Severe hyponatremia due to hypopituitarism with adrenal insufficiency: a case report.
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.


METHODS
Case report.


METHODS
Intensive Care Unit of a teaching hospital.


METHODS
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.


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.
Tarantini
F
F
Unit of Geriatric Medicine, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. taranf@unifi.it
Fumagalli
S
S
Boncinelli
L
L
Cavallini
M C
MC
Mossello
E
E
Marchionni
N
N
D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D004562:Electrocardiography; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007010:Hyponatremia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007018:Hypopituitarism / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008297:Male; D012720:Severity of Illness Index
D006854:Hydrocortisone