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Hydro-saline Alterations in Central Adrenal Insufficiency

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Hydro Saline Metabolism

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

Central adrenal insufficiency (CAI) is a rare endocrine disorder characterized by impaired adrenocorticotropic hormone (ACTH) production, due to primary pituitary alterations or improper hypothalamic stimulation, leading to reduced cortisol production by adrenal glands. CAI may be associated with hydro-saline alterations, mainly represented by hyponatremia. Although the exact physiopathology of hyponatremia in CAI is still matter of debate, the decrease in glucocorticoid (GC) circulating levels has been reportedly associated with decreased renal sodium reabsorption, due to a decreased activity of renal tubular sodium channels, and with increased water retention, due to an abnormally increased secretion of vasopressin (AVP). The prevalence of hyponatremia in CAI patients is actually not fully clarified, largely varying, across different studies, according to the specific cause of CAI, including both isolated ACTH deficiency and CAI in the context of combined pituitary hormonal deficiency (CPHD). Hyponatremia in CAI patients is usually mild, mainly asymptomatic, and more likely occurs in elderly patients, although careful evaluations should be performed in patients with acute hyponatremia due to the potential life-threatening occurrence of brain edema. In patients with hyponatremia, CAI should be properly assessed with both basal and dynamic hormonal testing, and a differential diagnosis with other frequent causes of hyponatremia, namely the syndrome of inappropriate antidiuresis (SIAD), should be carefully performed. In CAI patients with hyponatremia, GC replacement therapy is usually able to restore normal serum sodium levels, although in more severe cases, hypertonic saline infusion is required; nevertheless, a gradual increase in sodium levels is suggested to avoid osmotic demyelination syndrome (ODS).

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References

  • Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581–9.

    Article  CAS  PubMed  Google Scholar 

  • Ahmed AB, George BC, Gonzalez-Auvert C, Dingman JF. Increased plasma arginine vasopressin in clinical adrenocortical insufficeincy and its inhibition by glucosteroids. J Clin Invest. 1967;46(1):111–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Araujo-Castro M, Berrocal VR, Pascual-Corrales E. Pituitary tumors: epidemiology and clinical presentation spectrum. Hormones (Athens). 2020;19(2):145–55.

    Article  PubMed  Google Scholar 

  • Arieff AI, Llach F, Massry SG. Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine (Baltimore). 1976;55:121–9.

    Article  CAS  PubMed  Google Scholar 

  • Asano T, Aoki A, Sasaki M, Ikoma A, Kakei M, Kawakami M, et al. Hyponatremia is the valuable manifestation for initiating diagnosis of hypopituitarism in elderly. Endocr J. 2012;59(11):1015–20.

    Article  CAS  PubMed  Google Scholar 

  • Attmane-Elakeb A, et al. Regulation by glucocorticoids of expression and activity of rBSC1, the Na+-K+(NH4+)-2Cl- cotransporter of medullary thick ascending limb. J Biol Chem. 2000;275(43):33548–53. PMID: 10942780. https://doi.org/10.1074/jbc.M006591200

  • Bankir L, Bichet DG, Morgenthaler NG. Vasopressin: physiology, assessment and osmosensation. J Intern Med. 2017;282(4):284–97.

    Article  CAS  PubMed  Google Scholar 

  • Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med. 1967;42:790–806.

    Article  CAS  PubMed  Google Scholar 

  • Beasley R, Harper J, Bird G, Maijers I, Weatherall M, Pavord ID. Inhaled corticosteroid therapy in adult asthma. Time for a new therapeutic dose terminology. Am J Respir Crit Care Med. 2019;199(12):1471–7.

    Article  CAS  PubMed  Google Scholar 

  • Bie P. Mechanisms of sodium balance: total body sodium, surrogate variables, and renal sodium excretion. Am J Physiol Regul Integr Comp Physiol. 2018;315(5):R945–62.

    Article  CAS  PubMed  Google Scholar 

  • Broersen LH, Pereira AM, Jørgensen JO, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(6):2171–80.

    Article  CAS  PubMed  Google Scholar 

  • Buchfelder M, Schlaffer S. Surgical treatment of pituitary tumours. Best Pract Res Clin Endocrinol Metab. 2009;23(5):677–92.

