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

Abstract

Abstract.The case of a 55-year-old woman with inappropriate secretion of anti-diuretic hormone (ADH) is reported.Her pituitary-adrenocortical function test showed normal values on admission, but when she recovered from hyponatremia, severe panhypopituitarism became overt. Her adrenal insufficiency was considered to have been "masked" by endogenous stimulation of the hypothalamus-pituitaryadrenal axis under severe stress. One should be cautious in estimating the pituitary-adrenal function of severely ill patients.

Severe Hyponatremia Caused by Hypothalamic Adrenal Insufficiency.

“…Thus, we were finally able to confirm that the hyponatremia was caused by hypothalamic adrenal insufficiency. Weonly found one report in the literature regarding basal adrenal levels within the normal range in adrenal insufficiency (7). Hyponatremia is one of the features in patients with hypopituitarism.…”

Hyponatremia Can Be a Presenting Finding of Multiple Pituitary Hormone Deficiency in Children: Report of a Case and Review of Literature

“…15 There are several reports stating increased ADH levels in cases with hypocortisolism associated with hyponatremia. 3,16,17 Contrary to this finding, some defects in renal mechanisms were also considered. It was shown that rats with diabetes insipidus (Brattleboro rats) had impaired renal water excretion after 2 weeks of glucocorticoid depletion, suggesting ADHindependent pathways.…”

“…Similarly, virtually all hyponatremic patients with ACTH deficiency were reported to be over 50 years of age. 16,17,[20][21][22] Diederich et al 22 reported that 28 of 185 patients with hyponatremia had ACTH deficiency and only 3 of them were younger than 60 years of age. Their mean age was 68 years, which was nearly 10 years lower than with the other causes of SIADH.…”

The Role of Antidiuretic Hormone in Hyponatremia in Adrenal Insufficiency-Is the Guideline for the Diagnosis of Syndrome of Inappropriate Secretion of the Antidiuretic Hormone Appropriate?-

“…After the establishment of a sensitive radioimmunoassay ofADH, there came reports demonstrating a role of ADHin hyponatremic patients with hypoadrenalism due to hypopituitarism (12,13). Serum arginine vasopressin (AVP) was inappropriately high in relation to low serum osmolality in these patients.…”