Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis

To report a case of glucocorticoid substitution in panhypopituitarism that can lead to uncontrolled rise in serum sodium and myelinolysis.

A 42-year-old man presented with disturbed conscious level and hyponatremia. Initial data suggested glucocorticoid deficiency. Later, hormonal levels indicated panhypopituitarism. MRI of the brain led to the diagnosis of a pituitary macroadenoma. Glucocorticoid substitution was initiated immediately after admission, and possible myelinolysis subsequently became a complication. We report this case to illustrate the fact that glucocorticoid substitution can lead to rapid rise in serum sodium and myelinolysis in panhypopituitarism.

This case illustrated the need to use minimum doses of glucocortcoids with close monitoring of serum sodium, in order to avoid this complication.