Abstract: FR-PO0865
From Empty Sella to Full Recovery: Lessons from a Complex Case of Hyponatremia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Fatima, Hira, University of Utah Health, Salt Lake City, Utah, United States
- Bhakta, Kishan, University of Utah Health, Salt Lake City, Utah, United States
- Chilton, Merideth Brooke, University of Utah Health, Salt Lake City, Utah, United States
- Ramkumar, Nirupama, University of Utah Health, Salt Lake City, Utah, United States
Introduction
Hyponatremia affects approximately 35% of hospitalized patients and is associated with significant mortality.Management of severe hyponatremia (serum sodium <120) can be challenging, especially in patients with underlying endocrine disorders. We present a rare case of severe hyponatremia secondary to empty sella syndrome with hypopituitarism who had a complex course of sodium correction.
Case Description
A 47-year-old male with no significant past medical history presented with nausea, vomiting and visual changes. He was found to have severe hyponatremia with serum sodium levels of 104 mEq/L. He initially received 1 L of normal saline in the ER that rapidly increased his sodium to 112 mEq/L, raising concern for rapid overcorrection and osmotic demyelination syndrome. He was admitted to the ICU, managed with hypertonic saline, DDAVP and close monitoring for slow controlled correction. Over the next 4 days, his sodium gradually improved to 126 mEq/L. Further endocrine workup showed markedly low ACTH and cortisol level characteristic of secondary adrenal insufficiency, central hypothyroidism and hypogonadism. MRI brain revealed empty sella consistent with hypopituitarism. He was started on treatment with hydrocortisone and levothyroxine and transferred out of the ICU. Shortly after, his sodium increased rapidly from 126 to 137 mEq/L within 24 hours, and he developed severe confusion concerning for osmotic demyelination syndrome (ODS). He was restarted on DDAVP and free water with lowering of Na to 127 with improvement in mental status. Repeat MRI brain did not show any evidence of ODS, EEG was suggestive of encephalopathy without seizures or seizure tendencies. Over the following days, his sodium ranged between 120-125 mEq/L with clear mentation. Subsequently, his sodium was slowly raised to 135 mEq/L with hypertonic saline and he was discharged home with hormone replacement. His sodium levels has remained within normal range after discharge.
Discussion
This case highlights two main learning points – 1. Severe hyponatremia in the setting of empty sella syndrome is multifactorial and challenging to treat. 2. ODS can occur with serum sodium>125 and up to 7 days following rapid correction of sodium. Careful monitoring and prompt intervention are important for successful treatment and prevention of neurological complications associated with hyponatremia.