Department of Neuroendocrinology, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia.
Belgrade University School of Medicine, Belgrade, Serbia.
Endocrine. 2017 Nov;58(2):312-319. doi: 10.1007/s12020-017-1415-1. Epub 2017 Sep 14.
Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected.
In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade. We analyzed clinical characteristics, etiology, and severity of hypopituitarism in patients who presented with hyponatremia.
Hyponatremia was recorded in 9.6% of our patients with hypopituitarism. In 80.7% it was the key to diagnosis of hypopituitarism. All patients with hyponatremia were steroid deficient with complete hypopituitarism compared to 75% (steroid deficient) and 60% (complete hypopituitarism) of the patients in the cohort. The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). Patients with hyponatremia were divided into two groups, based on the etiology of hypopituitarism: Group 1. with NFPA n = 15 (5F/10M), mean age 71.47 ± 4.8 years, who were significantly older compared to patients with hyponatremia from other rare causes of hypopituitarism in Group 2. n = 10 (8F/2M), mean age 40.2 ± 15.3 years (p < 0.01), such as: congenital hypopituitarism(n = 2), Sheehan's syndrome (n = 2), intracranial aneurysm (n = 2), lymphocytic hypophysitis (n = 1), traumatic brain injury (n = 1), surgery and radiotherapy for astrocytoma (n = 1), pituitary metastasis from bronchial carcinoma (n = 1). Hyponatremia was more severe in Group 2. compared to Group 1. (113.5 ± 10.9 mmol/L vs. 124.3 ± 8.1 mmol/L, p < 0.01). Older age (p = 0.0001) and number of endocrine deficiencies (p < 0.05) were identified as predictive factors for hyponatremia by multivariate analysis in patients with hypopituitarism.
Hyponatremia is an important presenting feature of pituitary disease and a strong indicator of life-threatening steroid deficiency. Old age and severity of hypopituitarism are major risk factors for hyponatremia. In older patients NFPA is the most common etiology, while other rare causes of hypopituitarism are more prevalent in younger patients with hyponatremia.
低钠血症可揭示垂体功能减退症和继发性肾上腺功能不全。这很重要，因为在低钠血症患者中，经常忽略筛查类固醇缺乏症的必要性。
在我们专门的内分泌科单位对过去十年中 260 名因垂体功能减退症住院的患者进行回顾性研究，发现 25 名（13 名女性/12 名男性，年龄 58.9±18.6 岁）低钠血症（119.7±10.5mmol/L）患者存在垂体功能减退症。我们分析了伴有低钠血症的患者的临床特征、病因和垂体功能减退症的严重程度。
低钠血症在我们的垂体功能减退症患者中占 9.6%。在 80.7%的患者中，低钠血症是诊断垂体功能减退症的关键。与队列中的 75%（类固醇缺乏）和 60%（完全垂体功能减退症）的患者相比，伴有低钠血症的所有患者均存在类固醇缺乏症和完全垂体功能减退症。垂体功能减退症最常见的病因是非功能性垂体大腺瘤（NFPA）（n=128，49.2%）。根据垂体功能减退症的病因，将患者分为两组：组 1. NFPA 患者（n=15，5 名女性/10 名男性），平均年龄 71.47±4.8 岁，与组 2. 伴有低钠血症的其他罕见原因的垂体功能减退症患者相比，年龄明显较大。n=10（8 名女性/2 名男性），平均年龄 40.2±15.3 岁（p<0.01），如：先天性垂体功能减退症（n=2）、席汉氏综合征（n=2）、颅内动脉瘤（n=2）、淋巴细胞性垂体炎（n=1）、脑外伤（n=1）、星形细胞瘤的手术和放疗（n=1）、支气管癌的垂体转移（n=1）。与组 1 相比，组 2 的低钠血症更严重（113.5±10.9mmol/L vs. 124.3±8.1mmol/L，p<0.01）。多因素分析显示，年龄较大（p=0.0001）和内分泌缺乏数量较多（p<0.05）是垂体功能减退症患者发生低钠血症的预测因素。
低钠血症是垂体疾病的重要表现，也是危及生命的类固醇缺乏症的强烈指征。年龄较大和垂体功能减退症的严重程度是低钠血症的主要危险因素。在老年患者中，NFPA 是最常见的病因，而其他罕见的垂体功能减退症病因在伴有低钠血症的年轻患者中更为常见。
