Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK.
Department of Diabetes and Endocrinology, Tameside General Hospital, Ashton-under-Lyne, UK.
BMJ Case Rep. 2023 Jun 19;16(6):e254469. doi: 10.1136/bcr-2022-254469.
A man in his late 40s with no significant medical history presented with 2 weeks of lethargy, nausea and dizziness, alongside worsening headaches. Initial assessment revealed severe hyponatraemia and secondary hypothyroidism; urgent MRI pituitary was requested with a clinical suspicion of pituitary apoplexy. This demonstrated a likely cystic pituitary adenoma, with further testing revealing pituitary gland suppression, leading to a diagnosis of chronic secondary hypopituitarism. Initiating hormone replacement allowed substantial reported improvements in this patient's quality of life.A review of the patient's work-up revealed areas in which best practice was not followed. Cortisol measurements and paired urinary and serum osmolalities were initially not sent, nor results appropriately chased. A subsequent literature review identified that conformation with national and local guidelines on hyponatraemia management is poor. This patient's case, when combined with the literature review, provides evidence to support methods to increase educational awareness of an appropriate work-up of hyponatraemia among clinicians.
一位 40 多岁的男性，无明显病史，出现了 2 周的乏力、恶心和头晕，头痛加剧。初步评估显示严重的低钠血症和继发甲状腺功能减退；由于临床怀疑垂体型卒中，紧急请求进行垂体 MRI。MRI 显示可能是囊性垂体腺瘤，进一步的检查显示垂体抑制，导致慢性继发垂体功能减退症的诊断。开始激素替代治疗后，患者的生活质量有了显著改善。对患者的检查结果进行回顾后发现，有些方面没有遵循最佳实践。最初未进行皮质醇测量以及配对的尿液和血清渗透压检测，也未对结果进行适当的追踪。随后的文献复习发现，在低钠血症管理方面，与国家和地方指南的一致性很差。该患者的病例，结合文献复习，为提高临床医生对低钠血症适当检查的教育意识提供了证据。
