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James P, Gupta P and Patel P
There are numerous potential causes for hyponatraemia including hypovolaemia; oedema; syndrome of inappropriate ADH secretion; and acute episodes of Addison’s disease (hypopituitarism and adrenal insufficiency) [1]. Hyponatraemia can have serious consequences for patients and there are many ways to investigate the cause. Here we present a case of an elderly patient presenting with hyponatraemia and highlight the limitations of the standard dose (250 mcg) short synacthen test (SST) for the investigation of adrenal insufficiency as a potential cause of hyponatraemia.