# Case Report: Chorea as a Rare Manifestation of Secondary Adrenal Insufficiency

## TL;DR

A 48-year-old man with secondary adrenal insufficiency developed chorea, an unusual movement disorder, which improved with treatment targeting both the movement and hormone deficiencies.

## Contribution

This case report highlights chorea as a rare manifestation of secondary adrenal insufficiency, emphasizing the importance of considering endocrine causes in movement disorders.

## Key findings

- Chorea and behavioral disturbances were linked to secondary adrenal insufficiency in a patient with hypothyroidism.
- Treatment with tetrabenazine, trihexyphenidyl, and hydrocortisone led to clinical improvement.
- Low ACTH, prolactin, and testosterone levels confirmed adrenal insufficiency as the underlying cause.

## Abstract

The word "chorea" comes from the Latin word "choreus," which means dancing movement. Chorea is defined as a hyperkinetic movement disorder characterized by uncontrolled, unintended, jerky, brief, irregular, random movements involving the limbs or facial muscles.

Here, we discuss the case of a 48-year-old male with hypothyroidism for two years, which is well-controlled with medication. He presented with behavioral disturbances for the past seven months and choreiform movements affecting all four limbs, his tongue, and his face for the past six months. Investigations revealed hyponatremia and low serum osmolality. An MRI of the brain showed the empty sella sign. Further investigations revealed low levels of adrenocorticotropic hormone (ACTH), prolactin, and testosterone. Considering the diagnosis of chorea with euvolemic hyponatremia due to secondary adrenal insufficiency, the patient was started on tetrabenazine, trihexyphenidyl, oral hydrocortisone, and gradual correction of sodium level. The patient's condition improved during the hospital stay, and he continues to do well in routine follow-ups.