Endocrine Case Report: Confusion and Shaking

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This endocrine case report from Brady Pregerson, MD features a 32-year-old female with a history of polycystic ovary syndrome and diabetes who presents to the emergency department for sudden trouble swallowing, confusion, and shakiness. Can you determine the correct diagnosis?

History:

An otherwise healthy 32-year-old female with a history of polycystic ovaries and diabetes presents to the emergency department for sudden trouble swallowing, confusion, and shakiness. She was recently diagnosed with migraines due to recurrent left-sided headache.

Exam:

Vital signs are normal. The exam is notable for partial aphasia rather than true confusion and a slight tremor. There is no stridor and she is handling her secretions well. There are no focal neurologic findings and tremor does not appear to be seizure-like.

Relevant Test Results:

  • EKG: normal
  • Labs: normal except for a glucose of 222
  • Imaging: see CT scan below

CT Scan of a patient's brain. | Credit: Brady Pregerson, MD

Credit: Brady Pregerson, MD

What is the most likely diagnosis?


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