Oelkers W
Department of Internal Medicine, Klinikum Steglitz, Freie Universität Berlin, West Germany.
N Engl J Med. 1989 Aug 24;321(8):492-6. doi: 10.1056/NEJM198908243210802.
Severe hyponatremia occurs in some patients with untreated hypopituitarism, but it is not known whether such hyponatremia is caused by the hypersecretion of vasopressin (antidiuretic hormone). This report describes severe, symptomatic hyponatremia in five women 59 to 83 years old (serum sodium, 111 to 118 mmol per liter) who presented with hypopituitarism (which had been previously undiagnosed in four). Plasma vasopressin was inappropriately high (1.3 to 25.8 pmol per liter [1.4 to 28 ng per liter]) in relation to plasma osmolality (236 to 260 mOsm per kilogram of body weight). All five patients had normal renal function and no signs of dehydration or volume depletion. The hyponatremia was resolved within a few days after the institution of hydrocortisone therapy, after infusion of normotonic or hypertonic saline had been found to be less effective. When four of the patients were later restudied while receiving maintenance hydrocortisone treatment, the relation between plasma vasopressin and osmolality was normal. We conclude that ACTH deficiency may cause the syndrome of inappropriate secretion of antidiuretic hormone. The beneficial effect of hydrocortisone is probably exerted through the suppression of vasopressin secretion.
一些未经治疗的垂体功能减退患者会出现严重低钠血症，但尚不清楚这种低钠血症是否由血管加压素（抗利尿激素）分泌过多所致。本报告描述了5例年龄在59至83岁的女性患者出现严重的症状性低钠血症（血清钠浓度为111至118 mmol/L），她们均患有垂体功能减退（其中4例此前未被诊断）。相对于血浆渗透压（236至260 mOsm/每千克体重），血浆血管加压素水平异常升高（1.3至25.8 pmol/L [1.4至28 ng/L]）。所有5例患者肾功能正常，无脱水或血容量减少的迹象。在发现输注等渗或高渗盐水效果较差后，给予氢化可的松治疗，数天内低钠血症得到缓解。当其中4例患者在接受维持性氢化可的松治疗期间再次接受检查时，血浆血管加压素与渗透压之间的关系恢复正常。我们得出结论，促肾上腺皮质激素缺乏可能导致抗利尿激素分泌不当综合征。氢化可的松的有益作用可能是通过抑制血管加压素分泌来实现的。
