Welcome, my name is Devine. This episode 452 of the Devine Intervention

Podcast. In today's podcast I want to talk about Neurelectric

Malignant syndrome, Alleghenmia, and then compare and contrast

those with serotonin syndrome.

So we're going to go ahead and start with a vignette.

So what if they give you a question about a patient?

They tell you that this patient is a 33 year old meal, comes into the emergency room because he has been altered or his wife or whatever brings him in because he's been altered and he has very severe

muscle rigidity and you check his labs he has a lactic acidosis and he's crashing and

and he's burning and he tell you that he has a past history of a brain tumor

that was found when he presented with erectile dysfunctional lowly beetle and it was placed on pharmacotherapy.

And then and he was placed on pharmacotherapy and then he was lost to follow up and stop taking his medication and forgot to refill his prescription so he didn't

take his medication for like a week or two and then now he's presenting with these symptoms.

What's your diagnosis?

Well, this is going to be your elliptic malignant syndrome, NMS, NMS, NMS.

So let's kind of analyze some of the facts of this case. So first things first

this person had a brain mask that killed as libido caused erectile dysfunction

that's probably going to be a prolactinoma.

Proactinomas remember, they secret a lot of prolactin and that's going to shut down

GNRH. So your H-VG axis is basically going to be gone. You're going to have a hypo-gunatotropic hypogonadism.

Hypogonatism. That's very important to kind of keep in mind. So that's why the person has the low libido and the erectile dysfunction. And sometimes people can have visual problems. They'll have a bi-temporal hemianops here because that prolactinoma can compress the optic chasm.

Just one of those weird things to keep in mind.

So how in the world do we treat prolactinomers?

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