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Symptomatic hyponatremia as a presenting sign of hypothalamic-pituitary disease: A syndrome of inappropriate secretion of antidiuretic hormone (SIADH)-like glucocorticosteroid responsive condition
Year:
2005
Authors :
עזרא, דוד
;
.
Volume :
28
Co-Authors:
Olchovsky, D., Department of Medicine A, Sheba Medical Center, Tel-Hashomer, Israel, Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
Ezra, D., Department of Medicine A, Sheba Medical Center, Tel-Hashomer, Israel
Vered, I., Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
Hadani, M., Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Shimon, I., Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel, Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
Facilitators :
From page:
151
To page:
156
(
Total pages:
6
)
Abstract:
Hyponatremia associated with high urine osmolality is usually caused by inappropriate secretion of antidiuretic hormone. However, secondary hypoadrenalism is also accompanied by hyponatremia and with features indistinguishable from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). As secondary hypoadrenalism requires a specific treatment, a high index of suspicion and appropriate hormonal testing are required to differentiate between these two entities. We retrospectively studied 10 patients with a previously undiagnosed hypothalamic-pituitary disease who presented with an acute symptomatic hyponatremia. Mean age (±SD) was 65.1±8.4 yr. Mean serum sodium was 120.7±2.9 nmol/l and urinary osmolality, 453.9±74 mosmol/kg. Serum creatinine, urea and uric acid were low. Mean serum morning cortisol was low, 104.0±55.2 nmol/l. High-dose ACTH test showed adequate increment of serum cortisol in 3 out of 7 patients tested. Two of these 3 patients did not respond adequately to the low-dose ACTH test. Endocrine evaluation disclosed partial or complete hypopituitarism in all 10 patients. Six patients had pituitary macroadenomas, one had a craniopharyngioma, one patient had a large aneurysm of the internal carotid with sellar destruction and two others had empty sella. Treatment by fluid restriction did not affect serum sodium levels significantly. In contrast, all patients achieved normal sodium when treated by glucocorticosteroid. Central hypoadrenalism should be considered in any patient presenting with hyponatremia with high urine osmolality. Low-dose ACTH test should be performed and followed by appropriate endocrine and imaging studies. Hyponatremia in these patients is promptly corrected by glucocorticosteroid replacement. ©2005, Editrice Kurtis.
Note:
Related Files :
adult
Blood
clinical article
Female
hypophysis adenoma
Male
Pituitary Diseases
retrospective study
urine osmolality
עוד תגיות
תוכן קשור
More details
DOI :
Article number:
Affiliations:
Database:
סקופוס
Publication Type:
מאמר
;
.
Language:
אנגלית
Editors' remarks:
ID:
20359
Last updated date:
02/03/2022 17:27
Creation date:
16/04/2018 23:35
Scientific Publication
Symptomatic hyponatremia as a presenting sign of hypothalamic-pituitary disease: A syndrome of inappropriate secretion of antidiuretic hormone (SIADH)-like glucocorticosteroid responsive condition
28
Olchovsky, D., Department of Medicine A, Sheba Medical Center, Tel-Hashomer, Israel, Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
Ezra, D., Department of Medicine A, Sheba Medical Center, Tel-Hashomer, Israel
Vered, I., Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
Hadani, M., Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Shimon, I., Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel, Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
Symptomatic hyponatremia as a presenting sign of hypothalamic-pituitary disease: A syndrome of inappropriate secretion of antidiuretic hormone (SIADH)-like glucocorticosteroid responsive condition
Hyponatremia associated with high urine osmolality is usually caused by inappropriate secretion of antidiuretic hormone. However, secondary hypoadrenalism is also accompanied by hyponatremia and with features indistinguishable from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). As secondary hypoadrenalism requires a specific treatment, a high index of suspicion and appropriate hormonal testing are required to differentiate between these two entities. We retrospectively studied 10 patients with a previously undiagnosed hypothalamic-pituitary disease who presented with an acute symptomatic hyponatremia. Mean age (±SD) was 65.1±8.4 yr. Mean serum sodium was 120.7±2.9 nmol/l and urinary osmolality, 453.9±74 mosmol/kg. Serum creatinine, urea and uric acid were low. Mean serum morning cortisol was low, 104.0±55.2 nmol/l. High-dose ACTH test showed adequate increment of serum cortisol in 3 out of 7 patients tested. Two of these 3 patients did not respond adequately to the low-dose ACTH test. Endocrine evaluation disclosed partial or complete hypopituitarism in all 10 patients. Six patients had pituitary macroadenomas, one had a craniopharyngioma, one patient had a large aneurysm of the internal carotid with sellar destruction and two others had empty sella. Treatment by fluid restriction did not affect serum sodium levels significantly. In contrast, all patients achieved normal sodium when treated by glucocorticosteroid. Central hypoadrenalism should be considered in any patient presenting with hyponatremia with high urine osmolality. Low-dose ACTH test should be performed and followed by appropriate endocrine and imaging studies. Hyponatremia in these patients is promptly corrected by glucocorticosteroid replacement. ©2005, Editrice Kurtis.
Scientific Publication
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