Endocrine manifestations of Madelung disease: A rare case report presenting with life-threatening alcohol-related hypoglycemic coma.

rationaleMadelung disease (MD), also known as multiple symmetrical lipomatosis, is a rare benign lipid metabolism disorder characterized by the gradual development of symmetrical, non-encapsulated lipomatous hyperplasia, primarily affecting the subcutaneous adipose tissue of the neck, shoulders, trunk, and extremities. Although existing literature has thoroughly elucidated the typical histomorphology and clinical manifestations of this disease, cases presenting with life-threatening metabolic complications as the initial clinical presentation are extremely rare, which poses significant challenges for early clinical diagnosis and timely intervention. PATIENT CONCERNS: A 62-year-old male presented with abrupt altered consciousness lasting more than 2 hours, with a long history of heavy daily alcohol intake, chronic alcoholic liver disease and gradually enlarged bilateral neck masses for 10 years. DIAGNOSES: 1. hypoglycemic coma; 2. MD.

interventionsThe patient was intravenously administered 40 mL of a 50% glucose solution in the emergency department. After admission, continuous blood glucose monitoring was performed and intravenous glucose infusion was continued. The patient also received standardized hepatoprotective and lipid-lowering treatment. OUTCOMES: Following prompt glucose supplementation, the patient regained full consciousness, achieved stable blood glucose control, and demonstrated improved liver function before hospital discharge. The patient declined surgical resection for MD, and no surgical intervention was performed for this admission. LESSONS: This case describes an extremely rare clinical scenario where chronic excessive alcohol consumption serves as the primary cause of hypoglycemic coma, while hepatic steatosis from Madelung-related diffuse lipomatosis aggravates impaired hepatic gluconeogenesis. It further highlights the critical importance of including MD in the differential diagnosis for patients presenting with unexplained coma who also exhibit characteristic symmetrical neck lipomatous hyperplasia. Timely intravenous glucose supplementation can rapidly reverse severe hypoglycemia and save lives; clinicians should maintain a high index of suspicion for this combined disorder in chronic alcoholic patients.