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Hypopituitarism: Case study involving hypernatremia prompting discovery of a pituitary disorder in a patient with lymphoma

BACKGROUND: The endocrine system contributes to numerous physiologic processes. Compensatory mechanisms are in place that can assist when endocrine dysfunction occurs, which may make it difficult to identify pathologic states. OBJECTIVES: The case study in this article presents a 74‐year‐old woman with diffuse large B‐cell lymphoma who was admitted to an oncology critical care unit with neutropenic fevers and suspicion of gastrointestinal bleeding. She was placed on NPO status (no oral intake) overnight and quickly developed hypernatremia. This prompted further investigation, resulting in the discovery of hypopituitarism. METHODS: A case study illustrates how altered endocrine function can contribute to rapid patient deterioration beyond hypothyroidism, diabetes, or other common endocrine conditions. FINDINGS: Compensatory mechanisms involving the endocrine system can mask dysfunction, which can cause providers to miss signs of altered endocrine function. Experienced clinical nurses should use critical thinking and assessment skills to monitor patients for abnormal signs and symptoms.