A Case of Periodic Hypokalemic Paralysis in a Patient with Celiac Disease

Ranjan, Amitabh; Debata, Pradeep

doi:10.7860/jcdr/2014/8372.4483

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…The suboptimal response to vitamin D replacement led to investigation into his absorption of vitamin D, and the diagnosis of celiac disease. There has been 1 reported case of celiac disease presenting as HPP that was not in celiac crisis (15). Concurrence of autoimmune thyroid disease and celiac disease is well known (16).…”

Section: Discussionmentioning

confidence: 99%

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Rajpal

Sood

2019

AACE Clinical Case Reports

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Objective: Thyrotoxic periodic paralysis is a sporadic form of hypokalemic periodic paralysis (HPP) that is most commonly seen in patients with Graves disease (GD) in association with acute thyrotoxicosis. A very few cases of HPP have been reported in patients with GD while the patient was euthyroid.Methods: We describe a case of a 62-year-old Caucasian male with a history of GD, who presented with acute progressive bilateral lower extremity weakness.Results: The patient was found to have severe hypokalemia, with no evidence of diarrhea or increased urinary potassium excretion. He was diagnosed as having HPP. He remained clinically and biochemically euthyroid during the admission. There was no history of high-carbohydrate meal intake, intense exercise, recent steroid exposure, or unusual stress. His symptoms improved gradually over the next 3 to 4 days with potassium supplementation. Nine months later, he progressed to overt hyperthyroidism and was treated with 25 mCi of iodine-131 and following that he has been on levothyroxine replacement for post-ablative hypothyroidism. Other unusual features in this patient were hypocalcemia, hypomagnesemia, and vitamin D deficiency during the acute presentation. Serum calcium and magnesium normalized 2 days after admission, while serum vitamin D continued to be low. He was later diagnosed to have celiac disease.Conclusion: Our case adds a rare presentation of HPP in a euthyroid patient with a known history of GD with associated celiac disease, hypomagnesemia, and hypocalcemia to the literature. (AACE Clinical Case Rep. 2019;5:e73-e76) Abbreviations: FT3 = free triiodothyronine; FT4 = free thyroxine; HPP = hypokalemic periodic paralysis; MMI = methimazole; TPP = thyrotoxic periodic paralysis; TSH = thyroidstimulating hormone; TSI = thyroid-stimulating immunoglobulin e74 Thyrotoxic Periodic Paralysis, AACE Clinical Case Rep. 2019;5(No. 1)

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Section: Discussionmentioning

confidence: 99%

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Rajpal

Sood

2019

AACE Clinical Case Reports

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“…Episodic flaccid weakness occurs based on the concentration of extracellular potassium ions, which are decisive for membrane excitability 1. Acquired causes include renal tubular acidosis, diabetes insipidus,4 coeliac disease5 and thyrotoxicosis6 and these should be ruled out. We describe a case presenting with late-onset myopathy and various phenotypes in the same family with a heterozygous pathogenic mutation in CACNA1S gene (figure 1 shows the pedigree).…”

Section: Introductionmentioning

confidence: 99%

Diverse phenotype of hypokalaemic periodic paralysis within a family

et al. 2017

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Hypokalaemic periodic paralysis typically presents with intermittent mild-to-moderate weakness lasting hours to days. We report a case with an uncommon phenotype of late-onset myopathy without episodic paralytic attacks. Initial work-up including muscle biopsy was inconclusive. A subsequent review of the right deltoid biopsy, long exercise testing and repeated family history was helpful, followed by appropriate genetic testing. We identified a heterozygous pathogenic mutation in calcium ion channel (:c.1583G>A p.Arg528His) causing hypokalaemic periodic paralysis. Myopathy can present without episodic paralysis and the frequency of paralytic episodes does not correlate well with the development and progression of a fixed myopathy. Our report also highlights the intrafamilial phenotypic variation of hypokalaemic periodic paralysis secondary to a gene mutation.

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“…Instances of such manifestation of celiac disease is truly rare, although have been reported in recently published medical literature a very few times. [13][14][15] Celiac disease is a rare cause of neuropathy that most commonly presents with symmetric distal sensory disturbances. 15,16 Neurologic manifestations, such as ataxia and peripheral neuropathy, are increasingly recognized to be the presenting features of CD.…”

Section: Discussionmentioning

confidence: 99%

A Case of Celiac Disease Presenting with Recurrent Attacks of Quadriparesis

et al. 2017

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Celiac disease, once considered a rare disease in Bangladeshi population, have recently been reported more frequently. Recognition of celiac disease is not easy and a high degree of suspicion in required. Although the disease presents usually with malabsorption syndromes, atypical presentations also may occur which may cause confusion in making a prompt diagnosis. We intend to report a case who presented primarily with flaccid type of quadriparesis who ultimately was proven to be a case of celiac disease. Although neurological symptoms have been associated with celiac disease, motor weakness is very uncommon. We have proposed that in our case electrolyte imbalance have caused or contributed in causing this motor weakness.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 138-141

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A Case of Periodic Hypokalemic Paralysis in a Patient with Celiac Disease

Cited by 4 publications

References 7 publications

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Diverse phenotype of hypokalaemic periodic paralysis within a family

A Case of Celiac Disease Presenting with Recurrent Attacks of Quadriparesis

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