{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:49Z","timestamp":1756339489977,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,1]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>Hyponatraemia is common in hospital practice, with the syndrome of inappropriate antidiuresis (SIAD) being the most common underlying aetiology. A relatively less frequent but important cause is adrenal insufficiency (AI). We describe the case of a 63-year-old man who presented with symptomatic hyponatraemia and hypoglycaemia associated with abnormal body movements (ballism). The recent commencement of levothyroxine for newly diagnosed hypothyroidism, followed by fluid restriction for presumed SIAD, led to the worsening of a previously undiagnosed AI. His investigations confirmed central AI in association with thyroid and growth hormone deficiencies. The underlying cause of hypopituitarism, in this case, was a traumatic brain injury He responded well to steroid replacement and fluids. This case highlights that SIAD remains a diagnosis of exclusion, and other causes of hyponatraemia, including AI, should always be considered. Second, levothyroxine treatment without steroid replacement can lead to an adrenal crisis in patients with underlying AI.<\/jats:p>","DOI":"10.1136\/bcr-2021-242764","type":"journal-article","created":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T11:56:21Z","timestamp":1626782181000},"page":"e242764","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Retracing the tracks for SIAD: hyponatraemia due to post-traumatic brain injury hypopituitarism"],"prefix":"10.1136","volume":"14","author":[{"given":"Nusrat Mehmood","family":"Awan","sequence":"first","affiliation":[{"name":"Endocrinology & Diabetes, St Vincent's University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9066-7957","authenticated-orcid":false,"given":"Arimin","family":"Mat","sequence":"additional","affiliation":[{"name":"Endocrinology & Diabetes, St Columcille's Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronan","family":"Canavan","sequence":"additional","affiliation":[{"name":"Endocrinology & Diabetes, St Vincent's University Hospital, Dublin, Ireland"},{"name":"Endocrinology & Diabetes, St Columcille's Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,20]]},"reference":[{"key":"2025082707503075000_14.7.e242764.1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1159\/000493239","article-title":"Hyponatremia and glucocorticoid deficiency","volume":"52","author":"Garrahy","year":"2019","journal-title":"Front Horm Res"},{"key":"2025082707503075000_14.7.e242764.2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2006.056515"},{"key":"2025082707503075000_14.7.e242764.3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.cca.2020.01.029","article-title":"Adrenal insufficiency: physiology, clinical presentation and diagnostic challenges","volume":"505","author":"Martin-Grace","year":"2020","journal-title":"Clin Chim Acta"},{"key":"2025082707503075000_14.7.e242764.4","doi-asserted-by":"crossref","first-page":"4027","DOI":"10.1210\/jc.2014-2476","article-title":"Central hypoadrenalism","volume":"99","author":"Crowley","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082707503075000_14.7.e242764.5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pcd.2013.09.002","article-title":"When hypoglycemia is not obvious: diagnosing and treating under-recognized and undisclosed hypoglycemia","volume":"8","author":"Kenny","year":"2014","journal-title":"Prim Care Diabetes"},{"key":"2025082707503075000_14.7.e242764.6","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4103\/0972-2327.91965","article-title":"Paroxysmal dystonic choreoathetosis with symptomatic seizures secondary to hypoglycemia caused by insulinoma","volume":"14","author":"Gupta","year":"2011","journal-title":"Ann Indian Acad Neurol"},{"key":"2025082707503075000_14.7.e242764.7","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0493"},{"key":"2025082707503075000_14.7.e242764.8","doi-asserted-by":"publisher","DOI":"10.1210\/er.2014-1065"},{"key":"2025082707503075000_14.7.e242764.9","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2020.00512","article-title":"Prevalence and description of hyponatremia in a Swiss tertiary care Hospital: an observational retrospective study","volume":"7","author":"Lu","year":"2020","journal-title":"Front Med"},{"key":"2025082707503075000_14.7.e242764.10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-2118"},{"key":"2025082707503075000_14.7.e242764.11","first-page":"882","article-title":"Adrenal cortical insufficiency--a life threatening illness with multiple etiologies","volume":"110","author":"Quinkler","year":"2013","journal-title":"Dtsch Arztebl Int"},{"key":"2025082707503075000_14.7.e242764.12","first-page":"278","article-title":"[Paroxysmal bilateral ballism induced by hypoglycemia]","volume":"46","author":"Takahashi","year":"2006","journal-title":"Rinsho Shinkeigaku"},{"key":"2025082707503075000_14.7.e242764.13","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-315500"},{"key":"2025082707503075000_14.7.e242764.14","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1177\/1758834017736210","article-title":"Managing hyponatremia in lung cancer: latest evidence and clinical implications","volume":"9","author":"Fiordoliva","year":"2017","journal-title":"Ther Adv Med Oncol"},{"key":"2025082707503075000_14.7.e242764.15","unstructured":"Ross DS . 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