Abstract
Patients who were surgically treated for Cushing's syndrome postoperatively surrender to "primary" adrenal insufficiency. However, the preoperative over-secretion of cortisol or the postoperative administration of excessive glucocorticoids can cause "secondary" adrenal insufficiency, in which the prevalence of hyponatremia is usually lower than that of primary adrenal insufficiency. A 60-year-old woman with a past medical history of Cushing's syndrome developed hyponatremia with symptoms of acute glucocorticoid deficiency, such as prolonged general fatigue and anorexia, after upper respiratory tract infection. A decrease in the serum cortisol level and the lack of increase in the ACTH level, despite the increased demand for cortisol, enabled a diagnosis of "secondary" adrenal insufficiency. Although the initial fluid replacement therapy was not effective, co-administration of dexamethasone and sodium chloride quickly resolved her symptoms and ameliorated the refractory hyponatremia. In this case, the hypothalamic-pituitary axis of the patient was thought to have become suppressed long after the surgical treatment for Cushing's syndrome. This case suggested a mechanism of refractory hyponatremia caused by secondary adrenal insuf...Continue Reading
References
Feb 1, 1991·Journal of Endocrinological Investigation·M JadoulJ Crabbé
Aug 24, 1989·The New England Journal of Medicine·W Oelkers
Nov 1, 1985·Clinics in Endocrinology and Metabolism·C W Burke
Mar 1, 1986·The Journal of Urology·J L MohlerJ W McRoberts
May 1, 1982·Southern Medical Journal·A Spital
Apr 1, 1994·Endocrine Journal·Y NagaiK Kobayashi
Mar 1, 1997·Clinical Endocrinology·S R PeaceyA P Weetman
Aug 16, 2000·The Journal of Biological Chemistry·A Attmane-ElakebM Bichara
Feb 1, 1962·The Journal of Clinical Endocrinology and Metabolism·J E PLAGER, P CUSHMAN
Apr 21, 2005·Kidney International·Itsuro KazamaMitsunobu Matsubara
Jun 30, 2005·International Journal of Urology : Official Journal of the Japanese Urological Association·Itsuro KazamaMikio Nagata
May 17, 2006·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Itsuro KazamaMitsunobu Matsubara
Aug 8, 2014·Medical Science Monitor : International Medical Journal of Experimental and Clinical Research·Anetta Lasek-BalJan Duława
Feb 3, 2015·Psychiatry Research·Arthur J Siegel