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[Myxedema coma with hypervasopressinism. 2 cases].

F Archambeaud-Mouveroux, C Dejax, J M Jadaud

    Annales De Medecine Interne
    |January 1, 1987
    PubMed
    Summary
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    Hyponatremia, a common issue in myxedema coma, can be linked to elevated arginine vasopressin (AVP). Early treatment involving fluid management and low-dose thyroid hormones improves consciousness and normalizes AVP levels.

    Area of Science:

    • Endocrinology
    • Nephrology
    • Internal Medicine

    Context:

    • Myxedema coma, a severe form of hypothyroidism, frequently presents with hyponatremia.
    • The underlying mechanisms of hyponatremia in this condition, particularly the role of arginine vasopressin (AVP), require further elucidation.

    Purpose:

    • To report two cases of myxedema coma with hyponatremia and elevated plasma AVP.
    • To investigate the therapeutic response to combined water restriction, hypertonic saline, furosemide, and low-dose thyroid hormone replacement.

    Summary:

    • Two patients with hypothyroid coma presented with hyponatremia, normal urine sodium, low serum osmolality, and increased plasma AVP.
    • Initial management included fluid restriction, hypertonic saline, furosemide, and low-dose oral thyroid hormones, leading to improved consciousness by day four.

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  • Both natremia and plasma AVP normalized before the patients returned to a euthyroid state, suggesting a complex interplay between thyroid status, AVP, and fluid balance.

    • Impact:

    • Highlights hyponatremia as a critical indicator of hypothyroidism severity.
    • Suggests that prompt correction of fluid and electrolyte imbalances, alongside cautious thyroid hormone initiation, is crucial for clinical improvement in myxedema coma.
    • Demonstrates the normalization of elevated plasma AVP levels during the treatment of hyponatremia associated with myxedema coma.