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Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report

BACKGROUND: Schmidt’s syndrome (SS) is a rare endocrine disorder (14-20:1000000), which consists of autoimmune thyroiditis (AIT) and autoimmune Addison’s disease (aAD), and usually occurs in young adults. Here, we report a unique case of late-onset SS manifesting initially with isolated severe hypon...

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Autores principales: Wiśniewski, Oskar Wojciech, Matuszak, Paulina, Kasprzak, Agnieszka, Łącka, Katarzyna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Babol University of Medical Sciences 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559643/
https://www.ncbi.nlm.nih.gov/pubmed/34760090
http://dx.doi.org/10.22088/cjim.12.0.392
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author Wiśniewski, Oskar Wojciech
Matuszak, Paulina
Kasprzak, Agnieszka
Łącka, Katarzyna
author_facet Wiśniewski, Oskar Wojciech
Matuszak, Paulina
Kasprzak, Agnieszka
Łącka, Katarzyna
author_sort Wiśniewski, Oskar Wojciech
collection PubMed
description BACKGROUND: Schmidt’s syndrome (SS) is a rare endocrine disorder (14-20:1000000), which consists of autoimmune thyroiditis (AIT) and autoimmune Addison’s disease (aAD), and usually occurs in young adults. Here, we report a unique case of late-onset SS manifesting initially with isolated severe hyponatremia and present the hazardous outcomes of preliminary misdiagnosis. CASE PRESENTATION: A 78-year-old female presented to the emergency department with a two-day history of diarrhea, emesis and disturbances in consciousness. She also reported general fatigue and increasing weakness in the last month. Urgent laboratory findings revealed isolated severe hyponatremia (serum sodium=108 mmol/l) and initial treatment with active sodium infusions was started, although with no improvement in the patient's neurological status after 5 days (serum sodium=127 mmol/l). Meanwhile, the patient developed recurring episodes of hypoglycemia and symptoms portending adrenal crisis (blood pressure=105/58 mmHg, heart rate=96 bpm, severe whole-body muscle pain, two loose stools), which required immediate i.e. hydrocortisone treatment. Reduced blood cortisol, elevated adrenocorticotropic hormone (ACTH) and atrophic morphology of the adrenal glands in computed tomography imaging contributed to the final diagnosis of aAD and SS consequently, since the patient had a past medical history of AIT. CONCLUSION: Isolated severe hyponatremia should not be underestimated as the first sign of aAD. Appropriate cause-specific treatment is crucial in managing hyponatremia.
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spelling pubmed-85596432021-11-09 Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report Wiśniewski, Oskar Wojciech Matuszak, Paulina Kasprzak, Agnieszka Łącka, Katarzyna Caspian J Intern Med Case Report BACKGROUND: Schmidt’s syndrome (SS) is a rare endocrine disorder (14-20:1000000), which consists of autoimmune thyroiditis (AIT) and autoimmune Addison’s disease (aAD), and usually occurs in young adults. Here, we report a unique case of late-onset SS manifesting initially with isolated severe hyponatremia and present the hazardous outcomes of preliminary misdiagnosis. CASE PRESENTATION: A 78-year-old female presented to the emergency department with a two-day history of diarrhea, emesis and disturbances in consciousness. She also reported general fatigue and increasing weakness in the last month. Urgent laboratory findings revealed isolated severe hyponatremia (serum sodium=108 mmol/l) and initial treatment with active sodium infusions was started, although with no improvement in the patient's neurological status after 5 days (serum sodium=127 mmol/l). Meanwhile, the patient developed recurring episodes of hypoglycemia and symptoms portending adrenal crisis (blood pressure=105/58 mmHg, heart rate=96 bpm, severe whole-body muscle pain, two loose stools), which required immediate i.e. hydrocortisone treatment. Reduced blood cortisol, elevated adrenocorticotropic hormone (ACTH) and atrophic morphology of the adrenal glands in computed tomography imaging contributed to the final diagnosis of aAD and SS consequently, since the patient had a past medical history of AIT. CONCLUSION: Isolated severe hyponatremia should not be underestimated as the first sign of aAD. Appropriate cause-specific treatment is crucial in managing hyponatremia. Babol University of Medical Sciences 2021 /pmc/articles/PMC8559643/ /pubmed/34760090 http://dx.doi.org/10.22088/cjim.12.0.392 Text en https://creativecommons.org/licenses/by/3.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/3.0/ (https://creativecommons.org/licenses/by/3.0/) ) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Wiśniewski, Oskar Wojciech
Matuszak, Paulina
Kasprzak, Agnieszka
Łącka, Katarzyna
Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title_full Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title_fullStr Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title_full_unstemmed Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title_short Severe hyponatremia as the first sign of late-onset Schmidt’s syndrome: A case report
title_sort severe hyponatremia as the first sign of late-onset schmidt’s syndrome: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559643/
https://www.ncbi.nlm.nih.gov/pubmed/34760090
http://dx.doi.org/10.22088/cjim.12.0.392
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