Medicine and Health Sciences Commons^™

Severe Hyponatremia Associated With Partial Empty Sella Syndrome, Lily Chen, Shyama Appareddy, Laura Garcia

Research Colloquium

Hyponatremia, serum sodium concentration < 135 mmol/L, is further classified by patient volume status. Symptoms are dependent on the acuity of sodium loss. Acute onset hyponatremia can present with confusion, disorientation, headache, agitation, vomiting, and lethargy. Patients with hyponatremia warrant a thorough workup and can be a leading manifestation of hypopituitarism in the geriatric population. A 77 year old patient, history of pituitary adenoma, presented with generalized symptoms of fatigue, gait instability, poor appetite and confusion associated with severe hyponatremia and hypoglycemia. The patient has a history of pituitary adenoma treated with cabergoline, hypothyroidism treated with levothyroxine and gonadal insufficiency treated with testosterone, with no reported history of diuretic use. On admission, the patient had a sodium level of 116 mmol/L. While the patient reported improvement in symptoms, patient’s confusion was noted to persist despite appropriate correction of sodium and glucose. Patient had an AM cortisol of 4 mcg/dL. Cosyntropin test was conducted and noted to be negative. MRI Brain with Gadolinium revealed empty sella turcica with a small amount of enhancing pituitary tissue, which may indicate a response to previous cabergoline therapy. Despite negative cosyntropin results, the patient was suspected to have relative adrenal insufficiency due to multiple acute stressors including illness, hospitalization, disruption of routine and abrupt smoking cessation. Patient was given a trial of hydrocortisone with improvements noted in his mental status, strength and appetite. Thus, careful consideration should be given towards adrenal insufficiency secondary to hypopituitarism as an etiology for severe hyponatremia.

Severe Hypercalcemia: Unusual Life-Threatening Presentation Of Addison’S Disease, Aramide Mikhail Tijani, Jonathan Yaw Gyebi-Agyepong, Nestor Gerardo Astorga, Niral G. Patel

Research Colloquium

Background: Addison’s Disease, also known as primary adrenal insufficiency, is a rare disorder of the adrenal gland typically characterized by the combination of cortisol and mineralocorticoid deficiencies in addition to electrolyte abnormalities including hyponatremia and hyperkalemia. Addison's disease is an uncommon cause of hypercalcemia. We present a rare case of hypercalcemia in the setting of primary adrenal insufficiency.

Case Presentation: Our patient is 43-year-old Hispanic lady with no reported medical history who presented to the Emergency Room for evaluation of intractable nausea and vomiting of about a month duration. Clinical examination revealed a lethargic, dehydrated, and hypotensive lady. Initial laboratory …