A case of Hyponatremia in Panhypopituitarism Caused by the Primary Empty Sella Syndrome

Abstract

A64-year-old woman was admitted for evaluation of hyponatremia. She

A Case of Glomerular Lipidosis Accompanied by Familial Combined Hyperlipidemia and Panhypopituitarism.

“…This was not primary adrenal insufficiency (Addison's disease) with hyponatremia, hyperkalemia, a high concentration of urinary Na , and a low concentration of urinary K. Secondary adrenal insufficiency decreases the delivery of Na to diluting sites, and directly or indirectly prevents the maintenance of normal water impermeability in the distal diluting segments of the nephron (8). Hyponatremia in this case was dramatically improved by glucocorticoid replacement, in accordance with a previous report on adrenal insufficiency (9). Thus, the present case was thought to involve secondary adrenal insufficiency associated with pituitary disease.…”

A Case of Initially Undiagnosed Hypoadrenalism Presenting Inappropriate Secretion of Anti-Diuretic Hormone.

“…Therefore ACTH stimulation test would not have been useful as a diagnostic method in this case. There are numbers of case reports with hyponatremia due to hypopituitarism [13][14][15][16], but as far as we searched, we found no cases with cortisol levels as high as this patient. It is to be noted that our patient did not have resistance to glucocorticoid [17,18].…”

Severe hyponatraemia in the setting of hypopituitarism associated with empty sella and herniation of the optic chiasm and gyrus rectus

“…The most accepted hypothesis is that the decrease in serum-cortisol due to panhypopituitarism fails to inhibit expression of ADH with secondary adrenal insufficiency leading to hyponatraemia. 6 Undiagnosed empty sella and failure to recognise the accompanying hypocortisolism as the cause of hyponatraemia leads to inadequate treatment and uncontrolled hyponatraemia. Mere substitution of fluids and salts in such a case will treat hyponatraemia only temporarily whereas treatment with hydrocortisone leads to permanent and satisfying recovery.…”