Hypernatraemic hypovolaemia with anaemia: an unusual presentation of primary testicular insufficiency

[摘要] Hypogonadal men may experience intense vasomotor symptoms, and vasomotor sweating can occasionally be associatedwith profound fluid losses. We describe a 37-year-old male, who exhibited persistent hypovolaemic hypernatraemia thatwas challenging to treat despite a continuous high fluid input (>4–5L/day). He was noted to have drenching sweats andnormochromic anaemia. He had recent traumatic head injury, which resulted in neurocognitive dysfunction, so pituitaryfunction tests were done which showed primary hypogonadism. After exclusion of all other possible causes of excesssweating, hypernatraemia and anaemia, a trial of testosterone therapy was instituted. Sweating dramatically ceasedwithin hours of his first testosterone injection, hydration status normalised within days and anaemia and neurocognitivefunction progressively improved with continued testosterone replacement. This case demonstrates how, in a susceptibleindividual, hypovolaemic hypernatraemia can arise from insensible cutaneous fluid loss through eccrine sweating,mediated by vasomotor symptoms of untreated hypogonadism. Although this scenario has not been described in theliterature, we felt it needed to be shared with the wider medical community because of how the diagnosis and treatmentutterly transformed this patient’s functional status and outcome.

[学科分类] 血液学