Journal of Endocrinological Investigation

, Volume 30, Issue 8, pp 684–687 | Cite as

Severe hyponatremia due to hypopituitarism with adrenal insufficiency: A case report

  • F. Tarantini
  • S. Fumagalli
  • L. Boncinelli
  • M. C. Cavallini
  • E. Mossello
  • N. Marchionni
Case Report

Abstract

Objective: Adrenal insufficiency due to hypopituitarism can lead to severe hyponatremia with potentially fatal consequences. Prompt diagnosis and adequate hormonal replacement therapy are essential to block an otherwise unfavorable course and to re-establish a healthy life. Unfortunately, this condition is often misdiagnosed. Design: Case report. Setting: Intensive Care Unit of a teaching hospital. Patient: A 76-yr-old man with refractory hypotension, acute myocardial infarction, and left ventricular dysfunction, secondary to severe chronic pan-hypopituitarism, associated with severe hyponatremia. Methods and main results: The patient underwent mechanical ventilation and continuous venous-venous hemodiafiltration, for severe respiratory and renal insufficiency. A hormonal replacement therapy with T4, hydrocortisone, and nandrolone was started and the patient was discharged to a rehabilitation facility after 31 days of hospitalization. Conclusions: Hypopituitarism with secondary adrenal insufficiency is often misdiagnosed at an early stage and a high degree of suspicion is necessary for early diagnosis. Determination of plasma cortisol level in patients with hyponatremia not explained by other causes should always be obtained.

Key-words

Hyponatremia pan-hypopituitarism adrenal insufficiency myocardial infarction hypothyroidism 

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Copyright information

© Italian Society of Endocrinology (SIE) 2007

Authors and Affiliations

  • F. Tarantini
    • 1
  • S. Fumagalli
    • 1
  • L. Boncinelli
    • 1
  • M. C. Cavallini
    • 1
  • E. Mossello
    • 1
  • N. Marchionni
    • 1
  1. 1.Unit of Geriatric Medicine, Department of Critical Care Medicine and SurgeryUniversity of Florence and Azienda Ospedaliero-Universitaria CareggiFlorenceItaly

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