Dr. Trần Thị Thu Hương. — Photo courtesy of Family Medical Practice

Dr. Trần Thị Thu Hương*

Dương is a vibrant 70-year-old who has embraced his retirement with energy. His passions include sports, spending time with friends and tending to his beloved garden.

Unfortunately, about six months ago, he began experiencing distressing symptoms such as frequent nausea and persistent vomiting.

Concerned about his health, Dương promptly sought medical attention and underwent a gastrointestinal (GI) endoscopy. The results of the procedure revealed the presence of gastritis, shedding light on the cause of his discomfort. He was rehydrated by intravenous fluids, antiemetic and gastric acid lowering agents. As he felt better he was discharged after three days.

A month later, still on treatment for gastritis, suddenly, he felt nauseous, vomited and fatigued. Despite Dương's attempt to remain at home for an additional day, his discomfort became unbearable. Consequently, he urgently sought medical attention at Family Medical Practice.

Upon arrival, he experienced a bout of vomiting. During his consultation with the doctor, Dương reported no abdominal pain, diarrhea or headache. The examination showed dehydration, blood pressure 90/60 mmHg and blood test low sodium. He received symptomatic treatment and his condition stabilised. After two days, his symptoms improved clinically. However, his sodium even though it was better but it was still low (around 130- 133 mmol/l).

The GP referred the patient to the endocrinologist of Family Medical Practice. In order to investigate the underlying cause of Dương's low sodium levels, additional tests were conducted. These tests revealed low sodium levels in the blood, accompanied by low osmotic pressure but normal fluid volume within the body.

Despite thorough evaluation and investigation, no definitive explanation or underlying condition could be identified as the source of his low sodium levels. Parametres such as thyroid function and cortisol hormone levels, which are regulated by the adrenal gland, were found to be within the normal range, adding to the mystery surrounding his condition.

The doctor suspected that Dương may be experiencing SIADH (syndrome of inappropriate antidiuretic hormone secretion), a condition characterised by excessive production of antidiuretic hormone (ADH) in the body.

However, despite this suspicion, no definitive findings indicated the underlying cause of SIADH in his case. After a seven-day hospital stay, Dương was discharged with a diagnosis of hyponatremia, and he was instructed to continue monitoring for SIADH. He was prescribed an oral electrolyte solution and advised to return for a follow-up appointment in one month's time.

One week before the planned appointment, he once again presented symptoms with nausea and vomiting. He consulted the endocrinologist in advance through telephone who advised him to come to FMP for examination and treatment. The endocrinologist decided to repeat hyponatremia tests, the result at this time showed hypothyroidism and adrenal insufficiency, low T4 thyroid hormone and Cortisol levels suggesting a possible pituitary gland disease. MRI of the brain including Pituitary gland was performed showing fluid-filled cysts in the pituitary gland.

The doctor explained to Dương that the pituitary gland is a small, pea-sized endocrine gland located at the base of your brain below your hypothalamus. It releases several important hormones and controls the function of many other endocrine system glands. Pituitary cysts are not cancerous. Many are small and cause no health problems. However, Pituitary cyst size can vary greatly over time. It affects pituitary function that causes pituitary insufficiency. In this patient, the cause of hyponatremia is secondary adrenal insufficiency due to pituitary insufficiency.

Hormone replacement was indicated. Firstly, he took hydrocortisone 20 mg/ day. After several days, thyroxin (Thyroid hormone) was added. Treatment is lifelong with hormone replacement therapy with regular follow-up and monitoring for other health problems.

At the follow-up after one month Dương reported that he feels well, gained weight, and has been taking hormone replacement medication every day and no longer deals with recurrent vomiting episodes. Examination showed normal blood pressure and normal serum sodium. He is planning to travel with his family. The doctor recommended that he not forget to take his medication and how to increase the dosage in case of illnesses to prevent acute adrenal crisis. Family Medical Practice

*Dr Trần Thị Thu Hương is our Internist and Endocrinologist. With 12 years of experience working in a public hospital, Hương brings a wealth of expertise to her field. She has a master's degree in Internal Medicine from Hanoi Medical University in Vietnam.

Additionally, she has completed a comprehensive continuing medical course focused on the diagnosis and treatment of Endocrine Disease and Diabetes.

Hương has also obtained a certificate in thyroid fine needle aspiration biopsy from Bạch Mai Hospital. Further enhancing her knowledge, she has completed an Endocrinology and Metabolism course at Cathay General Hospital in Taipei, Taiwan.

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FMP’s downtown location in Hồ Chí Minh City is in Diamond Plaza, 34 Lê Duẩn Street, Bến Nghé Ward, District 1, and 95 Thảo Điền Street, District 2. Tel. (028) 3822 7848 or email hcmc@vietnammedicalpractice.com.