Pituitary Apoplexy: An Overlooked Cause of Hyponatremia in the Elderly

我們描述一位七十三歲的女性病患，最近兩週有全身倦怠和逐漸意識不清的病史，以及嚴重低血鈉（血鈉濃度115 mmol/L，尿鈉濃度73 mmol/L，尿滲透壓407 mosmol/kg），最初認為是抗利尿激素不適當分泌症候群。然而，進一步探討發現腦下腺機能不足合併次發性腎上腺功能不全和甲狀腺機能不足為其低血鈉原因。腦部蝶鞍磁振掃描顯示腦下腺巨大腺瘤併發亞急性出血。經過腎上腺皮質素和甲狀腺素的賀爾蒙補充治療後，她的臨床症狀和低血鈉在幾天內緩解。病人後來順利地接受經蝶骨切除腦下腺腫瘤手術。此病例說明低血鈉可能是腦下腺中風的最初表徵，然而因為實驗室診斷標準和抗利尿激素不正當分泌症候群相似以及臨床上非特異性症狀，此疾病為老年人往往被忽略的低血鈉原因。

關鍵字

低血鈉；腦下腺機能不足；腦下腺中風；抗利尿激素不適當分泌症候群

並列摘要

We describe a 73-year-old female patient who presented with 2-week history of general fatigue and progressive confusion, and severe hyponatremia, (serum sodium concentration of 115 mmol/L, urine sodium concentration of 73 mmol/L, and urine osmolality of 407 mosmol/kg) which was putatively attributed to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). However, further investigations disclosed an etiology of hypopituitarism with secondary adrenal insufficiency and hypothyroidism responsible for the hyponatremia. Magnetic resonance imaging scan of sella demonstrated a pituitary macroadenoma with subacute hemorrhage. After hormonal replacement therapy with glucocorticoid and thyroxine, her clinical symptoms improved and the hyponatremia resolved within a few days. The patient underwent transsphenoidal resection of the pituitary adenoma uneventfully thereafter. This case illustrated that hyponatremia can be the presenting feature of pituitary apoplexy which is a frequently overlooked cause of hyponatremia in the elderly because of mimicking the laboratory diagnostic criteria of SIADH and nonspecific complaints.

並列關鍵字

hyponatremia ； hypopituitarism ； pituitary apoplexy ； syndrome of inappropriate secretion of antidiuretic hormone SIADH

國際替代計量

Pituitary Apoplexy: An Overlooked Cause of Hyponatremia in the Elderly

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