Tzoulis Ploutarchos, Bouloux Pierre Marc
Centre for Neuroendocrinology, Royal Free Campus, University College Medical School, London, UK
Centre for Neuroendocrinology, Royal Free Campus, University College Medical School, London, UK.
Clin Med (Lond). 2015 Feb;15(1):20-4. doi: 10.7861/clinmedicine.15-1-20.
This study assessed the effect of endocrine input on the investigation of hyponatraemia and examined the prevalence of endocrine causes of hyponatraemia. This single-centre, retrospective study included 139 inpatients (median age, 74 years) with serum sodium (Na) levels ≤128 mmol/l during hospitalisation at a UK teaching hospital over a three-month period. In total, 61.9% of patients underwent assessment of volume status and 28.8% had paired serum and urine osmolality, and Na measured. In addition, 14.4% of patients received endocrine input; 80% of these patients underwent full work-up of hyponatraemia compared with 5% of patients not referred to endocrine services (p < 0.001; relative risk, 15.86; 95% confidence interval, 7.17-31.06). The prevalence of adrenal insufficiency was 0.7%, but basal serum cortisol levels were not measured in around two-thirds of patients. Despite 26.7% of patients having abnormal thyroid function tests, no patient was diagnosed with severe hypothyroidism. More widespread provision of expert input should be considered.
本研究评估了内分泌因素对低钠血症检查的影响，并调查了低钠血症内分泌病因的患病率。这项单中心回顾性研究纳入了一家英国教学医院三个月期间住院的139例患者（中位年龄74岁），这些患者住院期间血清钠（Na）水平≤128 mmol/L。总体而言，61.9%的患者接受了容量状态评估，28.8%的患者检测了配对的血清和尿渗透压以及钠。此外，14.4%的患者接受了内分泌方面的会诊；这些患者中有80%接受了低钠血症的全面检查，而未转诊至内分泌科的患者中这一比例为5%（p<0.001；相对风险，15.86；95%置信区间，7.17 - 31.06）。肾上腺功能不全的患病率为0.7%，但约三分之二的患者未检测基础血清皮质醇水平。尽管26.7%的患者甲状腺功能检查异常，但无患者被诊断为严重甲状腺功能减退。应考虑更广泛地提供专家会诊。
