Endocrinology and Metabolism

Case Reports

A Case of Inappropriate Antidiuretic Hormone Syndrome Complicated with Tuberculous Meningitis Refractory to Antituberculosis Drugs.: Ju Hee Oh, Sang Pil Yun, So Young Lee, Yeo Kyung Lee, Young Sun Jung, Soo Kyung Kim, Sung Kwan Hong, Seok Won Park, Yong Wook Cho; J Korean Endocr Soc. 2007;22(3):210-214. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.210

Abstract PDF: Syndrome of inappropriate antidiuretic hormone is the most common cause of hyponatremia in hospitalized patients. It is defined as retention of water, loss of sodium and inappropriately concentrated urine in euvolemic patients with normal renal and adrenal function. A 26-year old male was admitted due to weight loss and fever that he had experienced for the previous 1 month. The chest X-ray and CT scan of lung showed about 2.5x1.2 cm lymph node enlargement at the left hilum and multiple lymph node enlargements. Thoracoscopic biopsy revealed tuberculosis. During treatment with antituberculosis drugs, the serum sodium was 125 mEq/L, the serum osmolality was 263 mOsm/kg, the urine osmolality was 577 mOsm/kg, and the urine sodium concentration was 177 mEq/L. He was treated by fluid restriction and hypertonic saline infusion, but he did not improve. Brain CT scan showed tuberculous meningitis with hydrocephalus. He fully recovered after undergoing ventriculoperitoneal shunt. We report here on a case of inappropriate antidiuretic hormone syndrome complicated by tuberculous meningitis that was refractory to antituberculosis drugs.

A Case of Cerebral Salt Wasting Syndrome associated with Tuberculous Meningitis.: Seung Hyuk Rho, Ji Yong Choi, Taek Man Nam, Hyeon Kyu Kim, Seong Jin Lee, In Kyung Jeong, Eun Gyung Hong, Cheol Soo Choi, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park, Hyoung Cheol Kim; J Korean Endocr Soc. 2002;17(5):698-704. Published online October 1, 2002

Abstract PDF: Hyponatremia in patients with central nervous system disorders is suggestive of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and volume restriction is recommended for its correction. However, if volume depletion is present in a situation otherwise compatible with SIADH, cerebral salt wasting syndrome (CSWS) should be considered as the cause of the hyponatremia to avoid hypovolemic shock that may be induced by the standard management of SIADH, i.e. volume restriction. We present a case of a 17-year-old male patient with CSWS associated with tuberculous meningitis. The clinical feature of the patient comprised hyponatremia, excessive natriuresis, polyuria, and hypovolemia. Following the administration of saline and fludrocortisone, natriuresis and polyuria were decreased, and the hyponatremia improved

A Case of Partial Hypopituitarism and Central Diabetes Insipidus Developed after Tuberculous Meningitis.: Soon Jib Yoo, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung, Yoon Shin, Hyuk Sang Kwon, Seung Won Jin; J Korean Endocr Soc. 1997;12(2):308-314. Published online January 1, 2001

Abstract PDF: Complications related to tuberculous menngitis (TBM) is frequently encountered in medical field during, just after treatment and long time later. Hypothalamo-pituitary dysfunctions such as diabetes incipidus, dwarfism, hypogonadism, growth failure, and hypopituitarism are one of rare complication secondary to TBM and of which obesity with hypogonadism is most commonly documented. Several pathologic mechanics like a granuloma in hypothalamus, or pituitary stalk, organization and progressive scarring of the purulent exudate in the basal cistern or progressive obliterative endarteritis that supplying the hypothalamo-hypophyseal system is well-defined in hypothalamopituitary dysfunction in neurotuberculosis. We recently experienced a diabetic patient with short stature and sexual infantilism who shows polyuria and polydipsia. Detailed endocrinological evaluation showed partial hypopituitarism and central diabetes incipidus secondary to tuberculous meningitis. Polyuria and polydipsia was improved with dDAVP and height increased 5 cm for 11 month with HGH, libido increased with oxadrolone but his extemal sexual characteristics was not changed until now. We present this case with a review of literature.

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