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Case Reports in Endocrinology
Volume 2019, Article ID 7592648, 4 pages
https://doi.org/10.1155/2019/7592648
Case Report

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Subsequent Central Diabetes Insipidus: A Rare Presentation of Pituitary Apoplexy

1Department of Internal Medicine, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark
2Department of Diabetes and Hormone Diseases (DoH), Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
3Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark

Correspondence should be addressed to N. Rittig; kd.ua.nilc@gittir.jalokin

Received 28 February 2019; Accepted 21 March 2019; Published 2 April 2019

Academic Editor: Hidetoshi Ikeda

Copyright © 2019 S. B. Smedegaard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pituitary apoplexy (PA) is a rare endocrine emergency that occasionally presents with sodium disturbances. Here we present a rare case with a previously healthy 41-year-old female who presented with acute onset headache and nausea without visual impairment or overt pituitary dysfunction. Plasma sodium concentrations declined abruptly during the first two days of admission to a nadir of 111 mmol/l. Urine and blood chemistry were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Magnetic resonance imaging revealed recent bleeding into a pituitary cystic process. Hyponatremia was successfully corrected with fluid restriction and both visual function and anterior pituitary function remained intact. Subsequently, the patient developed central diabetes insipidus (CDI), which responded well to desmopressin substitution. To our knowledge, this is the first case of PA presenting predominantly with posterior pituitary dysfunction that transitioned from SIADH to permanent CDI.