Endocrine Case Report: Confusion and Shaking
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
What is the most likely diagnosis?
