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

A Case Report of Late Onset Mania Caused by Hyponatremia in a Patient With Empty Sella Syndrome

“…Severe hyponatremia due to hypopituitarism and adrenal insufficiency is not a very rare situation. Petridis et al 7 reported a case of hyponatremia in empty sella caused by hypocortisolism. 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 hyponatremia.…”

Senile hypopituitarism: Characteristics of its diagnosis and treatment

“…However, due to the less influence on secretion of aldosterone than on glucocorticoid, the severity of hyonatremia is not so obvious as it is found in primary adrenal cortical hypofunction. [5,6] Pituitary crisis For patients with hypopituitarism, a variety of stress conditions can induce pituitary crisis, such as infection, sepsis, diarrhea, vomiting, dehydration, long-time starvation or cold, cardiovascular and cerebrovascular accidents and insufficient preoperative preparation. Clinical manifestations include: (1) hyperpyrexia >40°C, which is rarely seen in the elderly; (2) hypothermia <30°C;…”

“…A possible hypopituitarism needs to be considered after excluding the inducing factors such as insufficient intake, diuretic medication, etc. [5] Attentions to identifying the causes of hypoglycemia Some elderly patients develop recurrent episodes of hypoglycemia without obvious causes, even a hypoglycemic coma in severe cases. A possible hypopituitarism also needs to be considered after ruling out the conditions including misuse of antidiabetic drugs, insulinoma, etc.…”