A Case of Transient Hypercortisolism Simultaneously Occurring With the Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Olanzapine
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".