An unusual case of profound hyponatraemia and bilateral adrenal calcifications.
We report a case of a 65-year-old lady who presented with acute confusion and profound hyponatraemia (plasma sodium of 97 mmol/L). Five years earlier she had developed sepsis and was found to have hyponatraemia, thought to be due to syndrome of inappropriate antidiuretic hormone secretion. The patient was lost to follow-up. The patient was covered with steroids and investigations confirmed primary adrenal failure with flat response of cortisol to adrenocorticotropic hormone (ACTH) stimulation and very high level of ACTH. Adrenal auto-antibodies were negative and a computed tomography of the adrenals showed bilateral adrenal calcifications, suggestive of previous haemorrhage or infarction. Bilateral adrenal calcification due to haemorrhage/infarction usually does not present with severe hyponatraemia; however, adrenal insufficiency should be excluded in all cases of severe hyponatraemia. In suspected cases, patients should be treated with steroids, even when symptoms or signs are absent, while results of investigations are awaited.
Cassar
Charmaine
C
Department of Medicine, The Ayr Hospital, Scotland.
Procter
Richard
R
Davidson
Fraser
F
Collier
Andrew
A
Malik
Iqbal A
IA
Ghosh
Sujoy
S
Elhadd
Tarik A
TA
D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000368:Aged; D002114:Calcinosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007010:Hyponatremia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018805:Sepsis; D013256:Steroids / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D013256:Steroids; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone