Recurrent Hyponatremia as Presenting Manifestation of Pituitary Macroadenoma

Open access


Hyponatremia is commonly seen electrolyte disturbance clinically. It is potentially life-threatening and requires prompt diagnosis and treatment. Non-functioning pituitary macroadenoma generally presents with a headache, visual disturbances, and the diagnosis is often delayed because of nonspecific nature of symptoms. Hyponatremia being initial manifestation before other common symptoms of pituitary macroadenoma is rare. We present a case of 55-year-old male with recurrent episodes of hyponatremia who was found to non-functioning pituitary macroadenoma along with panhypopituitarism. He was managed with hormone replacements. Our case highlights the importance of correct diagnosis of hyponatremia, measurement of the thyroid, adrenal and pituitary function in cases of hyponatremia.

1. Spasovski G, Vanholder R, Allolio B et al; Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1-47.

2. Yamashiro S, Fuwa I, Seto H, Ushio Y. Initial and postoperative hyponatremia associated with pituitary adenoma:a case report. Acta Neurochir (Wien) 1997;139:987-91.

3. Adrogué HJ, Madias NE Hyponatremia. N Engl J Med. 2000;342:1581.

4. Thompson C, Hoorn EJ. Hyponatriemia: an overview of frequency, clinical presentation and complications. Clin Endocr Metab 26, 2012, suppl. 1, S1-S6.

5. Lin SH, Hung YH, Lin YF. Severe hyponatremia as the presenting feature of clinically non-functional pituitary adenoma with hypopituitarism. Clin Nephrol 2002;57:85-88.

6. Erkut ZA, Pool C, Swaab DF. Glucocorticoids suppress corticotropin-releasing hormone and vasopressin expression in human hypothalamic neurons. J Clin Endocrinol Metab 1998; 83:2066-73.

7. Shibata T, Oeda T, Saito Y. Severe hyponatremia caused by hypothalamic adrenal insufficiency. Intern Med 1999;38:426-32.

8. Hanna FW, Scanlon MF. Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 1997; 350:755.

9. Oelkers W. Hyponatremia and inappropriate secretion of vasopressin (antidiuretic hormone) in patients with hypopituitarism. N Engl J Med 1989;321:492.

10. Hanna FW, Scanlon MF. Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 1997; 350:755.

11. Thompson C, Berl T, Tejedor A, Johannsson G. Differential diagnosis of hyponatriemia. Clin Endocr Metab 26, 2012, suppl. 1, S7-S15.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 140 89 1
PDF Downloads 84 65 6