Endocrine Abstracts

JOINT1838

Introduction: Osmotic demyelination syndrome (ODS) is a critical condition resulting from water-electrolyte disturbances, most commonly due to the rapid correction of hyponatremia. ODS comprises two forms: central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM), characterized by demyelination in the pons and the white matter of the cerebral hemispheres, respectively. Clinical manifestations range from mild tremors and dysarthria to severe complications such as dysphagia, altered consciousness, and respiratory failure requiring resuscitation.

Clinical Case: In 2018, an 18-year-old female was diagnosed with panhypopituitarism following the removal of a stalk craniopharyngioma. She was started on hormone replacement therapy, achieving medical compensation for central diabetes insipidus, secondary hypocortisolism, hypothyroidism, and hypogonadism. In December 2020, while on 0.1 mg of desmopressin twice daily, she developed dyspeptic symptoms (vomiting and diarrhea), leading to a sodium level drop to 105 mmol/l(reference range: 136–145). She was urgently hospitalized in a coma and admitted to the intensive care unit, where rapid correction of chronic severe hyponatremia resulted in complications, including CPM, EPM, bilateral supranuclear paresis of the facial, masticatory, bulbar muscles, and tetraplegia. Due to declining vital functions, a tracheostomy and gastrostomy were performed, both of which were later removed following the restoration of consciousness. MRI findings were consistent with osmotic demyelination syndrome, showing pathological signals from the basal ganglia and brainstem. During her hospitalization at the Endocrinology Research Centre in 2022, she was diagnosed with severe depressive disorder, characterized by asthenic symptoms and impaired speech expressiveness, for which neuroleptics were prescribed. A follow-up MRI in 2023 showed improvement, with a reduction in the myelinolysis focus. Notably, there were no signs of central diabetes insipidus despite the absence of vasopressin analog therapy, with a sodium level of 142.3 mmol/l(136–145) and a urine specific gravity range of 1008–1020 g/L. Currently, the patient is undergoing psychosocial rehabilitation, showing partial recovery of mnemonic and speech functions.

Results: This case highlights the severe consequences of rapid hyponatremia correction, leading to life-threatening complications such as CPM and EPM. It also underscores the broad spectrum of neurological deficits associated with ODS, which can mimic acute cerebrovascular events.

Conclusions: Increasing awareness among physicians across specialties is crucial to preventing ODS through cautious correction of hyponatremia. Furthermore, vigilant monitoring and a comprehensive multidisciplinary neurorehabilitation approach can improve survival outcomes and reduce long-term disability in patients recovering from severe hyponatremia.