Publicação
Severe hyponatremia – a form of presentation of hypophyseal apoplexy
| Resumo: | The authors describe the case of a 68-year-old man, formerly a smoker with a history of alcoholism. Admitted to the emergency department complaining of pollakiuria and hypogastric pain evolving for a couple of days and fever in the previous week, with headaches and vomiting. He presented diffuse hair loss and gynecomastia; neurological examination was normal. Severe hyponatremia was found (Na+ 113 mEq/L), along with low serum osmolarity, normal urinary osmolarity, urinary ionogram and urinalysis. He started intravenous fluid therapy to correct the natremia. The chest and brain computed tomography scans were normal, the abdominal ultrasound showed signs of chronic liver disease. The hormonal study showed decreased levels of cortisol, adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone, testosterone and thyroxine; triiodothyronine, thyroid-stimulating hormone and prolactine were normal.The pituitary magnetic resonance imaging revealed intra-adenomatous hemorrhagic lesion, establishing the diagnosis of hypophyseal apoplexy. Since surgery was not recommended,he started hydrocortisone and levothyroxine therapy with clinical and analytic improvement. This case shows how important it is to ascertain hyponatremia etiology. |
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| Autores principais: | Rangel, Inês |
| Outros Autores: | Carneiro, Filipa; Paiva, Isabel; Gonçalves, Anabela |
| Assunto: | hiponatremia hipopituitarismo apoplexia hipofisária hyponatremia hypopituitarism hypophyseal apoplexy |
| Ano: | 2012 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | unknown |
| Instituição associada: | Sociedade Portuguesa de Medicina Interna |
| Idioma: | português |
| Origem: | Revista Portuguesa de Medicina Interna |
| Resumo: | The authors describe the case of a 68-year-old man, formerly a smoker with a history of alcoholism. Admitted to the emergency department complaining of pollakiuria and hypogastric pain evolving for a couple of days and fever in the previous week, with headaches and vomiting. He presented diffuse hair loss and gynecomastia; neurological examination was normal. Severe hyponatremia was found (Na+ 113 mEq/L), along with low serum osmolarity, normal urinary osmolarity, urinary ionogram and urinalysis. He started intravenous fluid therapy to correct the natremia. The chest and brain computed tomography scans were normal, the abdominal ultrasound showed signs of chronic liver disease. The hormonal study showed decreased levels of cortisol, adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone, testosterone and thyroxine; triiodothyronine, thyroid-stimulating hormone and prolactine were normal.The pituitary magnetic resonance imaging revealed intra-adenomatous hemorrhagic lesion, establishing the diagnosis of hypophyseal apoplexy. Since surgery was not recommended,he started hydrocortisone and levothyroxine therapy with clinical and analytic improvement. This case shows how important it is to ascertain hyponatremia etiology. |
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