Contributed by Douglas R. Johnson, MD
Published on line in June 1998
The patient was a 24 year old white man with a history of end-stage restrictive lung disease and end-stage liver disease with portal hypertension and esophageal varices who was status post pituitary gland resection in 1988 with subsequent panhypopituitarism. The patient was admitted for acute worsening of his respiratory status and liver failure. A neurologic exam showed no deficits and was negative for asterixis. His hospital course was complicated by acute gastrointestinal bleeding, acute renal failure, and increasing respiratory compromise requiring mechanical ventilation. He subsequently developed multi-system organ failure, and was deemed a poor surgical risk for lung and liver transplantation. The patient expired with comfort measures only, 24 days after admission. A complete autopsy was permitted.