Takano Shinnosuke, Beppu Hiroko, Fukuda Tatsuya, Ogawa Toshie, Kawanishi Tomoko, Kimura Hitomi, Endo Mariko, Abe Yasutomo
Department of Nephrology, Tokyo Metropolitan Okubo Hospital, Tokyo, Japan.
Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo, Japan.
CEN Case Rep. 2025 May 2. doi: 10.1007/s13730-025-00995-2.
This case report presents a 57-year-old Japanese woman with mild COVID-19 who developed severe symptomatic hyponatremia and altered consciousness, notably without pneumonia or central nervous system infection. Initial findings, including low plasma osmolality, high urine osmolality, and elevated IL-6 levels, suggested that the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was the primary cause of her hyponatremia. While initial saline infusion offered temporary symptom relief, sodium levels remained unstable, leading to intermittent steroid therapy. Her improvement with steroids, alongside additional hormonal testing, raised the possibility of partial adrenal insufficiency as a complicating factor. Although secondary adrenal insufficiency in COVID-19 cases has been previously reported, its exact contribution to hyponatremia remains unclear. This case underscores the diagnostic complexities in managing hyponatremia associated with COVID-19, as SIADH is often the leading cause but may not fully explain persistent cases unresponsive to standard treatments. The report also emphasizes the importance of considering adrenal insufficiency in similar cases, particularly given COVID-19's potential impact on the hypothalamic-pituitary-adrenal axis. This case highlights the need for further research into COVID-19's effects on hormonal regulation, as such disruptions may play a key role in COVID-19-related electrolyte imbalances.
本病例报告介绍了一名57岁的日本女性，患有轻度新冠肺炎，出现了严重的症状性低钠血症和意识改变，尤其没有肺炎或中枢神经系统感染。包括低血浆渗透压、高尿渗透压和白细胞介素-6水平升高在内的初始检查结果表明，抗利尿激素分泌不当综合征（SIADH）是其低钠血症的主要原因。虽然最初输注生理盐水提供了暂时的症状缓解，但钠水平仍不稳定，导致间歇性使用类固醇治疗。她使用类固醇后病情改善，以及进一步的激素检测，增加了存在部分肾上腺功能不全作为一个复杂因素的可能性。虽然此前已有新冠肺炎病例继发肾上腺功能不全的报道，但其对低钠血症的确切影响仍不清楚。本病例强调了管理与新冠肺炎相关的低钠血症时的诊断复杂性，因为SIADH通常是主要原因，但可能无法完全解释对标准治疗无反应的持续性病例。该报告还强调了在类似病例中考虑肾上腺功能不全的重要性，特别是考虑到新冠肺炎对下丘脑-垂体-肾上腺轴的潜在影响。本病例突出了对新冠肺炎对激素调节影响进行进一步研究的必要性，因为这种干扰可能在与新冠肺炎相关的电解质失衡中起关键作用。
