Central pontine and extrapontine myelinolysis due to rapid correction of severe hyponatremia: A clinical case
Abstract. Osmotic demyelinating syndrome (ODS) occurs with rapid correction of hyponatremia and includes central pontine and extrapontine myelinolysis. The article presents a clinical observation of an 18-year-old female patient with panhypopituitarism following craniopharyngioma removal. After 6 months of desmopressin intake for central diabetes insipidus, she developed dyspeptic symptoms followed by a decrease in blood sodium to 105 mmol/L (normal: 136–145 mmol/L). Consequently, the patient was hospitalized in the intensive care unit in a coma condition, where, due to a sharp change in the osmotic gradient and rapid hyponatremia treatment, she developed ODS. Currently the patient is undergoing neurorehabilitation with partial restoration of speech and memory functions. This case demonstrates the negative consequences of rapid correction of severe hyponatremia, including the development of central pontine and extrapontine myelinolysis. Increasing awareness of physicians, particularly among resuscitation specialists, regarding osmotic demyelinating syndrome (ODS) is critical for reducing the incidence of disability and improving survival in patients recovering from severe hyponatremia due to central diabetes insipidus.A.A. Koval, L.G. Ebanoidze, E..A. Pigarova, L.K. Dzeranova, E.G. Przhiyalkovskaya, V.N. Azizyan, A.Yu. Grigoriev, A.V. Khairieva, N.V. Tarbaeva
Keywords
central diabetes insipidus
hyponatremia
desmopressin
central pontine myelinolysis
extrapontine myelinolysis
osmotic demyelinating syndrome
References
1. Ильина Е.Ю, Стребкова Н.А, Кузнецова Э.С, Петеркова В.А. Краниофарингиомы у детей и подростков: диагностика и лечение. Вопросы современной педиатрии. 2011;10(6):67–70. (Ilyina EYu, Strebkova NA, Kuznetsova ES, Peterkova VA. Craniopharyngomas in children and adolescents: Diagnostics and treatment. Voprosy sovremennoy pediatrii = Current Pediatrics. 2011;10(6):67–70 (In Russ.)). EDN: ORRINF.
2. Diaz MJ, Kwak SH, Root KT, Fadil A, Nguyen A, Ladehoff L et al. Current approaches to craniopharyngioma management. Front Biosci (Landmark Ed). 2022;27(12):328.
PMID: 36624954. https://doi.org/10.31083/j.fbl2712328
3. Пигарова Е.А., Дзеранова Л.К. Диагностика и лечение центрального несахарного диабета. Ожирение и метаболизм. 2014;11(4):48–55. (Pigarova EA, Dzeranova LK. Diagnosis and treatment of central diabetes insipidus. Ozhirenie i metabolizm = Obesity and Metabolism. 2014;11(4):48–55 (In Russ.)).
EDN: TLDFIX. https://doi.org/10.14341/omet2014448-55
4. Дедов И.И., Мельниченко Г.А., Пигарова Е.А., Дзеранова Л.К., Рожинская Л.Я., Пржиялковская Е.Г. с соавт. Федеральные клинические рекомендации по диагностике и лечению несахарного диабета у взрослых. Ожирение и метаболизм. 2018;15(2):56–71. (Dedov II, Melnichenko GA, Pigarova EA, Dzeranova LK, Rozhinskaya LYa, Przhiyalkovskaya EG et al. Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults. Ozhirenie i metabolizm = Obesity and Metabolism. 2018;15(2):56–71 (In Russ.)).
EDN: XUNGTR. https://doi.org/10.14341/omet9670
5. Behan LA, Sherlock M, Moyles P, Renshaw O, Thompson CJ, Orr C et al. Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus. Eur J Endocrinol. 2015;172(3):243–50.
PMID: 39009016. https://doi.org/10.1530/EJE-14-0719. Erratum in: Nephrol Dial Transplant. 2025;40(6):1259. PMID: 39009016. https://doi.org/10.1093/ndt/gfae213
6. Spasovski G. Hyponatraemia-treatment standard 2024. Nephrol Dial Transplant. 2024;39(10):1583–92.
EDN NFYQGU. https://doi.org/10.1093/ndt/gfae162
7. Elshimy G, Chippa V, Kaur J, Jeong JM. Adrenal crisis. (Updated 2025 Feb 15). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499968/
8. Hossain T, Ghazipura M, Reddy V, Rivera PJ, Mukherjee V. Desmopressin-induced severe hyponatremia with central pontine myelinolysis: A case report. Drug Saf Case Rep. 2018;5(1):19.
PMID: 29696555. PMCID: PMC5918148. https://doi.org/10.1007/s40800-018-0084-1
9. Soupart A, Decaux G. Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol. 1996;46(3):149–69. PMID: 8879850.
10. Beck J. Treatment of chronic hyponatremia and controversy about osmotic demyelination syndrome. Best Pract Res Clin Endocrinol Metab. 2026;40(1):102067.
