Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis.

Abstract

OBJECTIVE:

To report a case of glucocorticoid substitution in panhypopituitarism that can lead to uncontrolled rise in serum sodium and myelinolysis.

CLINICAL PRESENTATION AND INTERVENTION:

A 42-year-old man presented with disturbed conscious level and hyponatremia. Initial data suggested glucocorticoid deficiency. Later, hormonal levels indicated panhypopituitarism. MRI of the brain led to the diagnosis of a pituitary macroadenoma. Glucocorticoid substitution was initiated immediately after admission, and possible myelinolysis subsequently became a complication. We report this case to illustrate the fact that glucocorticoid substitution can lead to rapid rise in serum sodium and myelinolysis in panhypopituitarism.

CONCLUSION:

This case illustrated the need to use minimum doses of glucocortcoids with close monitoring of serum sodium, in order to avoid this complication.

• Authors: Ibrahim Lasheen, Suhail A R Doi, Kamal A S Al-Shoumer
• Journal: Medical principles and practice : international journal of the Kuwait University, Health Science Centre (Med Princ Pract) 2005 Mar-Apr Vol. 14 Issue 2 Pg. 115-7 ISSN: 1011-7571 [Print] Switzerland
• PMID: 15785105 (Publication Type: Case Reports, Journal Article)
• Copyright: 2005 S. Karger AG, Basel.

Chemical References

• Glucocorticoids
• Sodium

Topics

• Adrenal Insufficiency
• Adult
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Hyponatremia (etiology)
• Hypopituitarism (complications, drug therapy, pathology)
• Kuwait
• Magnetic Resonance Imaging
• Male
• Myelinolysis, Central Pontine (complications, pathology)
• Sodium (blood)