    Article  PubMed  Google Scholar 

  • Buttgereit F. Views on glucocorticoid therapy in rheumatology: the age of convergence. Nat Rev Rheumatol. 2020;16(4):239–46.

    Article  CAS  PubMed  Google Scholar 

  • Byun DJ, Wolchok JD, Rosenberg LM, Girotra M. Cancer immunotherapy – immune checkpoint blockade and associated endocrinopathies. Nat Rev Endocrinol. 2017;13(4):195–207.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cain DW, Cidlowski JA. Immune regulation by glucocorticoids. Nat Rev Immunol. 2017;17(4):233–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Can A, Gross BA, Smith TR, Dammers R, Dirven CM, Woodmansee WW, et al. Pituitary dysfunction after aneurysmal subarachnoid Hemorrhage: a systematic review and meta-analysis. Neurosurgery. 2016;79(2):253–64.

    Article  PubMed  Google Scholar 

  • Carpinteri R, Patelli I, Casanueva FF, Giustina A. Pituitary tumours: inflammatory and granulomatous expansive lesions of the pituitary. Best Pract Res Clin Endocrinol Metab. 2009;23(5):639–50.

    Article  CAS  PubMed  Google Scholar 

  • Çetinkaya S, Güran T, Kurnaz E, Keskin M, Sağsak E, Erdeve SS, et al. A patient with proopiomelanocortin deficiency: an increasingly important diagnosis to make. J Clin Res Pediatr Endocrinol. 2018;10(1):68–73.

    Article  PubMed  PubMed Central  Google Scholar 

  • Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152–67.

    Article  CAS  PubMed  Google Scholar 

  • Chen Z, Vaughn DA, Blakely P, Fanestil DD. Adrenocortical steroids increase renal thiazide diuretic receptor density and response. J Am Soc Nephrol. 1994;5(6):1361–8.

    Article  CAS  PubMed  Google Scholar 

  • Chen YC, Cadnapaphornchai MA, Summer SN, Falk S, Li C, Wang W, et al. Molecular mechanisms of impaired urinary concentrating ability in glucocorticoid-deficient rats. J Am Soc Nephrol. 2005;16(10):2864–71.

    Google Scholar 

  • Chiloiro S, Giampietro A, Bianchi A, Tartaglione T, Capobianco A, Anile C, et al. Diagnosis of endocrine disease: primary empty sella: a comprehensive review. Eur J Endocrinol. 2017;177(6):R275–85.

    Article  CAS  PubMed  Google Scholar 

  • Cho KY, Miyoshi H, Nakamura A, Kurita T, Atsumi T. Hyponatremia can be a powerful predictor of the development of isolated ACTH deficiency associated with nivolumab treatment [letter to the editor]. Endocr J. 2017;64(2):235–6.

    Article  PubMed  Google Scholar 

  • Crowley RK, Argese N, Tomlinson JW, Stewart PM. Central hypoadrenalism. J Clin Endocrinol Metab. 2014;99(11):4027–36.

    Google Scholar 

  • Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, et al. The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study. Clin Endocrinol. 2016a;85(6):836–44.

    Google Scholar 

  • Cuesta M, et al. Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury. Clin Endocrinol. 2016b;84:92–8.

    Google Scholar 

  • Cuesta M, Hannon MJ, Thompson CJ. Diagnosis and treatment of hyponatraemia in neurosurgical patients. Endocrinol Nutr. 2016c;63(5):230–8.

    Google Scholar 

  • Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary “empty sella” in adults: endocrine findings. Endocr J. 2006 Dec;53(6):803–9.

    Article  PubMed  Google Scholar 

  • Delpire E, Gagnon KB. Water homeostasis and cell volume maintenance and regulation. Curr Top Membr. 2018;81:3–52.

    Article  PubMed  PubMed Central  Google Scholar 

  • Diker-Cohen T, Rozen-Zvi B, Yelin D, Akirov A, Robenshtok E, Gafter-Gvili A, et al. Endocrinopathy-induced euvolemic hyponatremia. Intern Emerg Med. 2018;13(5):679–88.

    Article  PubMed  Google Scholar 

  • Diri D, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan’s syndrome: new insights into an old disease. Endocrine. 2016;51(1):22–31.

