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A case of hyponatremia caused by central hypocortisolism

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 369–375 (2007)Cite this article

Abstract

Background A 43-year-old woman was referred to the Psychiatric Unit of the University of Florence Hospital, 1 year after the development of a clinical picture characterized by nausea, hyporexia, muscle weakness, insomnia, weight loss, amenorrhea and severe depression. These clinical manifestations had started 2 months after delivery of her first child. Initial laboratory investigations revealed hypoglycemia and hyponatremia. The patient was, therefore, transferred to the Endocrine Unit of the same hospital for further evaluation of the case.

Investigations Physical examination to evaluate extracellular volume status, standard laboratory investigations, and evaluation of plasma and urinary osmolality and urinary sodium excretion. Basal and dynamic evaluation of anterior pituitary function and a pituitary MRI were also performed.

Diagnosis Hyponatremia caused by central hypocortisolism (isolated adrenocorticotropic hormone deficit).

Management Glucocorticoid therapy (25 mg cortisone acetate tablets, 1.5 tablets per day).

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Figure 1: Results of dynamic tests for evaluation of pituitary hormones
Figure 2: Flowchart of the diagnostic work-up for hyponatremia
Figure 3: Schematic representation of the therapeutic approach for a patient with symptomatic hypotonic hyponatremia
Figure 4: Schematic representation of the therapeutic approach for a patient with asymptomatic hypotonic hyponatremia

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Author information

Authors and Affiliations

  1. M Serio is a Professor of Endocrinology and Chief of the Department of Clinical Physiopathology, Department of Clinical Physiopathology, G Parenti is a PhD student in Endocrine Sciences, A Zogheri is a Resident in Endocrinology, M Mannelli is a Professor of Endocrinology and A Peri is an Associate Professor of Endocrinology at the Endocrine Unit, University of Florence.,

    Gabriele Parenti, Alessia Zogheri, Mario Serio, Massimo Mannelli & Alessandro Peri

  2. V Ricca is a Psychiatrist and Psychotherapist at the Psychiatric Unit of Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,

    Valdo Ricca

Authors
  1. Gabriele Parenti
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  2. Valdo Ricca
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  3. Alessia Zogheri
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  4. Mario Serio
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  5. Massimo Mannelli
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  6. Alessandro Peri
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Corresponding author

Correspondence to Alessandro Peri.

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The authors declare no competing financial interests.

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Parenti, G., Ricca, V., Zogheri, A. et al. A case of hyponatremia caused by central hypocortisolism. Nat Rev Endocrinol 3, 369–375 (2007). https://doi.org/10.1038/ncpendmet0459

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