{
  "abstract": "A 52-year-old man presented with severe hyponatremia and Rathke's cleft cyst (RCC)-associated hypophysitis with enlargement of the pituitary stalk. Hyponatremia persisted despite treatment with high-dose hydrocortisone, hypertonic saline, and loop diuretics, ultimately requiring low-dose tolvaptan. Hyponatremia associated with RCC is usually attributed to secondary adrenal insufficiency (SAI), in which glucocorticoid replacement generally restores free water excretion but may unmask arginine vasopressin deficiency (AVP-D). In the present case, however, persistent AVP-mediated water retention beyond SAI appeared to predominate, suggesting AVP dysregulation associated with inflammatory pituitary involvement. This case highlights the therapeutic dilemma of balancing masked AVP-D against persistent AVP excess in hyponatremia associated with RCC.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "Yuya Shimizu"
    },
    {
      "name": "Reo Ishii"
    },
    {
      "name": "Kazumasa Tanaka"
    },
    {
      "name": "Koki Kinoshita"
    },
    {
      "name": "Jun Toyama"
    },
    {
      "name": "Noriaki Fukuhara"
    },
    {
      "name": "Masahiro Nezu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/drpbmts5h9x5n.bib",
  "cited_by": 0,
  "doi": "10.2169/internalmedicine.7951-26",
  "fulltext_url": "https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7951-26/_article",
  "id": "drpbmts5h9x5n",
  "issns": [
    "1349-7235",
    "0918-2918"
  ],
  "landing_url": "https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7951-26/_article",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "jstage-journal",
      "medicine/general"
    ],
    [
      "openalex",
      "2740|Electrolyte and hormonal disorders"
    ]
  ],
  "openalex": "W7221053895",
  "pdf_url": "https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7951-26/_pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/drpbmts5h9x5n.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "10.2169/internalmedicine.7951-26",
      "source": "jstage",
      "url": "https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7951-26/_article"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Electrolyte and hormonal disorders",
      "subfield": "general"
    }
  ],
  "title": "Persistent SIADH-like Hyponatremia Requiring Tolvaptan Despite Glucocorticoid Replacement in Rathke’s Cleft Cyst-Associated Hypophysitis: A Therapeutic Dilemma",
  "title_text": "Persistent SIADH-like Hyponatremia Requiring Tolvaptan Despite Glucocorticoid Replacement in Rathke’s Cleft Cyst-Associated Hypophysitis: A Therapeutic Dilemma",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:31Z",
  "url": "https://research.draconitic.com/paper/drpbmts5h9x5n",
  "venue": "Internal Medicine",
  "versions": []
}