    Article  CAS  PubMed  Google Scholar 

  • Dyck L, Mills KHG. Immune checkpoints and their inhibition in cancer and infectious diseases. Eur J Immunol. 2017;47(5):765–79.

    Article  CAS  PubMed  Google Scholar 

  • El Mernissi G, Doucet A. Short-term effect of aldosterone on renal sodium transport and tubular Na-K-ATPase in the rat. Pflugers Arch. 1983a;399(2):139–46. (El Mernissi 1983a).

    Article  PubMed  Google Scholar 

  • El Mernissi G, Doucet A. Short-term effects of aldosterone and dexamethasone on Na-K-ATPase along the rabbit nephron. Pflugers Arch. 1983b;399(2):147–51.

    Article  PubMed  Google Scholar 

  • El Mernissi G, Doucet A. Specific activity of Na-K-ATPase after adrenalectomy and hormone replacement along the rabbit nephron. Pflugers Arch. 1984;402(3):258–63.

    Article  CAS  PubMed  Google Scholar 

  • Escoubet B, Coureau C, Bonvalet JP, Farman N. Noncoordinate regulation of epithelial Na channel and Na pump subunit mRNAs in kidney and colon by aldosterone. Am J Physiol Cell Physiol. 1997;272:C1482–91.

    Article  CAS  Google Scholar 

  • Faje A, Reynolds K, Zubiri L, Lawrence D, Cohen JV, Sullivan RJ, et al. Hypophysitis secondary to nivolumab and pembrolizumab is a clinical entity distinct from ipilimumab-associated hypophysitis. Eur J Endocrinol. 2019;181(3):211–9.

    Article  CAS  PubMed  Google Scholar 

  • Fang Q, George AS, Brinkmeier ML, Mortensen AH, Gergics P, Cheung LY, et al. Genetics of combined pituitary hormone deficiency: Roadmap into the genome era. Endocr Rev. 2016;37(6):636–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Farman N, Coutry N, Logvinenko N, Blot-Chabaud M, Bourbouze R, Bonvalet JP. Adrenalectomy reduces alpha 1 and not beta 1 Na(+)-K (+)-ATPase mRNA expression in rat distal nephron. Am J Phys. 1992;263(4 Pt 1):C810–7.

    CAS  Google Scholar 

  • Féraille E, Doucet A. Sodium-potassium-adenosinetriphosphatase-dependent sodium transport in the kidney: hormonal control. Physiol Rev. 2001;81(1):345–418.

    Article  PubMed  Google Scholar 

  • Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging. 2017;12:1957–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fleseriu M, Hashim IA, et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. JCEM. 2016;101:0000–0.

    Google Scholar 

  • Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P. Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci. 2008;1(1):42–50.

    Article  CAS  PubMed  Google Scholar 

  • Garrahy A, Thompson CJ. Hyponatremia and glucocorticoid deficiency. Front Horm Res. 2019;52:80–92.

    Article  CAS  PubMed  Google Scholar 

  • Gharaibeh KA, Brewer JM, Agarwal M, et al. Risk factors, complication and measures to prevent or reverse catastrophic sodium overcorrection in chronic hyponatremia. Am J Med Sci. 2014;349:170–5.

    Article  Google Scholar 

  • Grant P. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Investig. 2015;45(8):888–94.

    Article  Google Scholar 

  • Gubbi S, Hannah-Shmouni F, Stratakis CA, Koch CA. Primary hypophysitis and other autoimmune disorders of the sellar and suprasellar regions. Rev Endocr Metab Disord. 2018;19(4):335–47.

    Article  CAS  PubMed  Google Scholar 

  • Gullans SR, Verbalis JG. Control of brain volume during hyperosmolar and hypoosmolar conditions. Annu Rev Med. 1993;44:289–301.

    Google Scholar 

  • Gupta N, Tarif SR, Seikaly M, Baum M. Role of glucocorticoids in the maturation of the rat renal Na+/H+ antiporter (NHE3). Kidney Int. 2001;60(1):173–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gupta N, Dwarakanath V, Baum M. Maturation of the Na+/H+ antiporter (NHE3) in the proximal tubule of the hypothyroid adrenalectomized rat. Am J Physiol Renal Physiol. 2004;287(3):F521–7.

