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Diagnosis and Treatment > Medication

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Tzy Harn Chua Department of Endocrinology, Changi General Hospital, Singapore

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Wann Jia Loh Department of Endocrinology, Changi General Hospital, Singapore

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Summary

Severe hyponatremia and osmotic demyelination syndrome (ODS) are opposite ends of a spectrum of emergency disorders related to sodium concentrations. Management of severe hyponatremia is challenging because of the difficulty in balancing the risk of overcorrection leading to ODS as well as under-correction causing cerebral oedema, particularly in a patient with chronic hypocortisolism and hypothyroidism. We report a case of a patient with Noonan syndrome and untreated anterior hypopituitarism who presented with symptomatic hyponatremia and developed transient ODS.

Learning points:

  • Patients with severe anterior hypopituitarism with severe hyponatremia are susceptible to the rapid rise of sodium level with a small amount of fluid and hydrocortisone.

  • These patients with chronic anterior hypopituitarism are at high risk of developing ODS and therefore, care should be taken to avoid a rise of more than 4–6 mmol/L per day.

  • Early recognition and rescue desmopressin and i.v. dextrose 5% fluids to reduce serum sodium concentration may be helpful in treating acute ODS.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, ACTH, Cortisol, FSH, GH, IGF1, LH, Testosterone, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Hyponatraemia, Hypopituitarism, Microadenoma, Noonan syndrome, Pituitary adenoma, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, Asian - other, Country of Treatment, Singapore, Diagnosis and Treatment, Signs and Symptoms, Abdominal pain, Aphasia, Dizziness, Ears - low set, Gynaecomastia, Headache, Hypogonadism, Hyponatraemia, Hypopituitarism, Hypotension, Hypothyroidism, Hypotonia, Insomnia, Kyphoscoliosis, Nausea, Neck - loose skin (nape), Neck - short, Osteoporosis, Seizures, Short stature, Vomiting, Investigation, 25-hydroxyvitamin-D3, ACTH, Blood pressure, Bone mineral density, Chloride, Cortisol, Cortisol (9am), Cortisol (serum), FSH, FT3, FT4, GH, Haemoglobin, IGF1, LH, MRI, Serum osmolality, Sex hormone binding globulin, Sodium, Testosterone, TSH, Urine osmolality, X-ray, Intervention, Fluid repletion, Medication, Desmopressin, Glucocorticoids, Glucose, Hydrocortisone, Levothyroxine, Saline, Valproic acid, Related Disciplines, Neurology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-20-0039
Volume/Issue:
Volume 2020: Issue 1
Open access