A case of acute areflexic, flaccid quadriplegia resulting from acute hypophysitis

Abstract

Introduction: Acute flaccid paralysis, though relatively common, can pose a diagnostic challenge because of its varied etiology. Case Report: We report a 42-year-old Afro-Caribbean woman whose third and final admission over a 3-week period was because of acute onset quadriparesis. At the final admission, she had flaccid paralysis, no ankle and knee reflexes, and equivocal plantar responses. Investigations revealed severe hypokalemia and hypernatremia, increased creatinine, and low adrenocorticotropic hormone, cortisol, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone. She had marked polyuria and increased plasma osmolality. Atrial natriuretic factor was detected and chest computed tomography showed a dilated esophagus and bilateral acute pulmonary emboli. Magnetic resonance imaging revealed an enlarged 1.2x1.4x1.8 cm pituitary gland showing enhancement, indicating hypophysitis. She was diagnosed with quadriparesis secondary to hypokalemia and neurogenic diabetes insipidus secondary to panhypopituitarism involving the stalk,