title: Fatigue and hyponatremia in a 75-year-old woman: unusual presentation of hypophysitis.
abstract: A 75-year-old woman presented with general fatigue progressing to somnolence. Laboratory tests showed marked hyponatremia. TSH in the normal range, but low levels of free T3 and free T4. Evaluation of pituitary hormones and magnetic resonance imaging of the pituitary unmasked findings characteristic for hypophysitis with secondary adrenal insufficiency and secondary hypothyroidism. Hormonal substitution with hydrocortisone and levothyroxine resulted in rapid improvement of all symptoms and signs. Without additional treatment shrinkage of the pituitary gland could be documented. Our report extends the known clinical and pathological spectrum of hypophysitis and illustrates the need to include this uncommon entity in the differential diagnosis of hyponatremia even in elderly patients.
authors.affiliation: Department of Internal Medicine I, Medical University of Lübeck, Germany. johannes.klein@medinf.mu-luebeck.de
authors.forename: J
authors.initials: J
authors.lastname: Klein
authors.forename: W
authors.initials: W
authors.lastname: Kern
authors.forename: H L
authors.initials: HL
authors.lastname: Fehm
mesh_terms: D000309:Adrenal Insufficiency / Q000209:etiology; D000368:Aged; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007010:Hyponatremia / Q000209:etiology*; D007037:Hypothyroidism / Q000209:etiology; D007249:Inflammation / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D010900:Pituitary Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013974:Thyroxine / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D013974:Thyroxine; D006854:Hydrocortisone