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*Corresponding author:Ahmed N Ghanem, Consultant Urologist Surgeon No1 President Mubarak Street, Mansoura 35511, Egypt
Received: November 21, 2018; Published: December 03, 2018
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I congratulate the authors on their success in investigating and treating this case of severe hyponatremia (HN) [BMJ 2008;337: a2377]. I admire the impressive style and delightfully stimulating “Endgame” analysis. The report highlighted hormonal pathways that play vital role in the patho-physiology and replacement/ maintenance therapy of secondary HN of Sheehan Syndrome (SS). The case report seems impeccable but appraisal/criticism using scientific reasoning analysis illustrates the multidimensional complexity of HN puzzle. It demonstrates how the primary insult causing SS and its secondary HN remains obscure that may be a different primary cause of HN. In sport spirit, may I contribute thoughts to this intellectual “Endgame” analysis? I have spent my career life seriously studying, analysing and resolving the puzzle of HN starting with that of the transurethral resection of the prostate (TURP) syndrome  and beyond . The first reported case of HN as the TURP syndrome  was made possible after serum sodium estimation became available in clinical practice- as based on previous original animal research work .
Abbreviations : SS: Sheehan Syndrome; TURP: Transurethral Resection of the Prostate; ADH: Anti-Diuretic Hormone; ARF: Acute Renal Failure; VO: Volumetric Overload; HST: Hypertonic Sodium TherapyIntroduction| References|