[Secondary adrenal insufficiency presenting as hyponatremia: report of one case]

Rev Med Chil. 2010 Sep;138(9):1144-7. Epub 2010 Nov 9.
[Article in Spanish]

Abstract

Hyponatremia can be a marker of an underlying disease. We report a 52 years-old male with Diabetes Mellitus who consulted for an episode of nausea and vomiting lasting four days. His baseline serum sodium was 118 mEq/L. He had no neurological deficit. Hyponatremia was initially interpreted in context of gastrointestinal fluid loss but correction with saline solution was poor. His urine sodium was 105 mEq/L and his urine osmolality was 281 mOsm/L, so an Inappropriate Secretion of Antidiuretic Hormone Syndrome was suspected. Later, we found that the patient had a two year history of fatigue, weakness, anorexia, frequent nausea, vomiting and diarrhea, loss of libido and decreased axillary and pubic hair. Thyroid-Stimulating Hormone (TSH) was normal and serum Cortisol < 1 µg/dL. A CT scan showed a sellar mass compatible with a macroadenoma. There was also a moderately high serum prolactin and low testosterone, thyroxin and growth hormone levels. The visual fi eld exami-nation showed right temporal hemianopsia. The patient was treated with steroids with a very good clinical response and serum sodium normalization. Subsequently a transsphenoidal excision of the tumor was performed and replacement of the other hormones was started. Now the patient remains asymptomatic.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Adenoma / diagnosis
  • Adrenal Gland Neoplasms / diagnosis
  • Adrenal Insufficiency / complications*
  • Adrenal Insufficiency / diagnosis
  • Diabetes Mellitus, Type 2 / complications
  • Extracellular Space / metabolism
  • Humans
  • Hydrocortisone / blood
  • Hyponatremia / diagnosis
  • Hyponatremia / etiology*
  • Inappropriate ADH Syndrome / diagnosis
  • Male
  • Middle Aged
  • Thyrotropin / blood

Substances

  • Thyrotropin
  • Hydrocortisone