    Article  CAS  PubMed  Google Scholar 

  • Hannon MJ, Finucane FM, Sherlock M, et al. Clinical review: disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol Metab. 2012;97:1423–33.

    Article  CAS  PubMed  Google Scholar 

  • Hannon MJ, Crowley RK, Behan LA, O’Sullivan EP, O’Brien MMC, Sherlock M, et al. Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality. J Clin Endocrinol Metab. 2013;98(8):3229–37.

    Article  CAS  PubMed  Google Scholar 

  • Hannon MJ, Behan LA, O’Brien MM, Tormey W, Ball SG, Javadpour M, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. J Clin Endocrinol Metab. 2014;99(1):291–8.

    Article  CAS  PubMed  Google Scholar 

  • Hannon AM, Hunter S, Smith D, Sherlock M, O’Halloran D, Thompson CJ. Clinical features and autoimmune associations in patients presenting with idiopathic isolated ACTH deficiency. Clin Endocrinol. 2018;88(3):491–7.

    Article  CAS  Google Scholar 

  • Higham CE, Johannsson G, Shalet SM. Hypopituitarism. Lancet. 2016;388(10058):2403–15.

    Article  CAS  PubMed  Google Scholar 

  • Hunter RW, Ivy JR, Bailey MA. Glucocorticoids and renal Na+ transport: implications for hypertension and salt sensitivity. J Physiol. 2014;592(8):1731–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Inaba H, Ariyasu H, Iwakura H, Ueda Y, Kurimoto C, Uraki S, et al. Comparative analysis of human leucocyte antigen between idiopathic and anti-PD-1 antibody induced isolated adrenocorticotropic hormone deficiency: a pilot study. Clin Endocrinol. 2019;91(6):786–92.

    Article  CAS  Google Scholar 

  • Ishikawa S, Schrier RW. Effect of arginine vasopressin antagonist on renal water excretion in glucocorticoid and mineralocorticoid deficient rats. Kidney Int. 1982;22(6):587–93.

    Article  CAS  PubMed  Google Scholar 

  • Ishikawa S, Fujisawa G, Tsuboi Y, Okada K, Kuzuya T, Saito T. Role of antidiuretic hormone in hyponatremia in patients with isolated adrenocorticotropic hormone deficiency. Endocrinol Jpn. 1991;38(3):325–30.

    Article  CAS  PubMed  Google Scholar 

  • Ivy GR, Oosthuyzen W, Peltz TS, et al. Glucocorticoids induce nondipping blood pressure by activating the thiazide-sensitive cotransporter. Hypertension. 2016;67(5):1029–37.

    Google Scholar 

  • Karavitaki N, Wass JA. Non-adenomatous pituitary tumours. Best Pract Res Clin Endocrinol Metab. 2009;23(5):651–65.

    Article  CAS  PubMed  Google Scholar 

  • Karp BI, Laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine (Baltimore). 1993;72:359–73.

    Article  CAS  PubMed  Google Scholar 

  • Katoch CD, Brar KS, Singh B. Evaluation of thyroid and adrenal functions in patients with hyponatremia. Med J Armed Forces India. 2013;69:237–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kumar S, Berl T. Sodium. Lancet. 1998;352:220–8.

    Article  CAS  PubMed  Google Scholar 

  • Kurtulmus N, Yarman S. Hyponatremia as the presenting manifestation of Sheehan’s syndrome in elderly patients. Aging Clin Exp Res. 2006;18(6):536–9.

    Article  CAS  PubMed  Google Scholar 

  • Lam T, Chan MM, Sweeting AN, De Sousa SM, Clements A, Carlino MS, et al. Ipilimumab-induced hypophysitis in melanoma patients: an Australian case series. Intern Med J. 2015;45(10):1066–73.

    Article  CAS  PubMed  Google Scholar 

  • Lasheen I, Doi SA, Al-Shoumer KA. Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis. Med Princ Pract. 2005;14:115–7.

