Three Patients with Isolated Adrenocorticotropin Deficiency Presenting with Neuroleptic Malignant Syndrome-like Symptoms.

Sekijima, Yoshiki; Hoshi, Kenichi; Kasai, Hideaki; Okada, Mitsuyo; Namiki, Shin; Ohta, Kazuki; Nakano, Takeshi; Hirayama, Junichi; Ikeda, Shu‐ichi

doi:10.2169/internalmedicine.40.510

Cited by 8 publications

(5 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regardless of clinical alertness, it might not be easy to differentiate NMS from a case of, for example, adrenocorticotropic hormone (ACTH) deficiency. Patients with ACTH deficiency can manifest a clinical picture very similar to that of NMS 110,111…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

View full text Add to dashboard Cite

Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.

show abstract

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

View full text Add to dashboard Cite

show abstract

“…Hyponatremia has also been documented in association with neuroleptic malignant syndrome. [87][88][89][90] In fact, some authors have suggested that hyponatremia could act as precipitating factor for the development of this syndrome. [89][90] and ACTH deficiency 87 have been proposed to explain the hyponatremia in these patients.…”

Section: Hyponatremia In Other Neurologic Conditionsmentioning

confidence: 99%

Hyponatremia in Critically Ill Neurological Patients

2003

View full text Add to dashboard Cite

show abstract

“…Several cases of NMS accompanied by adrenal insufficiency have been reported [ 20 , 21 ]. Those patients easily recovered from NMS in response to corticosteroid supplementation.…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic Malignant Syndrome with Adrenal Insufficiency After BNT162b2 COVID-19 Vaccination in a Man Taking Valproate: A Case Report

et al. 2022

View full text Add to dashboard Cite

Patient: Male, 48-year-old Final Diagnosis: Neuroleptic malignant syndrome Symptoms: Altered mental status • fatigue • fever • generalized weakness • loss of appetite Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Endocrinology and Metabolic • Neurology Objective: Unusual clinical course Background: Considering the ongoing coronavirus disease 2019 (COVID-19) pandemic, sufficient information about common and serious adverse events is needed to rapidly distribute COVID-19 vaccines worldwide. We report a case of neuroleptic malignant syndrome (NMS) with adrenal insufficiency after initial vaccination with Pfizer/BioNTech BNT162b2. Case Report: A 48-year-old man presented to the Emergency Department with fever and an altered mental status 7 days after receiving the first dose of the BNT162b2 COVID-19 vaccine. The patient had a history of end-stage renal disease and epilepsy treated with valproate. He was diagnosed with NMS based on the clinical findings of hyperthermia, muscular rigidity, and an elevated creatine kinase level. Additionally, a reduction in the response of cortisol to adrenocorticotropic hormone (ACTH) stimulation was observed in the rapid ACTH stimulation test. The patient was treated with dantrolene, bromocriptine, and hydrocortisone, and he responded well to treatment. Dantrolene and bromocriptine were tapered off over 4 weeks. Hydrocortisone was also tapered, and the patient was discharged on oral hydrocortisone (30 mg). Conclusions: The present case suggests a possible link between the BNT162b2 COVID-19 vaccine and NMS with adrenal insufficiency based on the temporal relationship between vaccine administration and disease onset, although the patient was taking valproate, a potential cause of NMS. Having a high level of suspicion is important because the diagnosis of NMS with adrenal insufficiency is often challenging due to non-specific clinical manifestations. However, this case does not negate the utility of vaccination because these complications are extremely rare and can be treated with early diagnosis and proper management.

show abstract

Three Patients with Isolated Adrenocorticotropin Deficiency Presenting with Neuroleptic Malignant Syndrome-like Symptoms.

Cited by 8 publications

References 14 publications

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Hyponatremia in Critically Ill Neurological Patients

Neuroleptic Malignant Syndrome with Adrenal Insufficiency After BNT162b2 COVID-19 Vaccination in a Man Taking Valproate: A Case Report

Contact Info

Product

Resources

About