Category: Other - HYPONATREMIA

Type: e-Poster

Monitor: 21

21 - HYPONATREMIA:PITUITARY, ADRENAL OR RENAL ORIGIN

Saturday, Apr 27
10:00 AM – 10:30 AM

Objective : Review the evaluation and treatment of hyponatremia precipitated by a number of confounding variables including possible pituitary, adrenal and renal etiologies.


Methods : We discuss an otherwise healthy patient presenting with recurrent, persistent, symptomatic, difficult to control hyponatremia, leading to multiple hospitalizations and syncopal episodes.


Results : A 69 year old white male presented to the Endocrinology Clinic at the Orlando Veterans Hospital in 2018 for evaluation of hyponatremia. He was originally diagnosed with hyponatremia attributed to beer potomania in 2011. At that time, he reported sodium levels ranging between 126-129mEq/L. He was treated with fluid restriction. In 2015 he had a syncopal episode precipitated by a serum sodium of 119mEq/L. He suffered at least three additional syncopal episodes over the years. He failed fluid restriction and did not tolerate salt tablets. Tolvaptan therapy was initated in 2015 without a thorough evaluation. Because of the toxicity associated with long-term use  of ADH receptor antagonists, we elected to stop the tolvaptan and complete a diagnostic work-up. His laboratory evaluation revealed conflicting evidence of SIADH and polydipsia as well as aldosterone deficiency. His aldosterone level was low in the face fo hyperreninemia on multiple occasions. His vasopressin level was undetectable at the time of a urine osmolality of 400mOsm/kg. He underwent an ACTH stimulation test with a normal cortisol response and a peak aldosterone level of 5ng/dL. He was given a trial of a number of medications. His response to therapy is discussed along with a review of the diagnostic work-up of difficult hyponatremia.


Discussion : The counterregulatory responses to hyponatremia occur over a continuum of electrolyte abnormality and hormonal responses.  The most effective treatment requires a thorough understanding of the pathophysiology of hyponatremia and the effects of concomittent illness and concurrent disorders on serum sodium.


Conclusion : Hyponatremia is often multifactorial and not all patients respond to fluid restrictions.

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Daise Vieira

Endocrinology Fellow
University of Central Florida College of Medicine
Orlando, Florida

Endocrinology Fellow at the University of Central Florida College of Medicine.

Suzanne Martinez

Program Director
Orlando VA Hospital
ORLANDO, Florida

DR. MARTINEZ IS PROGRAM DIRECTOR FOR THE HCA, UNIVERSITY OF CENTRAL FLORIDA CONSORTIUM ENDOCRINOLOGY, DIABETES AND METABOLISM FELLOWSHIP AT THE ORLANDO VETERANS HOSPITAL.

Daise Vieira

Endocrinology Fellow
University of Central Florida College of Medicine
Orlando, Florida

Endocrinology Fellow at the University of Central Florida College of Medicine.