• Joaquin Gomez-Daspet, Lucinda Elko, Dmitry Grebenev, and David L Vesely.
• Department of Internal Medicine, University of South Florida for Health Sciences, James A. Haley Veterans Medical Center, 13000 Bruce B. Downs Blvd, Tampa, FLorida 33612, USA.
• Am. J. Med. Sci. 2002 Dec 1; 324 (6): 321-5.

AbstractA 41-year-old woman who had undergone transfrontal craniotomy for a pituitary tumor 4 months before presentation was admitted with confusion and orientation only to self. She had a fever of 40 degrees C. Serum sodium and chloride levels on admission were 180 and 139 mEq/L, respectively. Measured serum osmolality was 380 mOsmol/L with a urine osmolality of 360 mOsmol/L. Magnetic resonance imaging revealed a 1.5-cm mass in the sella turcica, which was nonfunctioning on endocrine evaluation. The "bright spot" of a normal posterior pituitary was absent. Central diabetes insipidus was confirmed by a 300% increase in urine osmolality with desmopressin. The patient survived her severe hypernatremia, which has 70% mortality with a serum sodium level of 160 mEq/L or above. However, she developed permanent (6 months) disorientation to time and place even when hypernatremia was corrected, which has not been described previously.

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