PMID: 41219109. https://doi.org/10.1016/j.beem.2025.102067
11. Дедов И.И., Мельниченко Г.А., Баркан А., Воронцов А.В., Дзеранова Л.К., Белая Ж.Е. с соавт. Основы клинической нейроэндокринологии. М.: ООО Издательская группа «ГЭОТАР-Медиа». 2022; 352 с. (Dedov II, Melnichenko GA, Barkan A, Vorontsov AV, Dzeranova LK, Belaya ZhE et al. Fundamentals of clinical neuroendocrinology. Moscow: “GEOTAR-Media” Publishing Group LLC. 2022; 352 pp. (In Russ.)).
ISBN 978-5-9704-6950-7. EDN: FQBOSI. https://doi.org/10.33029/9704-6950-7-FCN-2022-1-352
12. Sterns RH. Treatment of severe hyponatremia. Clin J Am Soc Nephrol. 2018;13(4):641–49.
PMID: 29295830; PMCID: PMC5968908. https://doi.org/10.2215/CJN.10440917
13. George JC, Zafar W, Bucaloiu ID, Chang AR. Risk factors and outcomes of rapid correction of severe hyponatremia. Clin J Am Soc Nephrol. 2018;13(7):984–92.
PMID: 29871886. PMCID: PMC6032596. https://doi.org/10.2215/CJN.13061117
14. Fang LJ, Xu MW, Zhou JY, Pan ZJ. Extrapontine myelinolysis caused by rapid correction of pituitrin-induced severe hyponatremia: A case report. World J Clin Cases. 2020;8(5):946–53.
PMID: 32190632. PMCID: PMC7062620. https://doi.org/10.12998/wjcc.v8.i5.946
15. Almalki MH, Ahmad MM, Brema I, Almehthel M, AlDahmani KM, Mahzari M, Beshyah SA. Management of diabetes insipidus following surgery for pituitary and suprasellar tumours. Sultan Qaboos Univ Med J. 2021;21(3):354–64.
PMID: 34522399. PMCID: PMC8407907. https://doi.org/10.18295/squmj.4.2021.010
16. Нуралиева Н.Ф., Юкина М.Ю., Трошина Е.А. Вторичная надпочечниковая недостаточность – новые аспекты диагностики и лечения. Доктор.Ру. 2021;20(2):51–59. (Nuralieva NF, Yukina MYu, Troshina EA. Secondary adrenal insufficiency: New aspects of diagnosis and therapy. Doctor.Ru. 2021;20(2):51–59 (In Russ.)).
EDN: FBCGTH. https://doi.org/10.31550/1727-2378-2021-20-2-51-59
17. Menger H, Jorg J. Outcome of central pontine and extrapontine myelinolysis (n = 44). J Neurol. 1999;246(8):700–5.
PMID: 10460448. https://doi.org/10.1007/s004150050435
About the Authors
Alena A. Koval, MD, clinical resident of Endocrinology Research Centre, Moscow, Russian Federation.E-mail: kovalalen4a0312@mail.ru
ORCID: https://orcid.org/0009-0005-4644-1244. eLibrary SPIN: 5294-6339
Laura G. Ebanoidze, MD, endocrinologist, postgraduate student of the Department of neuroendocrinology, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: lauragogievna97@gmail.com
ORCID: https://orcid.org/0009-0002-3625-6289. eLibrary SPIN: 4353-7915
Ekaterina A. Pigarova, MD, Dr. Sci. (Medicine), endocrinologist, physician of the highest qualification category, director of the Institute of higher and continuing professional education, leading researcher at the Department of neuroendocrinology, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: kpigarova@gmail.com
ORCID: https://orcid.org/0000-0001-6539-466X. Scopus ID: 55655098500. eLibrary SPIN: 6912-6331
Larisa K. Dzeranova, MD, Dr. Sci. (Medicine), professor of the Department of endocrinology, chief researcher at the Department of neuroendocrinology, academic secretary of Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: dzeranovalk@yandex.ru
ORCID: https://orcid.org/0000-0002-0327-4619. eLibrary SPIN: 2958-5555
Elena G. Przhiyalkovskaya, MD, PhD (Medicine), head of the Department of neuroendocrinology, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: przhiyalkovskaya.elena@gmail.com
ORCID: https://orcid.org/0000-0001-9119-2447. eLibrary SPIN: 9309-3256
Vilen N. Azizyan, MD, PhD (Medicine), neurosurgeon, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: vazizyan@mail.ru.
ORCID: https://orcid.org/0000-0001-9718-6099. eLibrary SPIN: 7666-5950
Andrey Yu. Grigoriev, MD, Dr. Sci. (Medicine), professor, neurosurgeon, head of the Department of neurosurgery, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: medway@list.ru.
ORCID: https://orcid.org/0000-0002-9575-4520. eLibrary SPIN: 8910-8130
Angelina V. Khairieva, MD, radiologist at the Department of computed tomography and magnetic resonance imaging of the Reference Center for Radiation Diagnostic Methods, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: komarito@mail.ru
ORCID: https://orcid.org/0000-0002-6758-5918. eLibrary SPIN: 4516-8297
Natalya V. Tarbaeva, MD, PhD (Medicine), associate professor, radiologist, researcher, head of the Department of X-ray and magnetic resonance studies, Endocrinology Research Centre, Moscow, Russian Federation.
E-mail: ntarbaeva@inbox.ru
ORCID: https://orcid.org/0000-0001-7965-9454. eLibrary SPIN: 5808-8065
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