Abstract
IntroductionHyponatremia associated with rhabdomyolysis is a rare event and a correct diagnostic approach is required to rule out this or other diseases as a primary cause and to avoid other complications resulting from a lack of appropriate treatment.Case presentationA 64-year-old Caucasian woman presented to our facility with worsening fatigue, slurred speech, nausea and vomiting, and high serum levels of creatine kinase and myoglobin together with hyponatremia. Normal arterial blood gas analysis results, normal serum potassium levels, increased urine sodium levels, urine specific gravity of >1003N/m3 and low urine volume suggested an endocrine etiology. Her low cortisol and thyroid hormone serum levels suggested a pituitary disorder. A magnetic resonance imaging study showed atrophy of her pituitary gland. A more detailed study of our patient’s obstetric history revealed a post-partum hemorrhage 30 years earlier. She was diagnosed as having late-onset Sheehan’s syndrome and treated with hormone replacement therapy, which normalized her clinical picture.ConclusionsThis case report shows that, in hyponatremia-associated rhabdomyolysis, an endocrinological origin should always be considered. This should include Sheehan’s syndrome as it can occur with late onset.
Highlights
Hyponatremia associated with rhabdomyolysis is a rare event and a correct diagnostic approach is required to rule out this or other diseases as a primary cause and to avoid other complications resulting from a lack of appropriate treatment.Case presentation: A 64-year-old Caucasian woman presented to our facility with worsening fatigue, slurred speech, nausea and vomiting, and high serum levels of creatine kinase and myoglobin together with hyponatremia
Hyponatremia is an event frequently found in clinical practice that physicians are often called upon to deal with, and it often results in complications including rhabdomyolysis [1]
In such cases in particular, a correct diagnostic approach is required to rule out this or other diseases as a primary cause and to avoid other complications resulting from a lack of appropriate treatment
Summary
Hyponatremia is an event frequently found in clinical practice that physicians are often called upon to deal with, and it often results in complications including rhabdomyolysis [1]. The results of a physical examination revealed no neurological deficits except for the alteration in speech Her skin was dry, her armpit hair was thinning and was reported by our patient to have been reduced for several years. Reduced levels of free circulating fractions of thyroid hormones associated with a thyroid-stimulating hormone (TSH) value inappropriately within the normal range indicated a possible thyroid and/or an anterior pituitary gland endocrine disorder [5,6]. After the first two weeks L-thyroxin replacement treatment at a dose of 1.6μg/kg body weight was added Her clinical symptoms and laboratory abnormalities resolved and serum sodium levels and myolysis indices normalized after five days. Given the age of our patient, estrogen replacement therapy was not necessary
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