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Hyponatremia and seizures caused by triamcinolone-induced adrenal insufficiency
Stefan Reuter1, Niklas Scholten, Hermann Pavenstädt
1University of Münster, Medizinische Klinik und Poliklinik D, Albert-Schweitzer Strasse 33, 48149 Münster, Germany. sreuter@uni-muenster.de
Background:
A 49-year-old woman presented to hospital with an 18-month history of hyponatremic episodes, nausea, vomiting, anorexia and fatigue.
Investigations:
Physical examination, laboratory tests including full blood count, measurement of electrolytes, hormones, autoantibodies, thyroid and renal function, corticotropin-releasing-hormone stimulation test, 24 h urinalysis and abdominal ultrasonography.
Diagnosis:
Severe symptomatic hyponatremia in a patient with secondary adrenal insufficiency caused by treatment of lumbago with triamcinolone injections.
Management:
Hydrocortisone replacement therapy (15 mg daily) for 3 months, followed by a tapering schedule over 12-24 months.
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