An analysis of the relationship between serum cortisol and serum sodium in routine clinical patients

Abstract

ObjectivesAdrenal insufficiency is an uncommon cause of hyponatraemia that should not be overlooked due to the severe consequences of an Addisonian crisis. Using the laboratory database of a large teaching hospital, we have explored the relationship between serum sodium and serum cortisol, and have estimated the frequency of hypoadrenalism in severely hyponatraemic patients.Design and methodsData were gathered over a 23 month period from the Laboratory Information Management System at the Leeds Teaching Hospitals NHS Trust for instances where serum sodium and cortisol had been measured on a single sample. Data were also gathered over the same time period for all patients with severe hyponatraemia (serum sodium ≤120 mmol/L) in order to determine the frequency of cortisol requesting and the incidence of adrenal insufficiency.ResultsAnalysis of the data (n=3268 patients) revealed a trend showing higher cortisol concentrations in patients who were severely hypo- or hypernatraemic. The median cortisol concentration for patients with sodium ≤110 mmol/L was 856 nmol/L, and there was a gradual decrease in cortisol over the sodium range ≤110–150 mmol/L (Rs =−0.323, p<0.0001). Patients with sodium ≥151 mmol/L had a median cortisol of 725 nmol/L. 42% of the 978 patients with serum sodium ≤120 mmol/L had serum cortisol measured within two weeks, of whom 1.7% were diagnosed with adrenal insufficiency.ConclusionsThis dataset shows rising cortisol in response to hypo- or hypernatraemia, in keeping with the stress response to illness. The data show that adrenal insufficiency is a rare cause of hyponatraemia which may be overlooked.

Anxiety Levels, Cortisol, Blood Gluc Ose and Sodium Levels in Working Wives: Comparison Between Husbands Who Were Hospitalized and Husbands Who Were Not Hospitalized

“…Working women have better cognitive function and health and lower levels of depression 30 . Those who work are able to overcome anxiety because they receive support from their family and work environment [31][32][33][34][35] .…”

“…Stress hyponatremia and hypernatremia are sufficient to cause an increase in cortisol. Elevated cortisol is a response to hypernatremia, and a stress response to disease 31,36,37 . Hyponatremia is caused by renal sodium hypovolemia which can stimulate antidiuretic hormone (ADH).…”

Effect of Social Isolation on Serum Electrolytes and Cortisol Level in Wistar Rats

“…Previous studies have reported Hyponatraemia as the most common electrolyte disorder recorded by clinical biochemists, and diagnosis is when the serum sodium level is below 135 mmol/L 13,20,21 . Hypernatremia has also been reported as a risk factor for mortality 21 . Results obtained from this study show a significant decrease in mean serum sodium level below normal physiologic range in the isolated males female (113 ± 2.9 mmol/L) and isolated female (125 ± 2.9 mmol/L), which indicates possible hyponatremia 22 and likely hypotension.…”

Renal medullary osmolytes NaCl and urea differentially modulate human tubular cell cytokine expression and monocyte recruitment

“…Their underlying signaling remains to be determined. NaCl intake and hypernatremia cause catabolism in humans and mice [2, 3, 45] and increase renal medullary urea content [2, 3]. As no catabolic patient cohorts who underwent kidney biopsies were identified, we analyzed renal gene expression in two independent datasets of short‐ and long‐term catabolic mice.…”