Rhabdomyolysis is occasionally associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. We describe rhabdomyolysis accom panying thyroid crisis. A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. Postmortem examination revealed rhabdomyolysis in the cardiac and psoas muscles, old myocardial infarction, hepatic centrilobular necrosis, renal cortical necrosis, and follicular hyperplasia in the thyroid. Circulatory collapse and dehydration under excessive hypermetabolic state presumably suppressed the source of energy and oxygen for muscle cells, leading to cellular damage.
We compared endothelial function noninvasively in 15 elderly patients with noninsulin-dependent diabetes mellitus (NIDDM) with 12 nondiabetic elderly patients. Using high resolution ultrasound, we measured flow-mediated dilatation (FMD) of the brachial artery and sublingual nitroglycerin (NTG)-mediated dilatation. FMD was significantly impaired in subjects with NIDDM compared with control subjects. In NIDDM subjects, FMD with complications was lower than in subjects with noncomplications. However, there was no significant difference in NTG between NIDDM subjects and the control group. Hyperemic blood flow change was lower in NIDDM subjects, but not significant. These results suggest that elderly patients with NIDDM have impaired L-arginine/nitric oxide (NO) pathways and the possibility of capillary rarefaction.
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