenal tumor. Elevated serum aldosterone levels supported the diagnosis of hyperaldosteronism. The patient's condition stabilized with intravenous potassium and antihypertensive medications, and a laparoscopic adrenalectomy was performed to remove the adrenal tumor. Postoperatively, the patient's blood pressure and electrolyte levels normalized, and she experienced a full recovery of muscle strength. This case highlights the importance of considering endocrine disorders in the differential diagnosis of acute quadriparesis and underscores the need for a comprehensive diagnostic approach, including routine electrolyte assessments, hormonal evaluations, and thorough imaging studies. Effective management involving prompt identification and treatment of underlying causes is critical for optimal patient outcomes. This case contributes valuable insights into the diverse clinical manifestations of adrenal tumors and the importance of early and accurate diagnosis.
急性四肢瘫是由四肢严重且突然的无力引起的,这是一种令人痛苦的临床表现,需要立即进行全面检查。本病例报告呈现了一例继发于肾上腺肿瘤的急性四肢瘫的独特病例。一名54岁女性在6小时内出现上肢和下肢急性无力,之前无发热、惊厥或其他全身症状病史。实验室检查显示严重低钾血症,促使进一步检查。通过临床评估和诊断测试,系统性地排除了格林-巴利综合征、脱髓鞘病变和肌病等鉴别诊断。患者的低钾血症通过静脉补钾积极治疗,肌力有显著改善。影像学检查显示左肾上腺有一个强化明显的病变,与肾上腺肿瘤一致。血清醛固酮水平升高支持醛固酮增多症的诊断。患者的病情通过静脉补钾和抗高血压药物得以稳定,随后进行了腹腔镜肾上腺切除术以切除肾上腺肿瘤。术后,患者的血压和电解质水平恢复正常,肌力完全恢复。本病例强调了在急性四肢瘫的鉴别诊断中考虑内分泌紊乱的重要性,并强调了采用包括常规电解质评估、激素评估和全面影像学检查在内的综合诊断方法的必要性。涉及及时识别和治疗潜在病因的有效管理对于实现最佳患者预后至关重要。本病例为肾上腺肿瘤的多种临床表现以及早期准确诊断的重要性提供了有价值的见解。