A 28-Year-Old Bodybuilder With Palpitations and Confusion

Ricardo Correa, MD; Sri Harsha Tella, MD

Disclosures

January 16, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 28-year-old man presents to an endocrine clinic for evaluation of a broad spectrum of symptoms, which his family members suggested were most likely the result of a hormonal abnormality. He reports episodic heart palpitations and tremors that progressed to worsening fatigue and confusion over the past 6 months. When the episodes started about 6 months ago, they typically lasted for 30-60 seconds. At that time, he had six to 10 episodes when he was awake. He does not recall having such episodes at night. Changes in weather did not affect his symptoms.

The patient claims that he was mostly healthy throughout his life, except for a personality disorder that was treated with psychotherapy and medications about 5 years ago. He says that he has been "free of the disease" for at least 5 years and denies any other comorbidities. He has been worried that "something is wrong" over the past 6 months, despite trying his best to keep his body in good shape by spending 2-3 hours in the gym almost 7 days per week. He admits using a supplement over the past 6 months to gain muscle, because he felt his intense workouts did not help him much.

His family history is significant for type 2 diabetes mellitus and premature menopause in his mother. He said that he has no clue about the health of other family members. In terms of social history, the patient smokes about a pack of cigarettes per day and has three beers per day about 4-5 days per week.

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