    Article  PubMed  Google Scholar 

  • Levy M, Abeillon J, Dalle S, Assaad S, Borson-Chazot F, Disse E, et al. Anti-PD1 and anti-PDL1-induced hypophysitis: a cohort study of 17 patients with longitudinal follow-up. J Clin Med. 2020;9(10):3280.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Li B, Chan HL, Chen P. Immune checkpoint inhibitors: basics and challenges. Curr Med Chem. 2019;26(17):3009–25.

    Article  CAS  PubMed  Google Scholar 

  • Liamis G, Filippatos TD, Liontos A, Elisaf AS. Management of endocrine disease: hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol. 2017;176(1):R15–20.

    Article  CAS  PubMed  Google Scholar 

  • MacDonald P, MacKenzie S, Ramage LE, Seckl JR, Brown RW. Corticosteroid regulation of amiloride-sensitive sodium-channel subunit mRNA expression in mouse kidney. J Endocrinol. 2000;165(1):25–37.

    Article  CAS  PubMed  Google Scholar 

  • Mandal S, Mukhopadhyay P, Banerjee M, Ghosh S. Clinical, endocrine, metabolic profile, and bone health in Sheehan’s syndrome. Indian J Endocrinol Metab. 2020;24(4):338–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McLaughlan E, Barth JH. An analysis of the relationship between serum cortisol and serum sodium in routine clinical patients. Pract Lab Med. 2017;8:30–3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miljic D, Doknic M, Stojanovic M, Nikolic-Djurovic M, Petakov M, Popovic V, et al. Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit. Endocrine. 2017;58(2):312–9.

    Article  CAS  PubMed  Google Scholar 

  • Miller AH, Brock P, Jim Yeung SC. Pituitary dysfunction: a case series of immune checkpoint inhibitor-related hypophysitis in an emergency department. Ann Emerg Med. 2016;68(2):249–50.

    Article  PubMed  Google Scholar 

  • Minniti G, Flickinger J. The risk/benefit ratio of radiotherapy in pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101269.

    Article  PubMed  Google Scholar 

  • Murayama Y, Suzuki A, Tadokoro M, Sakai F. Microperfusion of Henle’s loop in the kidney of adrenalectomized rat. Jpn J Pharmacol. 1968;18:518–9.

    Article  CAS  PubMed  Google Scholar 

  • Nielsen J, Kwon TH, Masilamani S, Beutler K, Hager H, Nielsen S, et al. Sodium transporter abundance profiling in kidney: effect of spironolactone. Am J Physiol Renal Physiol. 2002;283(5):F923–33.

    Article  PubMed  Google Scholar 

  • Nigro N, et al. Symptoms and characteristics of individuals with profound hyponatremia: a prospective multicenter observational study. J Am Geriatr Soc. 2015;63:470–5.

    Article  PubMed  Google Scholar 

  • Nishizawa S, Yokoyama T, Yokota N, Ohta S. Preoperative hyponatremia as a clinical characteristic in elderly patients with large pituitary tumor. Neurol Med Chir (Tokyo). 2000;40(5):249–54; discussion 254–5

    Article  CAS  PubMed  Google Scholar 

  • Ntali G, Tsagarakis S. Pituitary dysfunction after traumatic brain injury: prevalence and screening strategies. Expert Rev Endocrinol Metab. 2020;15(5):341–54.

    Article  CAS  PubMed  Google Scholar 

  • Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett. 2005;26(3):257–60.

    PubMed  Google Scholar 

  • Paragliola RM, Papi G, Pontecorvi A, Corsello SM. Treatment with synthetic glucocorticoids and the hypothalamus-pituitary-adrenal axis. Int J Mol Sci. 2017;18(10):2201.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patel S, Rauf A, Khan H, Abu-Izneid T. Renin-angiotensin-aldosterone (RAAS): the ubiquitous system for homeostasis and pathologies. Biomed Pharmacother. 2017;94:317–25.

    Article  CAS  PubMed  Google Scholar 

  • Pekic S, et al. Case seminar: a young female with acute hyponatremia and a sellar mass. Endocrine. 2011;40:325–31.

    Article  CAS  PubMed  Google Scholar 

  • Percik R, Shlomai G, Tirosh A, Tirosh A, Leibowitz-Amit R, Eshet Y, et al. Isolated autoimmune adrenocorticotropic hormone deficiency: from a rare disease to the dominant cause of adrenal insufficiency related to check point inhibitors. Autoimmun Rev. 2020;19(2):102454.

