Two Cases of Isolated ACTH Deficiency Presenting As Hyponatremia - Case Report

Abstract

Non-specific symptoms such as asthenia, anorexia, unintentional weight loss, nausea/vomiting particularly in the elderly population are often overlooked both by caretakers and physicians. Deteriorating general health and neuro-psychiatric symptoms are often attributed to depression in the elderly population. The most common electrolyte abnormality, hyponatremia is again more common in the elderly population. Often neglected chronic hyponatremia remains asymptomatic in many cases. Once hyponatremia is detected clinicians should establish a proper diagnosis before supplementation. Failure to diagnose such cases will lead to repeated hospitalization, poor quality of life, wastage of resources and even death. Isolated ACTH deficiency (IAD) is a rare disorder and potentially fatal. IAD can present rarely as hyponatremia and diagnosis can easily be missed if not suspected. IAD may not be as rare as earlier thought as more and more such cases are been reported. Here we report two cases of generalized weakness and nausea; they were repeatedly hospitalized and treated for hyponatremia and ultimately diagnosed as IAD in our hospital.