Endocrine Abstracts

JOINT766

Hyponatremia, characterized by low serum sodium levels, is a frequent electrolyte abnormality encountered in clinical settings. In this report, we elucidate the case of a 91-year-old patient presenting with hyponatremia. The patient has been experiencing postprandial fatigue and weakness for the past 3-4 years, with symptoms worsening after meals. The patient has been managing hyponatremia for about 6 years with dietary treatment and fluid restriction, despite a regular appetite and normal food intake. 1.5 years ago, and the patient experienced complete vision loss in the left eye in 2021 due to macular degeneration. Recent hospital admission revealed a sodium level of 125, indicating hyponatremia, along with postprandial hypoglycemia. The patient was diagnosed with SIADH and was placed on a fluid restriction and given dietary salt supplementation. Blood sugar monitoring was initiated due to concerns about early-onset diabetes. After a Holter monitor study, the patient’s fatigue worsened, and blood pressure dropped to 68/48 mmHg with a heart rate of 112 bpm. IV saline improved their blood pressure, and investigations pointed toward adrenal insufficiency and hypothyroidism. Diagnosis was confirmed as secondary adrenal insufficiency and central hypothyroidism, and treatment with prednisolone and thyroid hormone replacement was started. A pituitary MRI showed a possible macroadenoma with a cystic lesion extending into the cavernous sinus and impacting the optic chiasm. The patient’s sodium levels and clinical condition, including hypotension and hypoglycemia, improved with treatment.

Figure-1 Magnetic resonans imaging of pituitary revealing centrally cystic-necrotic macroadenoma