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. 2021 Dec 16;10(12):1623-1631.
doi: 10.1530/EC-21-0500.

Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Amit Kumar  1 , Maria Ghosh  2 , Jubbin Jagan Jacob  3
Affiliations

Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Amit Kumar et al. Endocr Connect. .

Abstract

Background: The diagnosis of syndrome of inappropriate anti-diuresis requires the exclusion of secondary adrenal insufficiency (AI) among patients with euvolemic hyponatremia (EuVHNa). Studies have suggested that about 2.7-3.8% of unselected patients presenting to the emergency room with EuVHNa have undiagnosed AI and it is as high as 15% among patients admitted to specialized units for evaluation of hyponatremia.

Objective: To study the prevalence of AI among in-patients with EuVHNa in a general medical ward setting.

Methods: This was a prospective, single-center observational study conducted among general medical in-patients with EuVHNa, defined as patients with a serum sodium <135 mmol/L, clinical euvolemia and urine spot sodium >30 mmol/L. Additionally, patients with recent vomiting, current renal failure, diuretic use and those with uncontrolled hyperglycemia were excluded. Adrenal functions were assessed by a modified adrenocorticotropic hormone (ACTH) stimulation test called the Acton Prolongatum™ stimulation test (APST). A cut-off cortisol value of <18 mg/dL after 60 min of ACTH injection was used to diagnose AI.

Results: One hundred forty-one patients were included and underwent an APST. APST suggested 20/141 (14.2%) had undiagnosed AI. The commonest cause of AI (9/20) was secondary AI because of the use of steroids including inhaled steroids and indigenous medicines contaminated with steroids. In 5 (3.5%) patients hypopituitarism was newly diagnosed. Despite primary AI (PAI) not commonly presenting as EuVHNa, 2/20 patients had PAI.

Conclusions: AI is much commoner in our country, among in-patients with EuVHNa primarily driven by exogenous steroid use and undiagnosed hypopituitarism.

Keywords: adrenal insufficiency; euvolemic hyponatremia; hyponatremia; hypopituitarism; secondary adrenal insufficiency.

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Figures

Figure 1
Figure 1
Bar graph detailing the various causes of adrenal insufficiency among the patients with euvolaemic hyponatremia.
See this image and copyright information in PMC

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