The Myxedema coma in children and adolescents: A rare endocrine emergency - Personal experience and review of literature : Myxedema coma in children and adolescents

Vincenzo De Sanctis; Ashraf  Soliman; Shahina  Daar; Salvatore  Di Maio; Noora  Alhumaidi; Mayam  Alali; Aml  Sabt; Christos  Kattamis

doi:10.23750/abm.v92i5.12252

The Myxedema coma in children and adolescents: A rare endocrine emergency - Personal experience and review of literature

Myxedema coma in children and adolescents

Authors

Vincenzo De Sanctis Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
Ashraf Soliman Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
Shahina Daar Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
Salvatore Di Maio Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon”, Naples, Italy
Noora Alhumaidi Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
Mayam Alali Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
Aml Sabt Sidra Hospital, Doha, Qatar
Christos Kattamis First Department of Pediatrics, National Kapodistrian University of Athens, Greece

Keywords:

: Myxedema coma, hypothyroidism, iron overload, aplastic anemia, Hashimoto thyroiditis, treatment, prognosis

Abstract

Abstract. Decompensated hypothyroidism, formerly known as myxedema coma, represents the most extreme clinical expression of severe primary or secondary hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. The exact incidence of myxedema coma in adults is not known, but some authors have estimated that is approximately 0.22 per 100.0000 per year in the western world. Myxedema coma is more common in females and during winter months. The diagnosis of myxedema coma is primarily clinical with supportive evidence of the abnormal thyroid function tests. Clinical features vary depending on a several factors including the age of onset and the severity of the disease. In the majority of patients (95%), the cause of underlying hypothyroidism is autoimmunity, i.e., Hashimoto thyroiditis or congenital abnormalities. Rarely it occurs in secondary (central) hypothyroidism, due to thyrotropin deficiency related to pituitary disease, or pituitary-thyroid damage due to iron overload. Treatment consists of thyroid hormone replacement, correction of electrolyte disturbances, passive rewarming, treatment of infections, respiratory and hemodynamic support, and administration of stress-dose glucocorticoids. Prognosis seems to be better in children and adolescents compared to adults. The present review reports personal experience and the literature data on 13 patients.

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