    Article  CAS  PubMed  Google Scholar 

  • Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BM, Colao A. Complications of Cushing’s syndrome: state of the art. Lancet Diabetes Endocrinol. 2016;4(7):611–29.

    Article  CAS  PubMed  Google Scholar 

  • Pyo HJ, Summer SN, Kim JK, Schrier RW. Vasopressin gene expression in glucocorticoid hormone-deficient rats. Ann N Y Acad Sci. 1993;689:659–62.

    Article  CAS  PubMed  Google Scholar 

  • Renneboog B, Musch W, Vandemergel X, et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119(71):e1–8.

    Google Scholar 

  • Rice JB, White AG, Scarpati LM, Wan G, Nelson WW. Long-term systemic corticosteroid exposure: a systematic literature review. Clin Ther. 2017;39(11):2216–29.

    Article  CAS  PubMed  Google Scholar 

  • Robinson AG, Seif SM, Verbalis JG, Brownstein MJ. Quantitation of changes in the content of neurohypophyseal peptides in hypothalamic nuclei after adrenalectomy. Neuroendocrinology. 1983;36:347–50.

    Article  CAS  PubMed  Google Scholar 

  • Saito T, Saito T, Kasono K, Otani T, Tamemoto H, Kawakami M, et al. Vasopressin-dependent upregulation of aquaporin-2 gene expression in aged rats with glucocorticoid deficiency. Acta Physiol (Oxf). 2009;196(2):239–47.

    Google Scholar 

  • Salehmohamed MR, et al. Patients treated with immunosoppressive steroids are less aware of sick day rules than those on endocrine replacement therapy and may be at greater risk of adrenal crisis. Ir J Med Sci. 2018;187:69–74.

    Article  CAS  PubMed  Google Scholar 

  • Salyer SA, Parks J, Barati MT, Lederer ED, Clark BJ, Klein JD, et al. Aldosterone regulates Na (+), K(+) ATPase activity in human renal proximal tubule cells through mineralocorticoid receptor. Biochim Biophys Acta. 2013;1833(10):2143–52.

    Article  CAS  PubMed  Google Scholar 

  • Schnermann J, Briggs JP. Tubular control of renin synthesis and secretion. Pflugers Arch. 2013;465(1):39–51.

    Article  CAS  PubMed  Google Scholar 

  • Schrier RW. Molecular mechanisms of clinical concentrating and diluting disorders. Prog Brain Res. 2008;170:539–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seif SM, Robinson AG, Zimmerman EA, Wilkins J. Plasma neurophysin and vasopressin in the rat: response to adrenalectomy and steroid replacement. Endocrinology. 1978;103(4):1009–15.

    Article  CAS  PubMed  Google Scholar 

  • Sert M, et al. Clinical report of 28 patients with Sheehan’s syndrome. Endocr J. 2003;50(3):297–301.

    Google Scholar 

  • Shoji M, et al. Cortical laminar necrosis and central pontine myelinolysis in a patient with Sheehan syndrome and severe hyponatremia. Intern Med. 1996;35:427–31.

    Google Scholar 

  • Slessor A. Studies concerning the mechanism of water retention in Addison’s disease and in hypopituitarism. J Clin Endocrinol Metab. 1951;11(7):700–23.

    Google Scholar 

  • Snyders T, Chakos D, Swami U, Latour E, Chen Y, Fleseriu M, et al. Ipilimumab-induced hypophysitis, a single academic center experience. Pituitary. 2019;22(5):488–96.

    Google Scholar 

  • Srimanee D, Bhidayasiri R, Phanthumchinda K. Extrapontine myelinolysis in preoperative sellar region tumour: report of two cases. J Med Assoc Thail. 2009;92:1548–53.

    Google Scholar 

  • Sterns RH, Riggs JE, Schochet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med. 1986;314:1535–42.

