Aggressive macroprolactinomas represent 0.4 to 4% of pituitary adenomas, they are more frequent in men, the positive diagnosis is easy, the evaluation of aggressiveness is essentially based on MRI and The treatment with dopaminergic agonist in first intention is now well established and should not be deferred apart from neurological emergency situations.
Hyponatremia in panhypopituitarism is multifactorial, it can be explained by the corticotropic deficit observed in pituitary insufficiency which is responsible for a lifting of inhibition on the anti-diuretic hormone with a consequent net reduction of water excretion, Hypothyroidism is also cited as a contributing mechanism for the development of acute hyponatremia in pituitary insufficiency through reduced free water excretion. Hyponatremia as a mode of revelation remains rare, we report a case of severe hyponatremia revealing pituitary insufficiency on pituitary macroadenoma.
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