PDF(Pubmed)
Abstract：
A man in his late 40s with no significant medical history presented with 2 weeks of lethargy, nausea and dizziness, alongside worsening headaches. Initial assessment revealed severe hyponatraemia and secondary hypothyroidism; urgent MRI pituitary was requested with a clinical suspicion of pituitary apoplexy. This demonstrated a likely cystic pituitary adenoma, with further testing revealing pituitary gland suppression, leading to a diagnosis of chronic secondary hypopituitarism. Initiating hormone replacement allowed substantial reported improvements in this patient\'s quality of life.A review of the patient\'s work-up revealed areas in which best practice was not followed. Cortisol measurements and paired urinary and serum osmolalities were initially not sent, nor results appropriately chased. A subsequent literature review identified that conformation with national and local guidelines on hyponatraemia management is poor. This patient\'s case, when combined with the literature review, provides evidence to support methods to increase educational awareness of an appropriate work-up of hyponatraemia among clinicians.
摘要：
一名40多岁无明显病史的男子表现为2周嗜睡，恶心和头晕，伴随着恶化的头痛。初步评估显示严重低钠血症和继发性甲状腺功能减退症；临床怀疑垂体中风，要求紧急MRI垂体。这表明可能是囊性垂体腺瘤，进一步的测试显示垂体抑制，导致诊断为慢性继发性垂体功能减退。开始激素替代使患者的生活质量得到了实质性的改善。对患者的检查结果进行了回顾，揭示了未遵循最佳实践的领域。最初没有发送皮质醇测量以及配对的尿液和血清渗透压，也没有适当追逐的结果。随后的文献综述发现，与国家和地方低钠血症管理指南的一致性很差。这个病人的案子,结合文献综述，提供了支持方法的证据，以提高对临床医生适当治疗低钠血症的教育意识。
