since four days; followed by pain over the right flank, which radiated to the anterior abdomen. There was no dysuria, haematuria, lithuria, gravelurea; or history of passage of any fleshy material in the urine. Furthermore, there was no history of reduction in the urine output nor similar complaints in the past. He looked clinically unwell. He had tachycardia with a pulse rate of 120/minute, with a normal blood pressure and respiratory rate. His temperature was 38 °C, weight was 68 kg and a BMI of 22.6 kg/m 2. A systemic examination revealed tenderness and guarding in the right upper quadrant. A clinical diagnosis of acute right sided pyelonephritis was considered. Investigations revealed a haemoglobin of 13.1 gm/dL (normal range: 12 gm/ dL to 16 gm/dL); and a white cell count of 15000/mm 3 (normal range: 4000/mm 3 to 11000/mm 3), with polymorphs of 73%, lymphocytes of 22% and eosinophils of 03%. Urine analysis showed the urine to be positive for leucocyte esterase. BUN was 19 mg/dL (normal range 15 mg/dL to 40 mg/dL), serum creatinine 1.02 mg/dL (normal range 0.6 mg/dL to 1.4 mg/dl), blood sugar fasting and post-prandial were 80 mg/dL and 103 mg/ dL respectively, serum bilirubin was 0.4 mg/dL, serum albumin 4.2 gm/dL, serum AST/ALT was 19/22 IU/L. HIV, HBsAg, anti-HCV were non-reactive. His blood, urine were sterile, chest X-ray was normal, 2D echocardiography did not reveal any vegetation, serum procalcitonin was 0.6; and his serum beta galactomannan was 0.34 (Normal < 0.50). Ultrasound of the kidneys revealed an enlarged right kidney and a hypoechoic lesion in the inferior pole of right kidney. Contrast-enhanced computerised tomography (CECT) of the kidney, ureter and bladder (KUB) conducted on day two, revealed

No abstract

SARS-CoV-2 disease (COVID-19) has dramatically increased since March 2020. There is insufficient data to establish the risk of acquiring the hyponatremia in patient with COVID-19 infection. We report here the clinical features and therapeutic course of the severe hyponatremia secondary to pituitary macroadenoma with confirmed COVID-19 pneumonia. This is a 59-year-old man without renal disease, who developed severe hyponatremia, hardly explained by the emetic episode and/or diuretic treatment with thiazides. We know that hyponatremia occurs in patients with hypopituitarism, but infrequently as first presenting feature of a pituitary tumor in the context of a respiratory infection by COVID-19, which has probably exacerbated its presentation. We conclude, that in our case, in addition to the finding of a non-functioning pituitary macroadenoma that determines a cortisol deficiency, we consider that COVID-19 infection could have played a role in the severity of the symptoms of hyponatremia.