Severe Hyponatremia As an Atypical Manifestation of Pituitary Macroadenoma: a Case Report

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2023 May 25

PMID 37229053

Authors

Alisha Yadav

Sanjeev Kharel

Bikash K Shah

Naresh Parajuli

Affiliations

Soon will be listed here.

Abstract

Case Presentation: We present a case of a 45-year-old woman who presented with symptoms of lethargy, vomiting, altered sensorium, and seizure. Her initial sodium level was 107 mEq/l, plasma and urinary osmolality were 250 and 455 mOsm/kg, respectively, and her urine sodium level was 141 mEq/day, suggestive of hyponatremia due to SIADH. MRI scan of the brain revealed approximately 14×13×11 mm pituitary mass. Prolactin and cortisol levels were 41.1 ng/ml and 5.65 μg/dl, respectively.

Clinical Discussion: Hyponatremia can result from various diseases, making it hard to identify the cause. A pituitary adenoma is a rare cause of hyponatremia due to SIADH.

Conclusion: Pituitary adenoma rarely might be the cause of SIADH presenting as severe hyponatremia. So, in case of hyponatremia due to SIADH, clinicians should keep pituitary adenoma as well in their differential diagnoses.

References

Famini P, Maya M, Melmed S . Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab. 2011; 96(6):1633-41. PMC: 3100749. DOI: 10.1210/jc.2011-0168. View

Ryu W, Tam S, Rotenberg B, Labib M, Lee D, Nicolle D . Conservative management of pituitary macroadenoma contacting the optic apparatus. Can J Neurol Sci. 2010; 37(6):837-42. DOI: 10.1017/s0317167100051532. View

Lake M, Krook L, Cruz S . Pituitary adenomas: an overview. Am Fam Physician. 2013; 88(5):319-27. View

Karimian-Jazi K . [Pituitary gland tumors]. Radiologe. 2019; 59(11):982-991. DOI: 10.1007/s00117-019-0570-1. View

Nawal C, Chejara R, Meena P, Jain S, Marker S, Tuteja V . Severe Hyponatremia as an Uncommon Presenting Feature of Pituitary Macroadenoma. J Assoc Physicians India. 2019; 66(8):96-98. View

Bopeththa B, Niyaz S, Medagedara C . Pituitary macroadenoma presenting as severe hyponatremia: a case report. J Med Case Rep. 2019; 13(1):40. PMC: 6387537. DOI: 10.1186/s13256-019-2000-4. View

Melmed S . Pituitary Medicine From Discovery to Patient-Focused Outcomes. J Clin Endocrinol Metab. 2016; 101(3):769-77. PMC: 4803158. DOI: 10.1210/jc.2015-3653. View

Zogheri A, Di Mambro A, Mannelli M, Serio M, Forti G, Peri A . Hyponatremia and pituitary adenoma: think twice about the etiopathogenesis. J Endocrinol Invest. 2006; 29(8):750-3. DOI: 10.1007/BF03344188. View

Mercado M, Melgar V, Salame L, Cuenca D . Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects. Endocrinol Diabetes Nutr. 2017; 64(7):384-395. DOI: 10.1016/j.endinu.2017.05.009. View

10.

Daly A, Beckers A . The Epidemiology of Pituitary Adenomas. Endocrinol Metab Clin North Am. 2020; 49(3):347-355. DOI: 10.1016/j.ecl.2020.04.002. View

11.

Grigsby P . Pituitary adenoma. Front Radiat Ther Oncol. 2001; 35:48-56. DOI: 10.1159/000061287. View

12.

Dekkers O, Pereira A, Romijn J . Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab. 2008; 93(10):3717-26. DOI: 10.1210/jc.2008-0643. View