Severe Hyponatremia in a 46-Year-Old Female With Pituitary Stalk Duplication and Primary Empty Sella Syndrome.

Pituitary duplication is a rare congenital malformation. It has been mainly reported in the pediatric and neonatal population, with few reported cases in the adult population. In this case report, we discuss the presentation of an adult female patient with pituitary stalk duplication and primary empty sella (PES). A 46-year-old South Asian female presented with severe euvolemic hyponatremia. Initial investigation showed low serum osmolality, high urine osmolality, high urinary sodium concentration, and normal chest X-ray. On physical examination, the patient had underdeveloped secondary sexual characteristics. Laboratory tests showed low follicle-stimulating hormone, luteinizing hormone, and estradiol. Prolactin was moderately elevated, morning cortisol was low, adrenocorticotropic hormone (ACTH) was within the lower normal range, ACTH dynamic test was suboptimal, and insulin-like growth factor 1 was low. MRI showed empty sella with duplication of the pituitary stalk and third ventricle sagging. Pituitary stalk duplication is a rare congenital malformation that can be associated with other craniofacial abnormalities. Here, we describe the occurrence of pituitary stalk duplication with PES. It is not known if the two conditions are associated with each other. However, we speculate that the duplication of the stalk might have altered the normal anatomy of the aperture in the sellar diaphragm creating a space for the third ventricle to sag or herniate, as well as compressing the pituitary gland.

Clinical characteristics of patients with mpox infection in the United Arab Emirates: a prospective cohort study.

OBJECTIVES: The study aims to explore the risk factors, clinical characteristics, and outcomes of mpox infection in Abu Dhabi, United Arab Emirates (UAE). METHODS: A prospective cohort study was conducted at two communicable disease centers in Abu Dhabi, UAE and patients admitted with confirmed mpox infections between May 01, 2022 and December 31, 2022 were included in our study. RESULTS: A total of 176 mpox patients were admitted, of which 93% (n = 164) were men and mean age was 30.4 ± 7 years. Individuals presented with mucocutaneous lesions, most commonly on the genital and anal regions (n = 157; 89%). Only 70 (39.8%) gave a history of sexual exposure. The most common systemic symptoms reported were fever (n = 91; 52%), exanthema (n = 92; 52%), and inguinal lymphadenopathy (n = 60; 34%). Median timeframe from systemic symptoms to appearance of lesions was 4 days (interquartile range 4-6 days). Complications were observed in seven (4%) participants; two (1.1%) individuals developed conjunctivitis, four (2.3%) patients developed penile edema, and one (0.6%) case of myocarditis was reported. In 60% (n = 106) of patients, a potential source of sexual exposure was not identified. CONCLUSION: The clinical characteristics of mpox cases in the UAE are similar to those in other countries. However, cultural and religious factors likely prevent patient disclosure of sexual exposure and symptoms, contributing to the limited information about the disease in the Middle East.