17-ketosteroids and Hyponatremia

A 64-year-old woman was admitted for evaluation of hyponatremia. She was maintained on hypertonic saline administration. Without this therapy, the serum Na concentration decreased progressively to 127 mEq/L and the plasma osmolality to 254 mOsm/Kg H2O, on Day 3. At that time, the concentration of antidiuretic hormone (ADH) was as high as 3.5 pg/ml. A skull radiogram revealed an enlarged sella turcica. Computed tomography (CT) revealed a low density in the sella, and magnetic resonance imaging revealed equal intensity of the sella turcica and the cerebrospinal fluid. A diagnosis of empty sella syndrome was made by metrizamide cisternography in conjunction with CT scanning. A diagnosis of panhypopituitarism was made by endocrine function tests. 123I-thyroidal uptake was 6% when her serum TSH was 10.9 microU/ml, suggesting that she might also have primary hypothyroidism. When this patient was given glucocorticoid before levothyroxine replacement, her serum Na concentration rose up to about 140 mEq/L and a normal relationship between her plasma ADH level (2.4 pg/ml) and plasma osmolality (281 mOsm/kg H2O) was restored. Therefore, it was suggested that ADH hypersecretion induced by the glucocorticoid deficiency might in part contribute to the development of hyponatremia. This is the case of primary empty syndrome associated with panhypopituitarism, in whom initial symptom was caused by hyponatremia.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenocorticotropic Hormone; Empty Sella Syndrome; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hydrocortisone; Hyponatremia; Hypopituitarism; Luteinizing Hormone; Magnetic Resonance Spectroscopy; Middle Aged; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone; Tomography, X-Ray Computed

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma, Chromophobe; Cortisone; Drinking; Ethanol; Growth Hormone; Humans; Hyponatremia; Hypopituitarism; Male; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Urination; Vasopressins

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Hyperplasia, Congenital; Aldosterone; Blood Pressure; Child; Clitoris; Female; Humans; Hyperplasia; Hyponatremia; Infant, Newborn; Male; Metabolism, Inborn Errors; Pregnanetriol; Renin; Sodium; Sodium Chloride; Steroid Hydroxylases; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Gland Diseases; Aging; Aldosterone; Androstanes; Androsterone; Child; Child, Preschool; Chlorides; Chromatography, Gas; Chromatography, Thin Layer; Dehydroepiandrosterone; Disorders of Sex Development; Etiocholanolone; Female; Glucuronates; Humans; Hydrocortisone; Hydroxysteroid Dehydrogenases; Hyperkalemia; Hyperplasia; Hyponatremia; Infant; Infant, Newborn; Male; Metabolism, Inborn Errors; Potassium; Pregnanetriol; Pregnenolone; Sodium; Sulfates; Testosterone

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Aldosterone; Androsterone; Child; Dehydroepiandrosterone; Desoxycorticosterone; Humans; Hydrocortisone; Hydroxysteroid Dehydrogenases; Hypogonadism; Hyponatremia; Male; Middle Aged; Postoperative Complications; Pregnanediol; Pregnanetriol; Steroids

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Adrenal Gland Diseases; Adrenal Hyperplasia, Congenital; Androgens; Child; Female; Humans; Hydrocortisone; Hyperplasia; Hyponatremia; Infant; Male; Metabolism, Inborn Errors; Progestins

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Insufficiency; Adrenocorticotropic Hormone; Dexamethasone; Diuresis; Ethanol; Extracellular Space; Female; Glucocorticoids; Growth Hormone; Humans; Hyponatremia; Hypopituitarism; Infusions, Parenteral; Metyrapone; Middle Aged; Natriuresis; Sodium Chloride; Vasopressins; Water-Electrolyte Balance

Topics: 17-Ketosteroids; Aged; Arrhythmias, Cardiac; Asthenia; Blood Pressure; Blood Volume; Chlorides; Creatine; Dehydration; Dysautonomia, Familial; Female; Fludrocortisone; Follow-Up Studies; Heart Diseases; Hemorrhage; Humans; Hyponatremia; Hypotension, Orthostatic; Kidney Diseases; Kidney Function Tests; Male; Nitrogen; Parkinson Disease; Potassium; Sex Factors; Sodium; Urinary Tract Infections; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Glands; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Desoxycorticosterone; Disorders of Sex Development; Humans; Hydrocortisone; Hydroxysteroid Dehydrogenases; Hypokalemia; Hyponatremia; Infant; Male; Metabolism, Inborn Errors; Mixed Function Oxygenases; Pregnanediol; Pregnanetriol; Pregnenolone; Secretory Rate; Urine; Water-Electrolyte Balance

Topics: 17-Ketosteroids; Adolescent; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Child; Child, Preschool; Cortisone; Electrolytes; Female; Humans; Hydrocortisone; Hyperkalemia; Hyponatremia; Infant; Infant, Newborn; Male; Mineralocorticoids; Mixed Function Oxygenases; Potassium; Sodium; Virilism

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Insufficiency; Adrenocorticotropic Hormone; Creatine; Creatinine; Diagnosis, Differential; Drug Therapy; Eosinophils; Follicle Stimulating Hormone; Humans; Hyponatremia; Hypothalamus; Pituitary Gland; Pituitary Gland, Posterior; Pituitary-Adrenal Function Tests; Prednisone; Sodium; Urine; Vasopressins; Water-Electrolyte Balance

Topics: 17-Ketosteroids; Adrenal Insufficiency; Aldosterone; Child, Preschool; Female; Humans; Hypokalemia; Hyponatremia; Infant; Male

Topics: 17-Ketosteroids; Adolescent; Adrenal Cortex Hormones; Anemia; Arrhythmias, Cardiac; Body Temperature; Bradycardia; Carbohydrate Metabolism; Cardiomegaly; China; Electrocardiography; Geriatrics; Hair; Humans; Hyperkalemia; Hyponatremia; Hypopituitarism; Pigmentation; Thyroid Function Tests

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Acidosis; Adolescent; Adrenocorticotropic Hormone; Chromatography; Deficiency Diseases; Diet; Electrocardiography; Humans; Hyperkalemia; Hyponatremia; Muscular Diseases; Paralysis; Sodium Chloride; Urine; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aldosterone; Birth Order; Consanguinity; Desoxycorticosterone; Genetics, Medical; Humans; Hyperkalemia; Hyponatremia; Infant; Metabolism, Inborn Errors; Pathology; Sex; Syndrome

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Adrenal Insufficiency; Adrenocorticotropic Hormone; Aldosterone; Chlorides; Cortisone; Desoxycorticosterone; Diencephalon; Diuresis; Humans; Hypoaldosteronism; Hyponatremia; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Tubules; Sodium; Urine; Water

Topics: 17-Ketosteroids; Adrenal Cortex; Animals; Chlorides; Hyponatremia; Rats; Sodium; Sodium Chloride; Steroids