Abstract
BackgroundCraniopharyngiomas are rare intracranial tumors commonly presenting with neurological symptoms. Reports of severe hyponatremia as a presenting manifestation of a craniopharyngioma and hyponatremia-induced myopathy are rare. We report the case of a patient with craniopharyngioma presenting with severe hyponatremia, panhypopituitarism, and hyponatremia-induced myopathy.Case presentationA 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week. The onset of his illness had been preceded by vomiting and diarrhea for 1 day which he attributed to food poisoning. On examination, he had an apathetic disposition with a generalized “sallow complexion.” He was not dehydrated. Apart from reduced muscle power (4/5) and hyporeflexia, the neurological examination was normal. His serum sodium was 102 mmol/l; potassium 4.1 mmol/l; chloride 63 mmol/l; plasma osmolality 272 mosm/KgH2O; urine osmolality 642 mosm/KgH2O; and urine sodium 79 mmol/l. His creatine phosphokinase was 12,400 U/l, lactate dehydrogenase 628 U/l, aspartate aminotransferase 360 U/l, and alanine aminotransferase 64 U/l. His hormone profile revealed panhypopituitarism. An electromyogram showed nonspecific abnormalities while a muscle biopsy did not show any pathology. Magnetic resonance imaging of his brain demonstrated a well-defined craniopharyngioma with suprasellar extension. His pituitary gland was compressed and the pituitary stalk was displaced by the tumor. He had marked improvement in muscle power and rapid reduction of serum creatine phosphokinase levels paralleling the correction of severe hyponatremia, even before the initiation of hormone replacement.ConclusionsThis case illustrates the rare presentation of severe hyponatremia and hyponatremia-induced myopathy in patients with craniopharyngioma, awareness of which would facilitate early appropriate investigations and treatment.
Highlights
BackgroundCraniopharyngiomas are rare, solid, or solid-mixed tumors that arise from remnants of the Rathke pouch along a line from the nasopharynx to the diencephalon [1]
Craniopharyngiomas are rare intracranial tumors commonly presenting with neurological symptoms
This case illustrates the rare presentation of severe hyponatremia and hyponatremia-induced myopathy in patients with craniopharyngioma, awareness of which would facilitate early appropriate investigations and treatment
Summary
Craniopharyngiomas are rare, solid, or solid-mixed tumors that arise from remnants of the Rathke pouch along a line from the nasopharynx to the diencephalon [1]. Case presentation A 52-year-old previously healthy Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week The onset of his illness had been preceded by a day of vomiting and diarrhea which he attributed to food poisoning. On admission he had constipation, moderate frontal headache, and generalized body weakness but did not report abdominal pain, fever, cough, or history of polyuria and increased thirst. His pituitary gland was compressed and the pituitary stalk was displaced by the tumor He was treated with 3 % saline during the acute phase, which led to a marked improvement in his muscle power and rapid reduction of his serum creatine phosphokinase (CPK) levels, which paralleled the correction of severe hyponatremia over 2 to 3 days. Once the diagnosis of panhypopituitarism was established, hormone replacement therapy was commenced with oral hydrocortisone followed by thyroxine after an interval of 1 week
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