A 52-year-old man with a 6-year history of type 2 diabetes mellitus treated with diet and diabetic retinopathy.
Consultation in the Emergency Department of the Hospital Clínico de la Pontificia Universidad Católica de Chile on February 27, 2009 for vomiting of four days of evolution without other associated symptoms.
Physical examination revealed blood pressure 114/64, heart rate 82 per minute, oral mucosa and dry skin, normal abdomen, with no neurological deficit.
The laboratory showed plasma sodium 118 mEq/L, urea nitrogen 11 mg/dl (normal: 8-25), creatininemia 0.67 mg/dl (normal: 0.5-0.9), plasma potassium 3.4 mEq/L (normal: 3.5 ml/L)
Hospitalization was decided in the Intermediate Care Unit.
The clinical situation was interpreted as decreased ECV associated hyponatremia in the context of the emetic syndrome.
Saline solution was given to the patient at 80 ml/h ( mEq/L), achieving a slight increase in serum sodium at 122 ml/L within 24 h.
Faced with this partial response and the presence of normal urea nitrogen and decreased uricemia, urinary sodium and osmolarity were measured, whose results were 105 mEq/L and 281 mOsm/L respectively.
Given the presence of high sodium and osmolarity in urine, SIADH was suspected or another pathogenic mechanism.
Thyrotropin (TSH) and plasma cortisol levels were requested to rule out hypothyroidism and adrenal insufficiency.
TSH: 3.17 μUI/ml (normal value: 0.3-4.2 μUI/ml) and cortisol: < 1 μg/dL (normal: 6.4-15 μg/dL).
Hyponatremia due to hypocalcaemia was diagnosed.
Reinterrupting the patient reported a history of 2 to 3 years of fatigue, weakness and muscle pain, asthenia and adynamia.
He also had anorexia, episodes of nausea, vomiting and intermittent diarrhea.
She also reported decreased libido, loss of axillary hair and pituitary gland.
Regarding her diabetes, she had good glycemic control exclusively with diet (HbA1C 6.7% in January 2009).
As part of his study it was decided to perform brain CT that showed a sellar mass suggestive of pituitary adenoma.
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She was evaluated by an endocrinology team who complemented the study: prolactinemia: 50 ng/ml (normal: 2.1-20 ng/ml), somatostatin: 26 ng/ml (normal: 87-238 280 ng/ml), testosterone: 12
In addition, turcica MRI confirmed a sellar mass suggestive of 14 x 16 x 17 mm adenoma with suprasellar extension, optic chiasm displacement and deviation of the pituitary stalk.
Visual field was evaluated by campimetry revealing right temporal hemianopsia.
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Cortisol treatment was started achieving serum sodium of 133 mEq/L and gradual remission of symptoms.
He also started levothyroxine 50 mcg/d.
Transsphenoidal adenoma resection was performed on March 19, without incidents and subsequently testosterone supplementation was started.
