Recurrent Symptomatic Severe Hyponatremia in Craniopharyngioma

This is a case of a 20-year-old male with history of craniopharyngioma status post resection in 2007, panhypopituitarism on hormonal replacement, and obstructive hydrocephalus status post ventriculoperitoneal (VP) shunt, who presented with recurrent episodes of hyponatremia requiring hospitalization. During the clinical course of the disease since 2007, the patient was on hormonal replacement with hydrocortisone for hypocortisolism and desmopressin for diabetes insipidus with recommendations for stress dose of steroids during episodes of illnesses. Treatment with desmopressin and adrenal insufficiency as well as non-compliance with stress dose steroids were the compounding factors, causing severe hyponatremia. This case illustrates the importance of close monitoring of sodium levels during treatment with desmopressin as well as optimum steroid replacement in managing recurrent severe hyponatremia.