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A case of hyponatremia caused by central hypocortisolism

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From Nature Clinical Practice Endocrinology & Metabolism

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Abstract

Background A 43-year-old woman was referred to the Psychiatric Unit of the University of Florence Hospital, 1 year after the development of a clinical picture characterized by nausea, hyporexia, muscle weakness, insomnia, weight loss, amenorrhea and severe depression. These clinical manifestations had started 2 months after delivery of her first child. Initial laboratory investigations revealed hypoglycemia and hyponatremia. The patient was, therefore, transferred to the Endocrine Unit of the same hospital for further evaluation of the case.

Investigations Physical examination to evaluate extracellular volume status, standard laboratory investigations, and evaluation of plasma and urinary osmolality and urinary sodium excretion. Basal and dynamic evaluation of anterior pituitary function and a pituitary MRI were also performed.

Diagnosis Hyponatremia caused by central hypocortisolism (isolated adrenocorticotropic hormone deficit).

Management Glucocorticoid therapy (25 mg cortisone acetate tablets, 1.5 tablets per day).

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Figure 1: Results of dynamic tests for evaluation of pituitary hormones
Figure 2: Flowchart of the diagnostic work-up for hyponatremia
Figure 3: Schematic representation of the therapeutic approach for a patient with symptomatic hypotonic hyponatremia
Figure 4: Schematic representation of the therapeutic approach for a patient with asymptomatic hypotonic hyponatremia

References

  1. Baylis PH (2003) The syndrome of inappropriate antidiuretic hormone secretion. Int J Biochem Cell Biol 35: 1495–1499

    Article  CAS  Google Scholar 

  2. Adroguè HJ and Madias EN (2000) Hyponatremia. N Engl J Med 342: 1581–1589

    Article  Google Scholar 

  3. Bartter FC and Schwartz WB (1967) The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42: 790–806

    Article  CAS  Google Scholar 

  4. Chanson P (2003) Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 149: 177–178

    Article  CAS  Google Scholar 

  5. Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252 (Pt 2): R635–R644

    Google Scholar 

  6. Saito T et al. (2000) Vasopressin-dependent upregulation of aquaporin-2 gene expression in glucocorticoid-deficient rats. Am J Physiol Renal Physiol 279: F502–F508

    Article  CAS  Google Scholar 

  7. Larsen PR and Davies TF (2002) Hypothyroidism. In Williams Textbook of Endocrinology, edn 10, 423–455 (Eds Larsen PR et al.) Philadelphia: WB Saunders

    Google Scholar 

  8. Robinson AG and Verbalis JG (2002) The syndrome of inappropriate antidiuretic hormone secretion. In Williams Textbook of Endocrinology, edn 10, 300–313 (Eds Larsen PR et al.) Philadelphia: WB Saunders

    Google Scholar 

  9. Raison CL and Miller AH (2003) When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry 160: 1554–1565

    Article  Google Scholar 

  10. Bellastella A et al. (2003) Lymphocytic hypophysitis: a rare or underestimated disease? Eur J Endocrinol 149: 363–367

    Article  CAS  Google Scholar 

  11. De Bellis A et al. (2005) Pituitary antibodies and lymphocytic hypophysitis. Best Pract Res Clin Endocrinol Metab 19: 67–84

    Article  CAS  Google Scholar 

  12. Dewailly D et al. (1988) Recovery of menstrual cycles under hydrocortisone in two amenorrheic women with isolated corticotropin deficiency. Horm Res 29: 14–16

    Article  CAS  Google Scholar 

  13. Ben-Rafael Z et al. (1988) Cortisol stimulation of estradiol and progesterone secretion by human granulosa cells is independent of follicle-stimulating hormone effects. Fertil Steril 49: 813–816

    Article  CAS  Google Scholar 

  14. Gross P et al. (2001) Treatment of severe hyponatremia: conventional and novel aspects. J Am Soc Nephrol 12 (Suppl 17): S10–S14

    CAS  PubMed  Google Scholar 

  15. Gheorghiade M et al. (2006) Vasopressin V2 receptor blockade with tolvaptan versus fluid restriction in the treatment of hyponatremia. Am J Cardiol 97: 1064–1067

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. M Serio is a Professor of Endocrinology and Chief of the Department of Clinical Physiopathology, Department of Clinical Physiopathology, G Parenti is a PhD student in Endocrine Sciences, A Zogheri is a Resident in Endocrinology, M Mannelli is a Professor of Endocrinology and A Peri is an Associate Professor of Endocrinology at the Endocrine Unit, University of Florence.,

    Gabriele Parenti, Alessia Zogheri, Mario Serio, Massimo Mannelli & Alessandro Peri

  2. V Ricca is a Psychiatrist and Psychotherapist at the Psychiatric Unit of Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,

    Valdo Ricca

Authors
  1. Gabriele Parenti
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  2. Valdo Ricca
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  3. Alessia Zogheri
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  4. Mario Serio
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  5. Massimo Mannelli
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  6. Alessandro Peri
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Corresponding author

Correspondence to Alessandro Peri.

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The authors declare no competing financial interests.

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Parenti, G., Ricca, V., Zogheri, A. et al. A case of hyponatremia caused by central hypocortisolism. Nat Rev Endocrinol 3, 369–375 (2007). https://doi.org/10.1038/ncpendmet0459

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  • DOI: https://doi.org/10.1038/ncpendmet0459

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