[Secondary adrenal insufficiency presenting as hyponatremia: report of one case].
Hyponatremia can be a marker of an underlying disease. We report a 52 years-old male with Diabetes Mellitus who consulted for an episode of nausea and vomiting lasting four days. His baseline serum sodium was 118 mEq/L. He had no neurological deficit. Hyponatremia was initially interpreted in context of gastrointestinal fluid loss but correction with saline solution was poor. His urine sodium was 105 mEq/L and his urine osmolality was 281 mOsm/L, so an Inappropriate Secretion of Antidiuretic Hormone Syndrome was suspected. Later, we found that the patient had a two year history of fatigue, weakness, anorexia, frequent nausea, vomiting and diarrhea, loss of libido and decreased axillary and pubic hair. Thyroid-Stimulating Hormone (TSH) was normal and serum Cortisol < 1 µg/dL. A CT scan showed a sellar mass compatible with a macroadenoma. There was also a moderately high serum prolactin and low testosterone, thyroxin and growth hormone levels. The visual fi eld exami-nation showed right temporal hemianopsia. The patient was treated with steroids with a very good clinical response and serum sodium normalization. Subsequently a transsphenoidal excision of the tumor was performed and replacement of the other hormones was started. Now the patient remains asymptomatic.
Departmento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile. asaizman@uc.cl
Andrés
A
Aizman
Soledad
S
Larraín
Luis
L
Rojas
D000236:Adenoma / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000309:Adrenal Insufficiency / Q000150:complications* / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005110:Extracellular Space / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007010:Hyponatremia / Q000175:diagnosis / Q000209:etiology*; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D013972:Thyrotropin / Q000097:blood
D013972:Thyrotropin; D006854:Hydrocortisone