Microsoft Word - NEF139BF

Dra. Antonia Mora, Calle Alicante, 51, E-03140 Guardamar del Segura, Alicante (Spain) Dear Sir, Hyponatremia is a complication of untreated hypopituitarism and has been associated with an inappropriately high secretion of antidiuretic hormone (ADH). Usually it is not severe and rarely becomes a major symptomatic problem [1]. We describe a patient with severe hyponatremia as the presenting feature of hypopituitarism. A 50-year-old woman was admitted to hospital for deterioration of her level of consciousness. She had started a week before with flu-like syndrome. Past history: prolonged delivery with profuse blood loss, requiring multiple packed red cell transfusions, 26 years before. Physical examination: blood pressure 100/60 mm Hg, temperature 36.8 °C, lethargy, well hydrated, without peripheral edema or decreased skin turgor. There was also mildly hoarse voice, absence of axillary and pubic hair and nipple hypo-pigmentation. The heart and lungs were normal. The abdomen and extremities were without pathological findings. Outstanding laboratory test: glucose 2.6 mmol/l, urea 1.05 mmol/l, creatinine 63 μmol/l, uric acid353 μmol/l, sodium 102mmol/l, potassium 3.6 mmol/l, chloride 71 mmol/l, bicarbonate16.3mmol/l, serum osmolality 196mosm/kg. Urine: sodium 41 mmol/l, potassium61.4 mmol/l, osmolality 552 mosm/kg. Electrocardiography and X-ray film of the chestwere normal. The hormonal profile showed: ADH 1.5 pg/ml (serum osmolality: 196 mosm/kg), cortisol at 8 h 2 μg/dl (normal value, NV, 6-90), cortisol at 20 h 2.3 μg/dl (NV 2-8), adrenocorticotropin 9.8 pg/ml (NV 9-52), triio-dothyronine 0.7 ng/ml (NV 0.8-2), thyroxine 3.5 μg/dl (NV 5-11.8), thyroid-stimulating hormone 1.9μIU/ml (NV 0.3-3.8), estrogens 13.6 pg/ml (NV 68-253), progesterone less than 0.3 ng/ml (NV 2-24), follicle-stimulating hormone 16.5 mIU/ml(NV 1.3-11), luteinizing hormone 5.5 mlU/ml (NV 0.4-19), prolactin 4.5 ng/ml (NV 2-20). Stimulation test with 200 μg of thyrotro-pin-releasing hormone: basal level of thyroidstimulating hormone 1.9μIU/ml, at 20 min 2.5 μlU/ml, at 30 min 3.3 μlU/ml, at 60 min 2.8 μlU/ml (NV 0.3-3.8). Cranial, including the sella turcica, and thoracic-abdominal CT scans were without alterations.