Amelioration of extrapontine myelinolysis and reversible parkinsonism in a patient with asymptomatic hypopituitarism.
A 37-year-old woman with a history of transphenoidal surgery and gamma knife treatment for prolactinoma was admitted because of pneumoniae with hyponatremia (Na 109 mmol/l). After the careful correction of the serum sodium level within 15 mmol/l/day, the patient developed parkinsonism. MRI of the brain disclosed a signal increase in the bilateral basal ganglias on T2-weighted images, a finding consistent with extrapontine myelinolysis (EPM). Interestingly, the parkinsonism fully disappeared after the replacement therapy of hydrocortisone for adrenal insufficiency due to hypopituitarism, and MRI 5 months later showed complete disappearance of the lesions, indicating the patient had ameliorated from the EPM.
Okada
Kyoko
K
Department of General Medicine, Kyushu University Hospital, Fukuoka.
Nomura
Masatoshi
M
Furusyo
Norihiro
N
Otaguro
Shigeru
S
Nabeshima
Shigeki
S
Hayashi
Jun
J
D000328:Adult; D001479:Basal Ganglia / Q000473:pathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology; D007018:Hypopituitarism / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis* / Q000453:epidemiology; D020734:Parkinsonian Disorders / Q000453:epidemiology*; D010911:Pituitary Neoplasms / Q000453:epidemiology; D012658:Sella Turcica