Severe hyponatremia due to hypopituitarism with adrenal insufficiency: a case report.

Objective: Adrenal insufficiency due to hypopititarism can lead to severe hyponatremia with potentiallly fatal consequences. Prompt diagnosis and adequate hormonal replacement therapy are essential to block an otherwise unfavorable course and to re-establish a healthy life. Unfortunately, this condition is often misdiagnosed. Design: Case report. Setting: A 76-yr-old man with refractory hypotension, acute myocardial infaction, and left ventricular dysfunction, secondary to severe chronic pan-hypopituitarism, associated with severe hyponatremia. Method and main results: The patient underwent mechanical ventilation and continuaos venous-venous hemodia-filtration, for severe respiratory and reanl insufficiecy. A hormonal replacement therapy with T-4 , hydrocortisone, and nandrolone was started and the patient was dischargedto a rehabilatation facility after 31 days of hospitalization. Conclusion: Hypopituitarism with secondary adrenal insufficiency is often misdiagnosed at an early stage and a high degree of suspicion is necessary for early diagnosis. Determine of plasma cortisol level in patients with hyponatremia not explained by other causes should always be obtained.