Hyponatremia-Finding the Cause

Hyponatremia is a very common finding in elderly and hospitalized patients. Finding its cause is where one has to scratch his head. This case emphasizes how a common occurrence (hyponatremia) can be a manifestation of an underlying rare diagnosis- hypopituitarism. This case is about a seventy years old female presenting with altered state of mentation. Her systemic examination was completely normal except for generalized hypertonia and a Glasgow coma scale of seven. Laboratory investigations revealed hyponatremia with normal chemistry and normal blood complete picture. CT brain and cerebrospinal fluid analysis was also unremarkable. When she was found resistant to treatment (free water restriction and hypertonic saline), she was further investigated and finally diagnosed as a case of hypopituitarism.