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Case Reports 2014; 35(4): 252-256 PubMed PMID: 25038596 Citation  Keywords:  Adult, Cerebrum:metabolism, Diabetes Insipidus:blood, Diagnosis, Differential, Humans, Hyponatremia:blood, Intraoperative Complications, Postoperative Complications:blood, Postoperative Period, Sodium:blood, Syndrome, Ventriculoperitoneal Shunt:adverse ef.   

: Cerebral salt wasting syndrome (CSW-cerebral salt wasting) was first described in 1950 by Peters. This syndrome can occur in patients who have sustained damage to the central nervous system (e.g. patients with subarachnoid bleeding, bacterial meningitis or after neurosurgery). Patients present with excessive natriuresis and hyponatremic dehydration. Differentiating this syndrome with the syndrome of inappropriate antidiuretic hormone secretion (SIADH-syndrome of inappropriate antidiuretic hormone secretion), which may occur in the same group of patients, is necessary in order to administer the correct treatment which consists of fluid restriction and sodium replacement in SIADH and fluid and sodium replacement as well as occasional mineralocorticoid therapy in CSW....

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Case Reports 2013; 34(7): 693-700 PubMed PMID: 24463998 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Aged, Endocrine System Diseases:blood, Female, Genetic Diseases, Inborn:blood, Glucocorticoids:therapeutic use, Humans, Hydrocortisone:blood, Hypoglycemia:blood, Hyponatremia:blood, Male, Middle Aged, Prednisone:therapeu.   

OBJECTIVES: Adult idiopathic isolated ACTH deficiency (AIIAD) is an underestimated disorder which is frequently misdiagnosed. We presented 3 new Chinese AIIAD cases, summarized their clinical characteristics and analyzed the available literature.

METHODS: Three cases of AIIAD managed in Chinese PLA General Hospital during the period 1998-2003 were retrospectively identified. We have collected information on clinical presentation, laboratory findings and treatment response. The clinical characteristics were summarized and pertinent literatures were analyzed.

RESULTS: Our 3 cases with AIIAD aged 52-68 years old were misdiagnosed for a long period of time. Clinical features of AIIAD were summarized by reviewing the limited literature: 1. Most patients were over 40 years; 2. Clinical presentations were insidious; 3. Usually no pigmentation; 4. Hypogonadism and amenorrhea could present; 5. mild hypoglycemia, hyponatremia, normal-high potassium, mild anemia, lymphocytosis and eosinophilia could present; 6. With low or absent cortisol, normal secretion of pituitary hormones other than ACTH; 7. High prevalence of thyroid disorder; 8. Usually present concomitantly with other autoimmune disease, which usually disappeared on steroid replacement; 9. Absence of structural pituitary defects except for empty sella; 10. No evidence in any infiltration, trauma, surgery, infectious or radiotherapy, or glucocorticoid medication; 11. No growth abnormalities.

CONCLUSION: AIIAD is an unspecified and underestimated condition with much misdiagnosis. We summarized the clinical features to improve the recognition. Indeed, every patient with unexplained hyponatremia and malaise, particularly in patients with autoimmune diseases, needs to be evaluated for the possibility of AIIAD....

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Case Reports 2007; 28(6): 745-748 PubMed PMID: 18063931 Citation  Keywords:  Adrenal Insufficiency:blood, Adrenocorticotropic Hormone:blood, Empty Sella Syndrome:blood, Female, Hormone Replacement Therapy, Humans, Hydrocortisone:blood, Hypoglycemia:blood, Hyponatremia:blood, Methylprednisolone:therapeutic use, Middle Aged, Pituita.   

: Isolated ACTH deficiency is an uncommon cause of secondary adrenocortical insufficiency and accompaniment with primary empty sella has been reported in several cases. We present a case of isolated ACTH deficiency associated with empty sella. A sixty-two year old woman was admitted to our endocrine clinic with complaints of weakness, fatigue, weight loss, nausea, vomiting, and lack of appetite for about one month. Physical examination indicated orthostatic hypotension and epigastric tenderness. Laboratory investigations revealed hypoglycemia, hyponatremia and anemia, in addition low plasma cortisole and ACTH levels. Serum cortisole responses to short and prolonged ACTH stimulation were tested and partial and accurate responses were obtained, respectively. Plasma ACTH and serum cortisole levels failed to respond after intravenous injection of human corticotropin releasing hormone. Other hypophysial hormone levels were within the normal reference ranges. Although cranial and abdominal computerized tomography images were evaluated as normal, cranial magnetic resonance imaging of the pituitary gland revealed 'primary empty sella turcica'. Replacement therapy with methylprednisolon resulted in the improvement of hypoglycemia, hyponatremia and clinical symptoms. Based on these results, the patient was diagnosed as isolated ACTH deficiency and was scheduled for follow up by our outpatient clinic. Our report is consistent with other reports pointing out that primary empty sella may be responsible for pathogenesis of isolated ACTH deficiency....

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Journal Article 2005; 26(3): 257-260 PubMed PMID: 15990732 Citation  Keywords:  Adult, Aged, Empty Sella Syndrome:blood, Female, Hormones:blood, Humans, Hypoglycemia:blood, Hyponatremia:blood, Hypopituitarism:blood, Hypothyroidism:blood, Middle Aged, Turkey:epidemiology,.   

: Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively who were diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 +/- 9.44 years (mean +/- SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 +/- 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) for hypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to LHRH challenge. All of the patients were imaged with pituitary MRI. Eleven patients had empty sella and 9 patients had partial empty sella. SS is still a common problem in our country, especially in rural areas. Considering the duration of disease, important delays occur in diagnosis and treatment of the disease....

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