Syndrome of inappropriate antidiuretic hormone secretion in a patient with pituitary apoplexy

Pituitary apoplexy (PA) is an endocrine emergency presenting with headache, visual and hormonal disturbances. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare after PA. A 64-year-old woman presented with acute frontal headache and nausea with normal neurological examination....

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Bibliographic Details
Published in:BMJ case reports 2021-02, Vol.14 (2), p.e236787
Main Authors: Sonmez Ince, Melda, Banka, Ajaz
Format: Article
Language:English
Subjects:
Biomarkers - blood
Cardiology
Cardiovascular disease
Case Report
Case reports
Creatinine
Diabetes
Diagnosis, Differential
Edema
Female
Headaches
Heart failure
Hormones
Humans
Hyponatremia - diagnosis
Hyponatremia - therapy
Inappropriate ADH Syndrome - diagnosis
Inappropriate ADH Syndrome - therapy
Insulin-like growth factors
Magnetic Resonance Imaging
Middle Aged
Nephrology
Neurosurgery
Patients
Peptides
Pituitary Apoplexy - diagnosis
Pituitary Apoplexy - therapy
Pituitary gland
Sodium
Surgery
Syndrome
Thyroid gland
Urine
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Summary:Pituitary apoplexy (PA) is an endocrine emergency presenting with headache, visual and hormonal disturbances. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare after PA. A 64-year-old woman presented with acute frontal headache and nausea with normal neurological examination. Labs included normal sodium and creatinine. Echo showed new-onset congestive heart failure (CHF) and MRI of the brain revealed PA. She had normal cortisol levels and low thyroid stimulating hormone with normal thyroxine (T4) levels. During her hospitalisation, patient developed hyponatraemia. Initially, this was attributed to CHF and she was treated with tolvaptan with normalisation of sodium. One week later, she was readmitted with diarrhoea and hyponatraemia. She was euvolaemic on examination indicating compensated CHF. Despite fluid challenge, patient had no improvement of sodium levels. The diagnosis of SIADH was made. Clinicians should suspect SIADH in patients with hyponatraemia in the setting of PA with normal T4 and cortisol levels.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-236787