    Article  CAS  PubMed  Google Scholar 

  • Suzuki K, Terakawa T, Furukawa J, Harada K, Hinata N, Nakano Y, et al. Nivolumab-induced adrenal insufficiency in patients with renal cell carcinoma. J Immunother. 2020;43(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  • Tanneau RS, Henry A, Rouhart F, et al. High incidence of neurologic complications following rapid correction of severe hyponatremia in polydipsic patients. J Clin Psychiatry. 1994;55:349–54.

    CAS  PubMed  Google Scholar 

  • Tsuchiya K, Giebisch G, Welling PA. Aldosterone-dependent regulation of Na-K-ATPase subunit mRNA in the rat CCD: competitive PCR analysis. Am J Physiol Renal Fluid Electrolyte Physiol. 1996;271:F7–F15.

    Article  CAS  Google Scholar 

  • Tzoulis P, Bouloux PM. Inpatient hyponatraemia: adequacy of investigation and prevalence of endocrine causes. Clin Med (Lond). 2015;15(1):20–4.

    Article  PubMed  Google Scholar 

  • Velázquez H, Bartiss A, Bernstein P, Ellison DH. Adrenal steroids stimulate thiazide-sensitive NaCl transport by rat renal distal tubules. Am J Phys. 1996;270(1 Pt 2):F211–9.

    Google Scholar 

  • Ventura M, Serra-Caetano J, Cardoso R, Dinis I, Melo M, Carrilho F, et al. The spectrum of pediatric adrenal insufficiency: insights from 34 years of experience. J Pediatr Endocrinol Metab. 2019;32(7):721–6.

    Article  PubMed  Google Scholar 

  • Verbalis JG. Hyponatremia: endocrinologic causes and consequences of therapy. Trends Endocrinol Metab. 1992;3:1–7.

    Article  CAS  PubMed  Google Scholar 

  • Verbalis JG, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 suppl 1):S1–S42.

    Article  PubMed  Google Scholar 

  • Wang W, Li C, Summer SN, Falk S, Cadnapaphornchai MA, Chen YC, et al. Molecular analysis of impaired urinary diluting capacity in glucocorticoid deficiency. Am J Physiol Renal Physiol. 2006;290:F1135–42.

    Article  CAS  PubMed  Google Scholar 

  • Workeneh BT, Jhaveri KD, Rondon-Berrios H. Hyponatremia in the cancer patient. Kidney Int. 2020;98(4):870–82.

    Article  CAS  PubMed  Google Scholar 

  • Yamauchi I, Taura D, Hakata T, Fujita H, Okamoto K, Ueda Y, et al. Clinical features and thyroid dysfunction in adverse events involving the pituitary gland during PD-1 blockade therapy. Clin Endocrinol. 2020.

    Google Scholar 

  • Yang IA, Shaw JG, Goddard JR, Clarke MS, Reid DW. Use of inhaled corticosteroids in COPD: improving efficacy. Expert Rev Respir Med. 2016;10(3):339–50.

    Article  CAS  PubMed  Google Scholar 

  • Yatagai T, Kusaka I, Nakamura T, Nagasaka S, Honda K, Ishibashi S, et al. Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency. Eur J Endocrinol. 2003;148(2):221–6.

    Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Naples, Italy

    Rosario Pivonello, Chiara Simeoli, Nicola Di Paola, Rosario Ferrigno & Annamaria Colao

  2. UNESCO Chair for Health Education and Sustainable Development, University Federico II, Naples, Italy

    Rosario Pivonello & Annamaria Colao

Authors
  1. Rosario Pivonello
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  2. Chiara Simeoli
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  3. Nicola Di Paola
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  4. Rosario Ferrigno
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  5. Annamaria Colao
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Corresponding author

Correspondence to Rosario Pivonello .

Editor information

Editors and Affiliations

  1. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy

    Massimiliano Caprio

  2. Université Paris Cité, PARCC, Inserm, Paris, France

    Fabio Luiz Fernandes-Rosa

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Pivonello, R., Simeoli, C., Di Paola, N., Ferrigno, R., Colao, A. (2023). Hydro-saline Alterations in Central Adrenal Insufficiency. In: Caprio, M., Fernandes-Rosa, F.L. (eds) Hydro Saline Metabolism. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-27119-9_7

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  • DOI: https://doi.org/10.1007/978-3-031-27119-9_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-27118-2

  • Online ISBN: 978-3-031-27119-9

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