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28 August 2015 : Case report  Japan

Hyponatremia due to Secondary Adrenal Insufficiency Successfully Treated by Dexamethasone with Sodium Chloride

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction, Rare coexistence of disease or pathology

Itsuro KazamaABCDEFG, Tsutomu TamadaB, Toshiyuki NakajimaB

DOI: 10.12659/AJCR.894468

Am J Case Rep 2015; 16:577-580

Abstract

BACKGROUND: Patients who were surgically treated for Cushing’s syndrome postoperatively surrender to “primary” adrenal insufficiency. However, the preoperative over-secretion of cortisol or the postoperative administration of excessive glucocorticoids can cause “secondary” adrenal insufficiency, in which the prevalence of hyponatremia is usually lower than that of primary adrenal insufficiency.

CASE REPORT: A 60-year-old woman with a past medical history of Cushing’s syndrome developed hyponatremia with symptoms of acute glucocorticoid deficiency, such as prolonged general fatigue and anorexia, after upper respiratory tract infection. A decrease in the serum cortisol level and the lack of increase in the ACTH level, despite the increased demand for cortisol, enabled a diagnosis of “secondary” adrenal insufficiency. Although the initial fluid replacement therapy was not effective, co-administration of dexamethasone and sodium chloride quickly resolved her symptoms and ameliorated the refractory hyponatremia.

CONCLUSIONS: In this case, the hypothalamic-pituitary axis of the patient was thought to have become suppressed long after the surgical treatment for Cushing’s syndrome. This case suggested a mechanism of refractory hyponatremia caused by secondary adrenal insufficiency, for which the administration of dexamethasone and sodium chloride exerted additional therapeutic efficacy.

Keywords: Dexamethasone - therapeutic use, Adrenal Insufficiency - complications, Glucocorticoids - therapeutic use, Hyponatremia - etiology, Sodium Chloride - therapeutic use

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923