Incremental Increases in Glucocorticoid Doses May Reduce the Risk of Osmotic Demyelination Syndrome in a Patient with Hyponatremia due to Central Adrenal Insufficiency

Abstract

A 50-year-old man was admitted to our hospital because of general malaise. Laboratory tests revealed severe hyponatremia (104 mEq/L), which was attributed to central adrenal insufficiency. To treat presumed central diabetes insipidus (CDI), we administered a small dose of hydrocortisone and gradually increased it to maintenance doses to prevent osmotic demyelination syndrome (ODS). Serum sodium levels did not increase more than 10 mEq/L/day and ODS did not occur. Thereafter, the patient was proven to have CDI. Incremental increases in glucocorticoid dose may reduce the risk of ODS for patients with hyponatremia due to central adrenal insufficiency, especially that complicated by CDI.

Anticancer Medications and Sodium Dysmetabolism

“…167,168 Slow up-titration of glucocorticoid doses to physiological levels in those with long-standing hyponatraemia has been suggested by some authorities to prevent this. 169 Rare cases of primary AI resulting from immune checkpoint inhibitors will require mineralocorticoid supplementation, in addition to glucocorticoids.…”