-39 years-old, female, had cholecystectomy 4 years ago with post-cholecystectomy symptoms

-She was quite well till 9 months ago when she complained of: fatigue, generalized weakness, diffuse muscles cramps, sweating profusely, hypersomnia (may be lying down for up to 48 hours)

-E.R. investigations: K⁺: 1 mg\dl, hypoxia, dehydration and was in a state of impending arrest

-She was admitted to I.C.U. units in different places, but without obvious diagnosis

-On presentation to us: hypoxia, hypotension (no pulse felt), hypokalemia and on inquiry she had menopause at the age of 35 years old

Discussion:

-Really, this early menopause was a crucial clue to pursue, denoting early ovarian Insufficiency. Also, on inquiry she gave a history of severe psychological stress during the last pregnancy.

-So, I considered this situation to be: Hypothalamic Dysfunction, either organic or functional.

-We have previously faced such cases due to organic causes e.g. sarcoidosis, hoping this case would be a functional one!

-It is to noted that the patient had a cushingoid facies, which may be caused by the episodic hypothalamic hyperfunction (inducing adrenal hypersecretion), which is one of the hypothalamic dysfunction characters.