Osmotic demyelination syndrome is a rare condition reported mainly in the case of rapid correction of hyponatremia, but it can occur even in the case of complicated diabetes mellitus either during rapid correction of hyperglycemia or anytime during the complicated diabetes mellitus. We report a case of complicated diabetes mellitus developing osmotic demyelination syndrome. The patient had presented with altered sensorium and seizure, which was initially diagnosed as hyperglycemia, but during his treatment, the magnetic resonance imaging of brain revealed central pontine myelinolysis. Our search on the causes of osmotic demyelination syndrome other than rapid correction of hyponatremia has revealed several other causes like autoimmune liver disease, Sjogren’s syndrome and non-Hodgkin’s lymphoma in addition to diabetes mellitus.
Objectives: This study intends to determine the association of parathormone with vitamin D and other biochemical parameters (calcium and phosphate) and evaluate the relationship between low vitamin D and parathormone levels. Methods: A hospital-based cross-sectional study was conducted among 310 study participants over the period of 1 year. Patients who underwent laboratory investigations for vitamin D, parathormone, calcium, and phosphate in the Clinical Biochemistry Laboratory at the Institute of Medicine, Tribhuvan University Teaching Hospital were included. Serum intact parathyroid hormone, vitamin D, calcium, and phosphate were measured in Abbott Architect (ci4100) integrated system autoanalyzer. Results: Among the 310 study participants, 177 (57%) were males and 43% were females. The mean age of the patient was 47.09 ± 19.01 years. High intact parathyroid hormone (>68 pg/ml) was observed in 73% of the patients. Low vitamin D (<20 ng/ml) was present in 30.2% of the patients. The findings from our study depict that there is a negative significant correlation between intact parathyroid hormone levels, vitamin D, and calcium levels and a positive correlation between intact parathyroid hormone and phosphate levels ( p < 0.001). Conclusions: The findings from our study illustrate that there is a swapping drift in the profile of hyperparathyroidism in the Nepalese population. We report the presence of hyperparathyroidism in the middle age group than in the older age group contradictory to that reported in the literature.
Stiff Person Syndrome (SPS), a progressive Central Nervous System disorder is accompanied by progressive muscle rigidity, hyperreflexia, and spasms mainly in truncal and proximal leg muscles mainly associated with autoimmune disorders. Here, we report a rare case of SPS in a middle‐aged Nepalese man with uncontrolled diabetes mellitus and ketonuria.
Introduction and importance:
Pituitary macroadenoma most commonly presents with visual disturbances, headache, and other symptoms secondary to adeno hypophyseal hormonal deficiencies and usually alleviates after tumor resection. Pituitary adenomas may be the cause of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) causing hyponatremia, although so far, there have only been a few documented cases. Here, we present a case of pituitary macroadenoma with SIADH and hyponatremia. This case has been reported in line with CARE (CAse REport) criteria.
Case presentation:
We present a case of a 45-year-old woman who presented with symptoms of lethargy, vomiting, altered sensorium, and seizure. Her initial sodium level was 107 mEq/l, plasma and urinary osmolality were 250 and 455 mOsm/kg, respectively, and her urine sodium level was 141 mEq/day, suggestive of hyponatremia due to SIADH. MRI scan of the brain revealed approximately 14×13×11 mm pituitary mass. Prolactin and cortisol levels were 41.1 ng/ml and 5.65 μg/dl, respectively.
Clinical discussion:
Hyponatremia can result from various diseases, making it hard to identify the cause. A pituitary adenoma is a rare cause of hyponatremia due to SIADH.
Conclusion:
Pituitary adenoma rarely might be the cause of SIADH presenting as severe hyponatremia. So, in case of hyponatremia due to SIADH, clinicians should keep pituitary adenoma as well in their differential diagnoses.
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