A Case of Transient Hypercortisolism Simultaneously Occurring With the Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Olanzapine

Hiroshi Yamaguchi, Shuhei Onishi, Yukari Oguro, Atsuhisa Shirakami


We herein present a case of a 71-year-old woman who was referred to our hospital with the prolonged disturbance of consciousness after two convulsive seizures the day before admission. She was in long-term hospitalization because of schizophrenia. Blood tests showed severe low-osmolar hyponatremia (Osm: 226 mOsm/kg and Na: 110.3 mEq/L) and hypokalemia (K: 2.67 mEq/L). An endocrine examination revealed that the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which was induced secondary to olanzapine, and transient hypercortisolism had simultaneously occurred. Low- and high-dose overnight dexamethasone suppression tests and the corticotropin-releasing hormone (CRH) test showed similar endocrine responses to those in patients with Cushing’s syndrome. However, no abnormality in the pituitary gland was detected using contrast magnetic resonance imaging (MRI). After admission, elevated adrenocorticotropic hormone (ACTH) and cortisol levels gradually decreased and normalized by the time of discharge. Transient hypercortisolism sometimes occurs in patients with schizophrenia. Hypercortisolism in the present case was considered to be induced by stress such as severe hypo-osmotic hyponatremia and convulsions in addition to the underlying disorder of schizophrenia. Clinicians need to routinely check electrolytes in patients taking olanzapine in order to prevent insidious progression to severe hyponatremia. To the best of our knowledge, this is the first case report in which an endocrine examination and its interpretation were performed for SIADH accompanied by transient hypercortisolism due to the stimulation of ACTH.

J Med Cases. 2017;8(8):259-263
doi: https://doi.org/10.14740/jmc2877w


Hypercortisolism; Syndrome of inappropriate antidiuretic hormone secretion; Olanzapine; Hyponatremia; Hypokalemia

Full Text: HTML PDF
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe



Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board



Company Profile

Editorial Office

Misconduct and Retraction


Company Registration

Contact Us

Abstracting and Indexing



Instructions to Authors


Declaration of Helsinki

Contact Publisher

Submission Checklist


Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy


Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians


Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal


Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.        
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.