Depression and hyponatraemia unmasking hypopituitarism

Abstract

Hyponatraemia is a common clinical problem encountered in clinical practice and has multifactorial aetiology. The presentation of hyponatremia due to hypopituitarism secondary to pituitary apoplexy is rarely seen and sometimes missed. We report the case of a 34-year-old male with a history of reduced social interaction, decreased sexual drive, fatigue, vomiting, hiccoughs and presented to the hospital with altered sensorium. Laboratory testing revealed hyponatraemia (107 mEq/L); there was reduced serum cortisol (8 AM), decrease in serum adrenocorticotropic hormone (8 AM) and pituitary hormone assay suggestive of hypopituitarism. Magnetic resonance imaging of the brain with dynamic pituitary contrast suggestive of pitutary apoplexy. The patient was managed with 3% sodium chloride infusion, hydrocortisone and thyroid supplementation.

Keywords

• hyponatraemia
• hypopituitarism
• pituitary apoplexy