Severe hyponatremia due to hypopituitarism with adrenal insufficiency: a case report

Misdiagnosis of hypopituitarism as gastroenteritis: A case report

BACKGROUND

The clinical manifestations of pituitary dysfunction are atypical, complex, and diverse, which can easily lead to misdiagnosis.

CASE SUMMARY

A 72-years-old male patient was admitted to the hospital due to "intermittent diarrhea for more than 10 years". He has previously been diagnosed with gastroenteritis, and the efficacy of oral administration of "norfloxacin and smecta" was not satisfactory. During hospitalization, he had mental symptoms such as delayed response, drowsiness, and difficulty answering questions. Upon examination, thyroid hormone levels, sex hormone levels, and cortisol levels were significantly reduced. Pituitary magnetic resonance imaging showed empty sella and pituitary compression, indicating hypopituitarism. After receiving glucocorticoid treatment, the patient's consciousness returned to normal and his diarrhea disappeared.

CONCLUSION

The clinical manifestations of hypopituitarism are atypical, complex, and diverse, which makes it prone to misdiagnosis and missed diagnosis. If not diagnosed and treated in a timely manner, pituitary crisis may occur, endangering patients' life. Hypofunction of the pituitary gland is not uncommon in clinical practice. For patients with dry and pale skin, poor elasticity or swelling, anemia, anorexia, constipation, hair loss, fear of cold, indifferent expression, low pitch, slow response, weakness, loss of appetite, nausea, vomiting, weight loss, slow heart rate, low heart sound, decreased blood pressure, hypoglycemia, etc., hypofunction of the pituitary gland should be considered.

Respiratory failure in diabetic ketoacidosis

Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include deficits of potassium, magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema. Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system, pre-existing respiratory or neuromuscular disease and miscellaneous other conditions. Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA.