Hyponatremia is the valuable manifestation for initiating diagnosis of hypopituitarism in elderly
The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirty-one elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80....
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| Published in | ENDOCRINE JOURNAL Vol. 59; no. 11; pp. 1015 - 1020 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japan Endocrine Society
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-8959 1348-4540 1348-4540 |
| DOI | 10.1507/endocrj.EJ12-0067 |
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| Abstract | The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirty-one elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80.6%) and hypoglycemia (29.0%) was found, and it was totally different from that in hypopituitarism from general population. There were two groups of hyponatremia derived from their clinical courses, namely, acute deterioration of hyponatremia and chronically persistent hyponatremia. Analysis for deficient hormones clearly showed that ACTH deficiency was highly found in 30 of 31 patients. There was no difference in serum cortisol levels between the hyponatremic and normonatremic patients. Despite hypoosmolality, plasma arginine vasopressin (AVP) was apparently high in the hyponatremic patients compared with in the normonatremic ones. The present study indicates that hyponatremia is the valuable finding for initiating diagnosis of hypopituitarism, and that augmented release of AVP may be involved in developing hyponatremia in elderly patients with hypopituitarism. |
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| AbstractList | The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirty-one elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80.6%) and hypoglycemia (29.0%) was found, and it was totally different from that in hypopituitarism from general population. There were two groups of hyponatremia derived from their clinical courses, namely, acute deterioration of hyponatremia and chronically persistent hyponatremia. Analysis for deficient hormones clearly showed that ACTH deficiency was highly found in 30 of 31 patients. There was no difference in serum cortisol levels between the hyponatremic and normonatremic patients. Despite hypoosmolality, plasma arginine vasopressin (AVP) was apparently high in the hyponatremic patients compared with in the normonatremic ones. The present study indicates that hyponatremia is the valuable finding for initiating diagnosis of hypopituitarism, and that augmented release of AVP may be involved in developing hyponatremia in elderly patients with hypopituitarism. The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirty-one elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80.6%) and hypoglycemia (29.0%) was found, and it was totally different from that in hypopituitarism from general population. There were two groups of hyponatremia derived from their clinical courses, namely, acute deterioration of hyponatremia and chronically persistent hyponatremia. Analysis for deficient hormones clearly showed that ACTH deficiency was highly found in 30 of 31 patients. There was no difference in serum cortisol levels between the hyponatremic and normonatremic patients. Despite hypoosmolality, plasma arginine vasopressin (AVP) was apparently high in the hyponatremic patients compared with in the normonatremic ones. The present study indicates that hyponatremia is the valuable finding for initiating diagnosis of hypopituitarism, and that augmented release of AVP may be involved in developing hyponatremia in elderly patients with hypopituitarism.The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirty-one elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80.6%) and hypoglycemia (29.0%) was found, and it was totally different from that in hypopituitarism from general population. There were two groups of hyponatremia derived from their clinical courses, namely, acute deterioration of hyponatremia and chronically persistent hyponatremia. Analysis for deficient hormones clearly showed that ACTH deficiency was highly found in 30 of 31 patients. There was no difference in serum cortisol levels between the hyponatremic and normonatremic patients. Despite hypoosmolality, plasma arginine vasopressin (AVP) was apparently high in the hyponatremic patients compared with in the normonatremic ones. The present study indicates that hyponatremia is the valuable finding for initiating diagnosis of hypopituitarism, and that augmented release of AVP may be involved in developing hyponatremia in elderly patients with hypopituitarism. 「Abstract.」 The present study was undertaken to determine clinical features of hypopituitarism in elderly subjects. Thirtyone elderly patients with hypopituitarism were enrolled. They were 19 males and 12 females, with the ages of 70.7±5.4 years ranging from 62 to 80 years. High prevalence of hyponatremia (80.6%) and hypoglycemia (29.0%) was found, and it was totally different from that in hypopituitarism from general population. There were two groups of hyponatremia derived from their clinical courses, namely, acute deterioration of hyponatremia and chronically persistent hyponatremia. Analysis for deficient hormones clearly showed that ACTH deficiency was highly found in 30 of 31 patients. There was no difference in serum cortisol levels between the hyponatremic and normonatremic patients. Despite hypoosmolality, plasma arginine vasopressin (AVP) was apparently high in the hyponatremic patients compared with in the normonatremic ones. The present study indicates that hyponatremia is the valuable finding for initiating diagnosis of hypopituitarism, and that augmented release of AVP may be involved in developing hyponatremia in elderly patients with hypopituitarism. |
| Author | Asano, Tomoko Aoki, Atsushi Kakei, Masahumi Ishikawa, San-e Ikoma, Aki Kawakami, Masanobu Sasaki, Masami |
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| Cites_doi | 10.1530/eje.0.1480221 10.1152/ajpregu.1987.252.4.R635 10.1046/j.1365-2265.2003.01647.x 10.1038/ki.1982.216 10.1507/endocrj1954.38.325 10.1210/endo-103-4-1009 10.1038/ki.1980.110 10.1159/000123479 10.1507/endocrj.43.101 10.1530/eje.0.1490177 10.1530/eje.0.1480609 10.1006/bbrc.2001.6114 10.7326/0003-4819-106-2-187 10.2174/1874609810801010042 10.1210/jcem-11-7-700 10.1152/ajprenal.1979.236.4.F321 10.1210/jc.77.6.1584 10.1172/JCI106390 10.1007/BF03345553 |
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| References | 21. Schrier RW, Berl T, Anderson RJ (1979) Osmotic and nonosmotic control of vasopressin release. Am J Physiol 236: F321-332. 12. Robinson AG, Seif SM, Verbalis JG, Brownstein MJ (1983) Quantitation of changes in the content of neurohypophyseal peptides in hypothalamic nuclei after adrenalectomy. Neuroendocrinology 36: 347-350. 17. Ishikawa S, Saito T, Kaneko K, Okada K,Kuzuya T (1987) Hyponatremia responsive to fludrocortisone acetate in elderly patinets after head injury. Ann Intern Med 106: 187-191. 8. Green HH, Harrington AR, Valtin H (1970) On the role of antidiuretic hormone in the inhibition of acute water diuresis in adrenal insufficiency and the effects of gluco- and mineralocorticoids in reversing the inhibition. J Clin Invest 49: 1724-1736. 15. Chanson P (2003) Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 149: 177-178. 4. Amhed AB, George BC, Gonzalez-auvert T, Dingman JF (1967) Increased plasma arginine vasopressin in clinical adrenocortical insufficiency and its inhibition of glucocorticoids. J Clin Invest 46: 111-123. 13. Seif SM, Robinson AG, Zimmerman EA, Wilkins J (1978) Plasma neurophysin and vasopressin in the rat: response to adrenalectomy and steroid replacement. Endocrinology 103: 1009-1015. 3. Ishikawa S, Saito T, Fukagawa A, Higashiyama M, Nakamura T, Kusaka I, Nagasaka S, Honda K, Saito T (2001) Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metabol 86: 1665-1671. 10. Linas SL, Berl T, Robertson GL, Aisenbrey GA, Schrier RW, Anderson RJ (1980) Role of vasopressin in the impaired water excretion of glucocorticoid deficiency. Kidney Int 18: 58-67. 18. Tsushima T (1996) Actual conditions of hypopituitarism in our country. Research Committee of the Ministry of Health, Labor and Welfare: 61-64 (In Japanese). 22. Ishikawa S, Fujita N, Fujisawa G, Tuboi Y, Sakuma N, Okada K, Saito T (1996) Involvment of arginine vasopressin and renal sodium handling in pathogenesis of hyponatremia in elderly patients. Endocr J 43: 101-108. 9. Ishikawa S, Schrier RW (1982) Effect of arginine vasopressin antagonist on renal water excretion in glucocorticoid and mineralocorticoid deficient rats. Kidney Int 22: 587-593. 16. Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P (2008) Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci 1: 42-50. 11. Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252: R635-644. 19. Faustini-Fustini M, Anagni M (2006) Beyond Semantics: Defining hyponatremia in secondary adrenal insufficiency. J Endocrinol Invest 29: 267-269. 6. Kamoi K, Tamura T, Tanaka K, Ishibashi M, Yamaji T (1993) Hyponatremia and osmoregulation of thirst and vasopressin secretion in patients with adrenal insufficiency. J Clin Endocrinol Metab 77: 1584-1588. 14. Ishikawa S, Schrier RW (2003) Pathophysiological roles of arginine vasopressin and aquaporin-2 in impaired water excretion. Clin Endocrinol (Oxf) 58: 1-17. 5. Ishikawa S, Fujisawa G, Tuboi Y, Okada K, Kuzuya T, Saito T (1991) Role of antidiuretic hormone in hyponatremia in patients with isolated adrenocorticotropic hormone deficiency. Endocrinol Jpn 38: 325-330. 20. Kim JK, Summer SN, Wood WM, Schrier RW (2001) Role of glucocorticoid hormones in arginine vasopressin gene regulation. Biochem Biophys Res Commun 289: 1252-1256. 7. Slessor A (1951) Studies concering the mechanism of water retention in Addison’s disease and in hypopituitarism. J Clin Endocrinol 11: 700-723. 1. Diederich S, Franzen NF, Bahr V, Oelkers W (2003) Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol 148: 609-617. 2. Yatagai T, Kusaka I, Nakamura T, Nagasaka S, Honda K, Ishibashi S, Ishikawa S (2003) Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency. Eur J Endocrinol 148: 221-226. 11 22 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 10 21 |
| References_xml | – reference: 4. Amhed AB, George BC, Gonzalez-auvert T, Dingman JF (1967) Increased plasma arginine vasopressin in clinical adrenocortical insufficiency and its inhibition of glucocorticoids. J Clin Invest 46: 111-123. – reference: 10. Linas SL, Berl T, Robertson GL, Aisenbrey GA, Schrier RW, Anderson RJ (1980) Role of vasopressin in the impaired water excretion of glucocorticoid deficiency. Kidney Int 18: 58-67. – reference: 2. Yatagai T, Kusaka I, Nakamura T, Nagasaka S, Honda K, Ishibashi S, Ishikawa S (2003) Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency. Eur J Endocrinol 148: 221-226. – reference: 17. Ishikawa S, Saito T, Kaneko K, Okada K,Kuzuya T (1987) Hyponatremia responsive to fludrocortisone acetate in elderly patinets after head injury. Ann Intern Med 106: 187-191. – reference: 5. Ishikawa S, Fujisawa G, Tuboi Y, Okada K, Kuzuya T, Saito T (1991) Role of antidiuretic hormone in hyponatremia in patients with isolated adrenocorticotropic hormone deficiency. Endocrinol Jpn 38: 325-330. – reference: 18. Tsushima T (1996) Actual conditions of hypopituitarism in our country. Research Committee of the Ministry of Health, Labor and Welfare: 61-64 (In Japanese). – reference: 19. Faustini-Fustini M, Anagni M (2006) Beyond Semantics: Defining hyponatremia in secondary adrenal insufficiency. J Endocrinol Invest 29: 267-269. – reference: 3. Ishikawa S, Saito T, Fukagawa A, Higashiyama M, Nakamura T, Kusaka I, Nagasaka S, Honda K, Saito T (2001) Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metabol 86: 1665-1671. – reference: 13. Seif SM, Robinson AG, Zimmerman EA, Wilkins J (1978) Plasma neurophysin and vasopressin in the rat: response to adrenalectomy and steroid replacement. Endocrinology 103: 1009-1015. – reference: 9. Ishikawa S, Schrier RW (1982) Effect of arginine vasopressin antagonist on renal water excretion in glucocorticoid and mineralocorticoid deficient rats. Kidney Int 22: 587-593. – reference: 12. Robinson AG, Seif SM, Verbalis JG, Brownstein MJ (1983) Quantitation of changes in the content of neurohypophyseal peptides in hypothalamic nuclei after adrenalectomy. Neuroendocrinology 36: 347-350. – reference: 20. Kim JK, Summer SN, Wood WM, Schrier RW (2001) Role of glucocorticoid hormones in arginine vasopressin gene regulation. Biochem Biophys Res Commun 289: 1252-1256. – reference: 16. Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P (2008) Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci 1: 42-50. – reference: 7. Slessor A (1951) Studies concering the mechanism of water retention in Addison’s disease and in hypopituitarism. J Clin Endocrinol 11: 700-723. – reference: 22. Ishikawa S, Fujita N, Fujisawa G, Tuboi Y, Sakuma N, Okada K, Saito T (1996) Involvment of arginine vasopressin and renal sodium handling in pathogenesis of hyponatremia in elderly patients. Endocr J 43: 101-108. – reference: 11. Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252: R635-644. – reference: 8. Green HH, Harrington AR, Valtin H (1970) On the role of antidiuretic hormone in the inhibition of acute water diuresis in adrenal insufficiency and the effects of gluco- and mineralocorticoids in reversing the inhibition. J Clin Invest 49: 1724-1736. – reference: 15. Chanson P (2003) Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 149: 177-178. – reference: 1. Diederich S, Franzen NF, Bahr V, Oelkers W (2003) Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol 148: 609-617. – reference: 6. Kamoi K, Tamura T, Tanaka K, Ishibashi M, Yamaji T (1993) Hyponatremia and osmoregulation of thirst and vasopressin secretion in patients with adrenal insufficiency. J Clin Endocrinol Metab 77: 1584-1588. – reference: 14. Ishikawa S, Schrier RW (2003) Pathophysiological roles of arginine vasopressin and aquaporin-2 in impaired water excretion. Clin Endocrinol (Oxf) 58: 1-17. – reference: 21. Schrier RW, Berl T, Anderson RJ (1979) Osmotic and nonosmotic control of vasopressin release. Am J Physiol 236: F321-332. – ident: 3 – ident: 18 – ident: 2 doi: 10.1530/eje.0.1480221 – ident: 4 – ident: 11 doi: 10.1152/ajpregu.1987.252.4.R635 – ident: 14 doi: 10.1046/j.1365-2265.2003.01647.x – ident: 9 doi: 10.1038/ki.1982.216 – ident: 5 doi: 10.1507/endocrj1954.38.325 – ident: 13 doi: 10.1210/endo-103-4-1009 – ident: 10 doi: 10.1038/ki.1980.110 – ident: 12 doi: 10.1159/000123479 – ident: 22 doi: 10.1507/endocrj.43.101 – ident: 15 doi: 10.1530/eje.0.1490177 – ident: 1 doi: 10.1530/eje.0.1480609 – ident: 20 doi: 10.1006/bbrc.2001.6114 – ident: 17 doi: 10.7326/0003-4819-106-2-187 – ident: 16 doi: 10.2174/1874609810801010042 – ident: 7 doi: 10.1210/jcem-11-7-700 – ident: 21 doi: 10.1152/ajprenal.1979.236.4.F321 – ident: 6 doi: 10.1210/jc.77.6.1584 – ident: 8 doi: 10.1172/JCI106390 – ident: 19 doi: 10.1007/BF03345553 |
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| SubjectTerms | Adrenal Insufficiency - blood Adrenal Insufficiency - diagnosis Aged Aged, 80 and over Anemia - etiology Arginine vasopressin Arginine Vasopressin - blood Female Humans Hypoglycemia - etiology Hyponatremia - blood Hyponatremia - complications Hypopituitarism - diagnosis Impaired water excretion Male Middle Aged Pituitary-adrenal axis |
| Title | Hyponatremia is the valuable manifestation for initiating diagnosis of hypopituitarism in elderly |
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