Sonmez Ince Melda, Banka Ajaz
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
Department of Endocrinology, Diabetes and Metabolism, William Beaumont Hospital, Royal Oak, Michigan, USA.
BMJ Case Rep. 2021 Feb 9;14(2):e236787. doi: 10.1136/bcr-2020-236787.
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 (T) 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 T and cortisol levels.
垂体卒中（PA）是一种内分泌急症，表现为头痛、视力和激素紊乱。垂体卒中后抗利尿激素分泌不当综合征（SIADH）较为罕见。一名64岁女性出现急性额部头痛和恶心，神经系统检查正常。实验室检查显示钠和肌酐水平正常。超声心动图显示新发充血性心力衰竭（CHF），脑部MRI显示垂体卒中。她的皮质醇水平正常，促甲状腺激素水平低，甲状腺素（T）水平正常。住院期间，患者出现低钠血症。起初，这被归因于充血性心力衰竭，她接受了托伐普坦治疗，钠水平恢复正常。一周后，她因腹泻和低钠血症再次入院。检查发现她血容量正常，提示充血性心力衰竭已得到代偿。尽管进行了补液试验，患者的钠水平仍无改善。最终诊断为抗利尿激素分泌不当综合征。对于垂体卒中患者，若T和皮质醇水平正常但出现低钠血症，临床医生应怀疑抗利尿激素分泌不当综合征。
