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| |  Case of Empty Sella Syndrome Syndrome Mistakenly Diagnosed as Syndrome of Inappropriate Antidiuretic Hormone: Presented at AACE By Maggie Schwarz WASHINGTON, DC -- May 26, 2005 -- Syndrome of inappropriate antidiuretic hormone secretion is often a "red herring" diagnosis in patients with hyponatremia due to empty sella syndrome, and isolated glucocorticoid deficiency must always be excluded in these patients. Few cases of empty sella syndrome mistakenly diagnosed as syndrome of inappropriate antidiuretic hormone have been reported in the literature. Kaushik Doshi, MD, Resident Physician, Jamaica Hospital Medical Center, Jamaica, New York, reported on one such case here on May 19th at the American Association of Clinical Endocrinologists (AACE) 14th Annual Meeting and Clinical Congress. "If an endocrinologist had not caught empty sella syndrome in this patient, she would have returned to the emergency department repeatedly with electrolyte imbalance," Dr. Doshi reflected. He described the case of a 75-year-old African-American woman who presented to the emergency department with electrolyte imbalance. She had nausea, vomiting and diarrhea and low levels of sodium, chloride and potassium. She was placed on fluid restriction. The patient was lethargic and could not give her medical history. Her family related that she had undergone pituitary surgery twice during the preceding 6 months but could give no details. The emergency physician administered hypertonic saline to correct the sodium and chloride decreases, but a continually dropping sodium level and increasing lethargy provoked the emergency department to consult an endocrinologist. The endocrinologist measured her cortisol level, which was found to be low. Her blood pressure at that time was 120/60 mm Hg, and pulse was 84 BPM. Intravenous hydrocortisone raised the serum sodium level rapidly, as well as the patient's mental status. After 16 hours, she improved and was able to give her medical history. She then related having taken cortisone orally but stopping a few months previously. Dr. Doshi searched the literature for other cases of empty sella syndrome initially diagnosed as syndrome of inappropriate antidiuretic hormone. He found fewer than 6 cases reported in the 1950s, 1960s and 1980s. He urges physicians to consider secondary adrenal insufficiency due to empty sella syndrome. "It's time to look at it again," he said, "because if these patients are not diagnosed properly, they could take a long time to recover from their electrolyte imbalance, or present repeatedly in the emergency department with electrolyte imbalance."
[Presentation title: "Red Herrings" and the Syndrome of Inappropriate Antidiuretic Hormone Secretion. Abstract 767]
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