Impaired Water Excretion in a Hyponatremic Patient following Thyroidectomy: Causal Role of Glucocorticoid Deficiency

Yonemura, Katsuhiko; Furuya, Ryuichi; Osuga, Yutaka; Matsushima, Hideki; Ohishi, Kentaro; Hishida, Akira

doi:10.1159/000057394

Cited by 5 publications

(5 citation statements)

References 36 publications

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“…Severe hypothyroidism, mostly the primary form, can also be associated with an SIADH-like syndrome (19), but in our cases the response of hyponatremia to hydrocortisone administration was such a regular observation that the role of thyroid hormone deficiency in the genesis of the syndrome was probably small. All patients with hypothyroidism were of course substituted with thyroid hormone and other deficient hormones once the diagnosis of hypopituitarism had been made.…”

Section: Discussionmentioning

confidence: 48%

Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases

Diederich

Franzen²,

Bähr³

et al. 2003

European Journal of Endocrinology

143

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Objective: Severe hyponatremia due to hypopituitarism and adrenal insufficiency can be lifethreatening, and treatment with glucocorticoids is very effective once the diagnosis of the underlying disorder has been made. In our experience, the diagnosis of hypopituitarism in hyponatremic patients is often overlooked. Methods: In a retrospective study we screened the files of 185 patients with severe hyponatremia (,130 mmol/l) that had been seen in one endocrinological unit of a university hospital between 1981 and 2001 in order to describe the clinical spectrum of patients with hyponatremia and hypopituitarism including secondary adrenal insufficiency. Results: In 139 cases it was possible to clearly ascribe the patients to the pathophysiological groups of (i) primary sodium deficiency, (ii) edematous disorders, and (iii) normovolemic disorders including the 'syndrome of inappropriate secretion of antidiuretic hormone' (SIADH). Twenty-eight patients with severe 'normovolemic hyponatremia' (serum sodium: 116^7 mmol/l, mean^S.D.) had hypopituitarism and secondary adrenal insufficiency as shown by basal cortisol measurements and dynamic tests of adrenal function. In 25 cases of this group hypopituitarism (mostly due to empty sella, Sheehan's syndrome and pituitary tumors) had not been recognized previously, and in 12 cases recurrent hyponatremia during previous hospital admissions (up to four times) could be documented. The mean age of these patients (21 women, seven men) was 68 years. The most frequently occurring clinical signs were missing or scanty pubic and axillary hair, pale and doughy skin, and small testicles in the men. Frequent symptoms like nausea and vomiting, confusion, disorientation, somnolence or coma were similar to those in 91 patients with SIADH. Basal serum cortisol levels in the acutely ill state ranged from 20 to 439 nmol/l (mean^S.D.: 157^123), while in 30 other severely hyponatremic patients it ranged from 274 to 1732 nmol/l (732^351 nmol/l). In most patients with hyponatremic hypopituitarism, plasma antidiuretic hormone levels were inappropriately high, probably due to a failure of endogenous cortisol to suppress the hormone in a stressful situation. All patients recovered after low-dose hydrocortisone substitution. Most patients had other pituitary hormone deficiencies and were appropriately substituted subsequently. Conclusions: Hypopituitarism including secondary adrenal insufficiency seems to be a frequently overlooked cause of severe hyponatremia. A high level of suspicion is the best way to recognize the underlying disorder. Treatment with hydrocortisone is very effective.

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Section: Discussionmentioning

confidence: 48%

Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases

Diederich

Franzen²,

Bähr³

et al. 2003

European Journal of Endocrinology

143

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“…Abnormal results would lead to further tests like the short synacthen test and pituitary profile. 9,10 The cause of low serum sodium in our patient is due to low adrenal hormones. Hypothyroidism-induced SIADH was one of the differentials after initial investigations.…”

Section: Discussionmentioning

confidence: 76%

Severe Hyponatremia due to Hypopituitarism Secondary to Empty Sella Syndrome

Shamim¹,

Hayat

Shafqat³

et al. 2021

JRMC

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This case is about a 68 years old patient presented with worsening generalized weakness, dizziness, low mood and reduced appetite with the background history of gout and vitamin D deficiency. On general examination, the patient appeared very lethargic. However, the systemic examination was unremarkable. The vitals check showed a low blood pressure of 104/72 mm Hg. The investigations showed low levels of serum Sodium, Thyroid stimulating hormone, Cortisol. The short Synacthen test was abnormal. The anterior pituitary hormones level showed low levels of Follicle stimulating hormone, Luteinizing hormone and prolactin. CT head with contrast showed enlarged fluid filled pituitary fossa with fat. An MRI Pituitary gland showed an empty sella syndrome. The patient was hydrated initially and electrolytes were monitored regularly. Treated with hydrocortisone and thyroxine to which the patient responded and improved significantly. A follow-up appointment was arranged at endocrine clinic

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“…Normalization of the serum sodium level with sodiumsupplementation suggests that the reduction in the level of exchangeable sodium maybe related to the elevation of the plasma ADHlevel in this case. A diminished cardiac output and reduced circulatory volume may also play a role in the development of inappropriately high plasma levels of ADH (4,14). In this case, there is some possibility for volume depletion due to the decrease in the hematocrit after treatment, it is unlikely, however, that the patient was in a severe hypovolemic state, as judged by the suppressed levels of both plasma renin activity and plasma aldosterone concentration.…”

Section: Discussionmentioning

confidence: 90%

“…While somereports have postulated inappropriate secretion of antidiuretic hormone (ADH)as being causative (2,3), others have implicated a relative deficiency of adrenal cortical hormone (4) or changes in renal function (5,6).…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia with Increased Plasma Antidiuretic Hormone in a Case of Hypothyroidism.

et al. 2000

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Wereport a 70-year-old womanwith hypothyroidism and severe hyponatremia. Her plasma antidiuretic hormone (ADH) level was inappropriately high for her low plasma osmolality. Her low serum sodium level was gradually corrected by water restriction and sodium supplementation prior to the initiation of thyroid hormone replacement. After a diagnosis of Hashimoto's thyroiditis had been made, the patient was treated with levothyroxine. Following this treatment, the patient's serum sodium level increased drastically. It is suggested that the elevated plasma ADHlevel played an important role in the development of hyponatremia in this case.

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Impaired Water Excretion in a Hyponatremic Patient following Thyroidectomy: Causal Role of Glucocorticoid Deficiency

Cited by 5 publications

References 36 publications

Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases

Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases

Severe Hyponatremia due to Hypopituitarism Secondary to Empty Sella Syndrome

Hyponatremia with Increased Plasma Antidiuretic Hormone in a Case of Hypothyroidism.

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