비기능성 뇌하수체 종양에 연관된 항이뇨호르몬 분비이상 증후군 1예
SIADH closely related to a non-functioning pituitary adenoma: case report
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초록
저자들은 저나트륨혈증을 주소로 내원하여 시행한 검사 상 항이뇨호르몬 분비이상 증후군으로 진단을 받은 환자에서 일반화학 및 방사선학적 검사를 통해 비기능성 뇌하수체 종양을 진단한 예를 경험하였다. 항이뇨호르몬의 과도한 분비를 유발하는 기전은 아직 분명하지 않으나 본 증례에서와 같이 비기능성 종양에 의한 물리적 압박이 하나의 원인으로 작용할 수 있다고 생각되어 보고하는 바이다.
Abstract
We present a case of severe hyponatremia in a 64-year-old man who had a pituitary tumor. He had nausea and recurrent vomiting with a severe headache, and was admitted to Chungnam National University Hospital for further evaluation. On physical examination, he was alert, and had bitemporal hemianopsia. There was no indication of dehydration or edema. Laboratory data showed a serum sodium level of 126 mEq/L, plasma osmolality of 259 mOsm/kg, and urinary osmolality of 544 mOsm/kg. The plasma argipressin level was 2.88 pg/mL, despite marked hyposmolality. Otherwise, pituitary function was normal. Brain magnetic resonance imaging showed a pituitary macroadenoma measuring 25×16×13 mm and no visible normal pituitary stalk or gland in the sella turcica. After the adenomectomy, the serum sodium level maintained normal without treatment. Histology showed the presence of a pituitary adenoma. These findings indicate that a non-functioning pituitary tumor may cause the exaggerated secretion of argipressin, resulting in inappropriate antidiuretic hormone syndrome.(Korean J Med 72:315-321, 2007)
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