Hypopituitarism misdiagnosed as stroke

Česká verzia

Authors: Jurečková Hana
Authors place of work: II. interní klinika – gastroenterologická a geriatrická LF UP a FN Olomouc
Published in the journal: Geriatrie a Gerontologie 2023, 12, č. 1: 45-48
Category:

Summary

Hypopituitarism is a condition caused by lack of pituitary hormones. A slowly developing and/ or partial insufficiency may go undetected for years, especially in the elderly. The disease is still considered rare, however literature data suggest it is rather significantly underdiagnosed. In this case report, hitherto undiagnosed hypopituitarism which was manifested by symptoms imitating stroke in presented. The differential diagnosis of accompanying hyponatraemia led to the correct diagnosis. In geriatric population, hyponatraemia proves to be a very valuable presenting feature of pituitary deficiency.

Keywords:

elderly – geriatric – neurologic – hypophysis – hyponatraemia

Zdroje

1. Kim SY. Diagnosis and treatment of hypopituitarism. Endocrinol Metab 2015; 30(4): 443–455.

2. van Aken MO, Lamberts SWJ. Diagnosis and treatment of hypopituitarism: an update. Pituitary 2005; 8(3–4): 183–191.

3. Higham CE. Johannsson G, Shalet SM. Hypopituitarism. Lancet Lond Engl 2016; 388(10058): 2403– 2415.

4. Curtò L, Trimarchi F. Hypopituitarism in the elderly: a narrative review on clinical management of hypothalamic-pituitary-gonadal, hypothalamic-pituitary-thyroid and hypothalamic-pituitary-adrenal axes dysfunction. J Endocrinol Invest 2016; 39(10): 1115–1124.

5. Foppiani L, Ruelle A, Bandelloni R, et al. Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci 2008; 1(1): 42–50.

6. Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004; 101(3): 613–619.

7. Stalldecker G, Ballarino C, Diez S, et al. Pituitary adenomas in elderly patients. Med B Aires 2019; 79(3): 191–196.

8. Antonopoulou M, Sharma R, Farag A, et al. Hypopituitarism in the elderly. Maturitas 2012; 72 (4): 277–285.

9. Veldhuis JD. Changes in pituitary function with ageing and implications for patient care. Nat Rev Endocrinol 2013; 9(4): 205–215.

10. Sedaghattalab M, Doustimotlagh AH. Acute secondary adrenal insufficiency misdiagnosed as acute cholecystitis. Case Rep Endocrinol 2021; 8318747.

11. Asano T, Aoki A, Sasaki M, et al. Hyponatremia is the valuable manifestation for initiating diagnosis of hypopituitarism in elderly. Endocr J 2012; 59(11): 1015–1020.

12. Catalano A, Basile G, Ferro C, et al. Hyponatremia as a leading sign of hypopituitarism. J Clin Transl Endocrinol Case Rep 2017; 5: 1–3.

13. Ishikawa S, Saito T, Fukagawa A, et al. Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metab 2001; 86(4): 1665–1671.

14. Miljic D, Doknic M, Stojanovic M, et al. Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit. Endocrine 2017; 58(2): 312–319.

15. Tasar PT, Turhan A, Binici, DN, et al. Hypopituitarism associated with a microadenoma in an elderly patient. Gerontol Geriatr Stud 2017; 1(3): GGS.000513.

16. Ricci Bitti S, Franco M, Albertelli M, et al. GH replacement in the elderly: is it worth it? Front Endocrinol 2021; 12: 680579.