Lixisenatide clinical experience on patients with type 2 diabetes and obesity in endocrinology offices in Malaga.

oral hydrocortisone 10 mg/m/day and fludrocortisone 0.1 mg/day, with subsequent normalization of electrolytes. Insulin therapy dosage had to be doubled (1.4 IU/kg/day), which decreased hypoglycemia episodes. Severe hyponatremia may cause rhabdomyolysis, which has mainly been reported in cases of water intoxication. Association of rhabdomyolysis with primary adrenal insufficiency is extremely uncommon. Concomitant hyponatremia exists in almost all cases, except in one reported in 2003. The lowest sodium level seen was 97 mmol/L. Potassium levels were increased in more than half the cases (highest value reported, 5.8 mmol/L). Our patient showed hyponatremia of 120 mmol/L and hyperkalemia of 6.8 mmol/L. Children with severe hyperkalemia (>7 mmol/L) may experience ascending muscle weakness, with occasional progression to flaccid paralysis. These findings are similar to those of patients with Guillain-Barré. In adrenal insufficiency, cortisol deficiency stimulates CRH release, with increased ADH secretion and decreased sodium levels. On the other hand, aldosterone deficiency promotes renal sodium excretion, causing hypovolemia and ADH release mediated by baroreceptors. The mechanism by which rhabdomyolysis occurs in the setting of hyponatremia is not clear, and various hypotheses have been proposed: rupture of the myocyte cell membrane caused by fluctuation in intracellular and extracellular osmolality by an increase in intracellular calcium through the sodium--calcium exchanger; on the other hand, correction of severe hyponatremia may also cause rhabdomyolysis because CPK increase has occasionally been seen some days after correction of electrolyte imbalance. Measurement of CPK levels in patients with adrenal insufficiency complicated with hyponatremia appears to be necessary because association with rhabdomyolysis may occur more frequently than previously recognized. Our patient is probably the first clinical case reported in children of an association of hyponatremic rhabdomyolysis and adrenal insufficiency in the setting of a Carpenter syndrome. References