Endocrine Case Report: Confusion and Shaking

Author(s):

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

Credit: Brady Pregerson, MD

What is the most likely diagnosis?