Change of the Image of the Posterior Pituitary in a Patient with Mineralocorticoid-responsive Hyponatremia of the Elderly:Comparison of Findings before and after Treatment

Abstract

F i g u r e 1 . Cr a n i a l ma g n e t i c r e s o n a n c e i ma g i n g ( MRI ) d e mo n s t r a t e d a n a b s e n c e o f h i g h i n t e n s i t y o f t h e p o s t e r i o r p i t u i t a r y o n T 1 -we i g h t e d i ma g e s ( F i g 1 A) . Af t e r n o r ma l i z a t i o n o f t h e s e r u m s od i u m l e v e l a n d p l a s ma o s mo l a l i t y , h i g h i n t e n s i t y o f t h e p o s t e r i o r p i t u i t a r y o n T 1 -we i g h t e d i ma g e s wa s i mp r o v e d ( F i g 1 B ) . SHORT COMMUNICATION

Mineralocorticoid responsive hyponatremia of the elderly

“…[9] Serum ADH levels were over the detectable concentration in 26 patients despite hyponatremia and its median is 0.9 pg/mL. [5,7,9–13,15] Water restriction test was performed among 7 patients in 5 reports to differentiate them from SIAD. [5,7,12,14,15] Hyponatremia in these 7 cases was exacerbated by the test.…”

Hyponatremia with Loss of High Signal Intensity in the Posterior Pituitary Lobe on T1-weighted Magnetic Resonance Imaging

“…Fludrocortisone is a mineralocorticoid that promotes sodium reabsorption in the distal renal tubule. These effects may occur in cases of mineralocorticoid-responsive hyponatremia of the elderly (MRHE) ( 13 ), SIADH, and heart failure. Therefore, fludrocortisone administration may not be a diagnostic treatment for MRHE.…”

Five cases of severe hyponatremia in the elderly successfully treated with low doses of hydrocortisone

“…The concept of mineralocorticoid-responsive hyponatremia of the elderly (MRHE) with unknown etiology is proposed in two reports. 11,12 In these reports, it is reported that the administration of fludrocortisone possesses benefit for the treatment of hyponatremia in the elderly. It is possible that fludrocortisones could have been used in all five of our cases.…”