Skip to main content
SpringerLink
Log in

Hyponatremia as the presenting manifestation of Sheehan’s syndrome in elderly patients

  • Short Communication
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: Hyponatremia is not a disease in itself, but a manifestation of a variety of disorders and side-effects of diuretics; alternatively, it may be the only manifestation of hypopituitarism or hypothyroidism. In our experience, diagnosis of hypopituitarism in hyponatremic patients is often overlooked, especially in the elderly. Methods: We report here data from five elderly multiparous women (mean age 69 yr; range 62–78 yr) with a past history of complicated delivery, in whom initial symptoms were due to hyponatremia (serum sodium less than 128 mEq/L) who went undiagnosed and untreated for a long time (up to 4:2 years) after the initial event. Results: Initial hormonal levels indicated hypopituitarism, and magnetic resonance imaging led to diagnosis of empty sella in all patients, so that they were diagnosed as suffering from Sheehan ’s syndrome (SS). The occurrence of sodium and water disorders associated with SS depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions which also play a role in sodium and water balance. In these patients, clinical condition and hyponatremia improved rapidly after glucocorticoid substitution. L-thyroxine was appropriately substituted subsequently. Conclusions: We suggest that, especially in elderly patients, much more attention should be paid to patients’ past history. Early recognition of severe hyponatremia due to hypopituitarism with adrenal insufficiency is critical, and treatment with hydrocortisone results in safe and improved quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Adrogue HJ, Madias NE. Hyponatremia. N Eng J Med 2000; 342: 1581–9.

    Article  CAS  Google Scholar 

  2. Smith DM. McKenna K. Thompson C. Hyponatremia. Clin Endocrinol 2000; 52: 667–78.

    Article  CAS  Google Scholar 

  3. Kelestimur F. Sheehan’s syndrome. Pituitary 2003; 6: 181–8.

    Article  PubMed  Google Scholar 

  4. Ozkan Y. Colak R. Sheehan Syndrome: Clinical and laboratory evaluation of 20 cases. Neuroendocrinol Lett 2005; 26: 257–60.

    Google Scholar 

  5. Sert M, Tetiker T, Kirim S, Kocak M. Clinical report of 28 patients with Sheehan’s Syndrome. Endocrine Journal 2003; 50: 297–301.

    Article  PubMed  Google Scholar 

  6. Pham PC, Pham PA, Pham PT. Sodium and water disturbances in patients with Sheehan’s syndrome. Am J Kidney Dis 2001; 38: E14.

    Article  PubMed  CAS  Google Scholar 

  7. Klein J, Kern W, Fehm HL. Fatigue and hyponatremia in a 75-year-old woman: unusual presentation of hypophysitis. Exp Clin Endocrinol Diabetes 2001; 109: 120–3.

    Article  PubMed  CAS  Google Scholar 

  8. Munz W, Seufert R, Knapstein PG, Pollow K. Early postpartum hyponatremia in a patient with transient Sheehan’s syndrome. Exp Clin Endocrinol Diabetes 2004; 112: 278–80.

    Article  PubMed  CAS  Google Scholar 

  9. Bunch TJ, Dunn WF, Basu A, Gosman RI. Hyponatremia and hypoglycemia in acute Sheehan’s syndrome. Gynecol Endocrinol 2002; 16: 419–23.

    PubMed  CAS  Google Scholar 

  10. Boulanger E, Pagniez D, Roueff S, et al. Sheehan’s syndrome presenting as early post-partum hyponatremia. Nephrol Dial Transplant 1999; 14: 2714–5.

    Article  PubMed  CAS  Google Scholar 

  11. Otsuka F, Kageyama J, Ogura T, Hattori T, Makino H. Sheehan’s syndrome of more than 30 years’ duration: an endocrine and MRI study of cases. Endocr J 1998; 45: 451–8.

    Article  PubMed  CAS  Google Scholar 

  12. Huang YY, Ting MK, Hsu BR, Tsai JS. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol 2000; 14: 99–104.

    Article  PubMed  CAS  Google Scholar 

  13. Ishikawa K, Sohmiya M, Furuya H, Kato Y. A case of Sheehan’s syndrome associated with severe anemia and empty sella proved 48 years after postpartum hemorrhage. Endocr J 1995; 42: 803–9.

