Severe hyponatremia due to hypopituitarism with adrenal …

Posted: September 20, 2017 at 4:49 am

Objective: Adrenal insufficiency due to hypopituitarism can lead to severe hyponatremia with potentially fatal consequences. Prompt diagnosis and adequate hormonal replacement therapy are essential to block an otherwise unfavorable course and to re-establish a healthy life. Unfortunately, this condition is often misdiagnosed. Design: Case report. Setting: Intensive Care Unit of a teaching hospital. Patient: A 76-yr-old man with refractory hypotension, acute myocardial infarction, and left ventricular dysfunction, secondary to severe chronic pan-hypopituitarism, associated with severe hyponatremia. Methods and main results: The patient underwent mechanical ventilation and continuous venous-venous hemodiafiltration, for severe respiratory and renal insufficiency. A hormonal replacement therapy with T4, hydrocortisone, and nandrolone was started and the patient was discharged to a rehabilitation facility after 31 days of hospitalization. Conclusions: Hypopituitarism with secondary adrenal insufficiency is often misdiagnosed at an early stage and a high degree of suspicion is necessary for early diagnosis. Determination of plasma cortisol level in patients with hyponatremia not explained by other causes should always be obtained.

Key-wordsHyponatremiapan-hypopituitarismadrenal insufficiencymyocardial infarctionhypothyroidism

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Yatagai T, Kusaka I, Nakamura T, et al. Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency. Eur J Endocrinol 2003, 148: 2216.


Ishikawa SE, Saito T, Fukagawa A, et al. Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metab 2001, 86: 166571.


Heneghan C, Goldrick P, Pham H. Management of acute symptomatic hyponatremia. BMJ 1994, 308: 203.


Goldstein CS, Braunstein S, Goldfarb S. Idiopathic syndrome of inappropriate antidiuretic hormone secretion possibly related to advanced age. Ann Intern Med 1983, 99: 1858.


Smith JC, Siddique H, Corrall RJM. Misinterpretation of serum cortisol in a patient with hyponatremia. BMJ 2004, 328: 2156.


Surawicz B, Mangiardi ML. Electrocardiogram in endocrine and metabolic disorders. Cardiovasc Clin 1977, 8: 24366.


Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002, 137: 90414.


Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001, 344: 5019.


Hazouard E, Piquemal R, Dequin PF, Tayoro J, Valat C, Legras A. Severe non-infectious circulatory shock related to hypopituitarism. Intensive Care Med 1999, 25: 8658.


Al Jarallah AS. Reversible cardiomyopathy caused by an uncommon form of congenital adrenal hyperplasia. Pediatr Cardiol 2004, 25: 6756.


Francque SM, Schwagten VM, Ysebaert DK, Van Marck EA, Beaucourt LA. Bilateral adrenal haemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review. Eur J Emerg Med 2004, 11: 1647.


Yanagi N, Maruyama T, Arita M, Kaji Y, Niho Y. Alterations in electrical and mechanical activity in Langendorff-perfused guinea pig hearts exposed to decreased external sodium concentration with or without hypotonic insult. Pathophysiology 2001, 7: 25161.

Italian Society of Endocrinology (SIE)2007

Severe hyponatremia due to hypopituitarism with adrenal ...

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