    Article  PubMed  CAS  Google Scholar 

  14. Clayton RN. Diagnosis of adrenal insufficiency. BMJ 1989; 298: 271–2.

    Article  PubMed  CAS  Google Scholar 

  15. Wilson JD, Foster DW, Krononberg HM, Larsen PR, Eds. Williams Textbook of Endocrinology, 9th ed. Philadelphia: W.B. Saunders Company, 1998.

    Google Scholar 

  16. Miller M, Morley JE, Rubenstein LZ. Hyponatremia in a nursing home population. J Am Geriatr Soc 1995; 43: 1410–3.

    PubMed  CAS  Google Scholar 

  17. Oelkers W. Hyponatremia and inappropriate secretion of vasopressin (antidiuretic hormone) in patients with hypopituitarism. N Eng J Med 1989: 321; 492–6.

    Article  CAS  Google Scholar 

  18. Bethune JE. Nelson DH. Hyponatremia in hypopituitarism. New Engl J Med 1989; 321: 492–6.

    Article  Google Scholar 

  19. Wakui H, Nishinari T, Nishimura S, Endo Y, Nakamoto Y, Miura AB. Inappropriate secretion of antidiuretic hormone in isolated adrenocorticotropin deficiency. Am J Med Sci 1991; 301: 319–21.

    Article  PubMed  CAS  Google Scholar 

  20. Chanson P. Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 2003; 149: 177–8.

    Article  PubMed  CAS  Google Scholar 

  21. Munoz Ruiz AI, Guerrero Vega E, Maldonado Castro G, de Diago Pozas P, Marcos Sanchez F, Duran Perez-Navarro A. Severe hyponatremia as the initial manifestation of hypopituitarism. An Med Intern 2002; 19: 323–4.

    CAS  Google Scholar 

  22. Ubeda Barbera F, Velasco Perez J, Perez Dura J. Isolated hyponatremia as a diagnostic sign of hypothyroidism and panhypopituitarism. Rev Clin Esp 1996; 19: 662.

    Google Scholar 

  23. Iwaoka T. A case of hypopituitarism associated with Hashimoto’s thyroiditis and candidiasis: lymphocytic hypophysitis or Sheehan’s syndrome? Endocr J 2001; 48: 585–90.

    Article  PubMed  CAS  Google Scholar 

  24. Jialal I, Naidoo C, Norman RJ, Rajput MC, Omar MA, Joubert SM. Pituitary function in Sheehan’s syndrome. Obstet Gynecol 1984; 63: 15–19.

    PubMed  CAS  Google Scholar 

  25. Dideerich S, Franzen N, Bahr V, Oalkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocr 2003; 148: 609–17.

    Article  Google Scholar 

  26. Vieira HB, Knoepfelmacher M, Salgado LR, Wajchenberg BL, Liberman B. Preservation of gonadotrophic function and pregnancy in Sheehan’s syndrome: a case report and review of the literature. Rev Assoc Med Bras 1995; 41: 135–8.

    PubMed  CAS  Google Scholar 

  27. Zargar AH, Wani AI, Laway BA, Masoodi SR, Salahuddin M. Regular ovulatory menstrual cycles in a case of Sheehan’s syndrome. J Assoc Physicians India 1998; 46: 474–5.

    PubMed  CAS  Google Scholar 

  28. Mitchell DM, Webb SC, Hoffbrand BI. Pituitary coma with continuing menstruation. Postgard Med J 1978; 54: 280–1.

    Article  CAS  Google Scholar 

  29. Barkan AL. Pituitary atrophy in patients with Sheehan’s syndrome. Am J Med Sci 1989; 298: 38–40.

    Article  PubMed  CAS  Google Scholar 

  30. Sheehan HL, Murdoch R. Post-partum necrosis of the anterior pituitary; pathological and clinical aspects. J Obstet Gynaecol Br Emp 1938; 45: 456–9.

    Article  Google Scholar 

  31. Brinkane A, Loucif T, Ounnadi-Corbille W, Damieri A, Levy R. Empty sella tursica revealed by panhypopituitarism disclosed by severe hyponatremia. Ann Endocrinol (Paris) 2003; 64: 281–3.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Educational Hospital of Government-Vakıf Gureba, Istanbul

    Neslihan Kurtulmus MD

  2. Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

    Sema Yarman

Authors
  1. Neslihan Kurtulmus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sema Yarman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neslihan Kurtulmus MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurtulmus, N., Yarman, S. Hyponatremia as the presenting manifestation of Sheehan’s syndrome in elderly patients. Aging Clin Exp Res 18, 536–539 (2006). https://doi.org/10.1007/BF03324855

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324855

Keywords

Search

Navigation