Demeclocycline treatment in the syndrome of inappropriate antidiuretic hormone secretion.

We have studied the effects of demeclocycline on the water metabolism of a patient with the syndrome of inappropriate antidiuretic hormone (ADH) secretion who presented with a serum sodium concentration of 110 meq/litre. Free water clearance was studied before, during, and after treatment with demeclocycline. This study shows that demeclocycline (900 mg/day) can at least partially inhibit the action of ADH in the setting of tumor-induced ADH secretion, with the production of a reversible, partial nephrogenic diabetes insipidus, and with few or no side effects. Demeclocycline may be useful in the treatment of chronic inappropriate ADH secretion.     

Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone secretion

Presented here is a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella-zoster encephalitis or dissemination. This is only the third such case reported in the English language literature to date, and it affirms that SIADH can develop in patients with herpetic involvement of just a single dermatome and corrects with resolution of the herpetic lesions.     

Mesothelioma associated with the syndrome of inappropriate secretion of antidiuretic hormone

A patient with a malignant mesothelioma developed the syndrome of inappropriate secretion of antidiuretic hormone. The electrolyte abnormalities were corrected by treatment with demethylchlortetracycline. Arginine vasopressin concentrations were increased in serum and urine. It is suggested that the syndrome might have been mediated by secretion of antidiuretic hormone from the posterior pituitary, because arginine vasopressin was not detected in the patient's tumor using a sensitive radioimmunoassay.     

Long-term treatment of the syndrome of inappropriate antidiuretic hormone secretion with phenytoin.

A 68-year-old patient with the syndrome of inappropriate antidiuretic hormone secretion secondary to basilary skull fracture was treated successfully with demeclocycline and phenytoin. Phenytoin, which was considered in the past only as a useful diagnostic tool, was given to the patient on a long-term basis. The drug reversed the patient's symptoms and abnormal laboratory values to normal limits without adverse reactions during a treatment period of 8 months.     

Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone secretion

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. This report describes SIADH that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella zoster encephalitis or dissemination. A 76-year-old woman was admitted to our department for evaluation of left facial pain, confusion and disorientation. Further investigation revealed hyponatremia 112 mEq/L, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 40 pg/mL. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the antiviral drug (acyclovir) or infection of varicella zoster virus (VZV) in a single dermatome.     

Treatment of the syndrome of inappropriate secretion of antidiuretic hormone by urea

Recent data have shown the role of urea in the urinary concentrating mechanism. We studied the effects of exogenous urea administration in hyponatremia associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In 20 patients with SIADH, we observed a positive correlation between serum sodium and blood urea levels (r = 0.65; p < 0.01). In one patient with an oat cell carcinoma and SIADH-induced hyponatremia, we observed the same positive correlation (r = 0.80; p < 0.01) but also a negative one between the excreted fraction of filtered sodium and urinary urea (r = -0.67; p < 0.001). The short-term administration of low doses of urea (4 to 10 g) resulted in correcting the “salt-losing” tendency of this patient. Longer term administration of high doses of urea (30 g/day) was attempted with the same patient as well as with a healthy volunteer subject with Pitressin^®-induced SIADH. In both patients, urea treatment lowered urinary sodium excretion as long as hyponatremia was significant (< 130 meq/liter). Urea treatment also induced a persistent osmotic diuresis, allowing a normal daily intake of water despite SIADH. This was clearly shown during the long-term treatment of a third patient with SIADH who was taking 30 g urea/day during 11 weeks.It is concluded that urea is a good alternative in the treatment of patients with SIADH who present with persistent hyponatremia despite the restriction of water intake.     

Amyotrophic lateral sclerosis associated with the syndrome of inappropriate secretion of antidiuretic hormone.

A 71-year-old female with amyotrophic lateral sclerosis (ALS) developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during respiratory failure due to atrophy of the respiratory muscles. Serum sodium concentration fell to 116 mEq/l and then returned to the normal range after water restriction and respiratory care. This is considered to be the first case report of ALS associated with SIADH.     

抗利尿激素分泌不适当综合征的诊断和治疗

抗利尿激素分泌不适当综合征(syndrome of inappropriate antidiuretic hormone secretion,简称SIADH)是指体内细胞外液的渗透压已降低,但仍有抗利尿激素(ADH)分泌,而使体内水分潴留,表现为稀释性低血钠,而尿钠和尿渗透压升高的临床综合征.     

Esophageal small-cell carcinoma with syndrome of inappropriate secretion of antidiuretic hormone

Small-cell carcinoma (SCC) of the esophagus is rare, and its clinical characteristics remain poorly understood. A 54-year-old man was given a diagnosis of esophageal SCC and underwent esophagectomy. Four months after surgery, he was admitted to our hospital because of rapidly developing hyponatremia. Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) due to extensive recurrence of SCC was diagnosed. Combined chemotherapy with irinotecan and cisplatin has dramatically reduced metastatic tumors, and it was concomitantly effective for SIADH. This case demonstrates that esophageal SCC could induce SIADH as a paraneoplastic syndrome and that the above combined chemotherapy was feasible and effective.     

Severe hypernatremia following treatment of the syndrome of inappropriate antidiuretic hormone secretion

Treatment strategies for hyponatremia such as hypertonic saline, normal saline with furosemide, urea, fluid restriction and demeclocycline are well established. However, these treatment modalities may themselves be associated with life-threatening complications. An important complication is rapid correction of hyponatremia with its consequent serious neurologic deficits and death. An unrecognized complication is the development of severe hypernatremia as a result of strict fluid restriction and concomitant excessive free water excretion from prolonged outpatient demeclocycline therapy. The authors report a case of a patient with hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion who developed severe hypernatremia as a result of rigid fluid restriction and demeclocycline therapy.     

Systemic lupus erythematosus and the syndrome of inappropriate secretion of antidiuretic hormone

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been reported rarely in systemic lupus erythematosus (SLE) with central nervous system disease. Previous case reports linking SIADH with lupus have either not documented clearly that SLE was the sole cause of the problem, or have not demonstrated a correlation between indicators of lupus activity and the onset and resolution of antidiuretic hormone secretion. We describe a case in which SLE was the sole contributor to the initiation of SIADH and where other evidence of lupus activity correlated temporally with inappropriate antidiuretic hormone secretion.     

Drug-induced syndrome of inappropriate diuresis or of antidiuretic hormone secretion?

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (Bartter and Schwartz, 1967) is defined as low effective plasma osmolality due to impaired renal water dilution together with impaired thirst center regulation once effective hypovolemia and corticotropin deficiency are ruled out (Robertson, 2006).Impaired water dilution is encountered following stimulation of voloreceptors triggering ADH (i.e., vasopressin) secretion through brain circumventricular organ stimulation [including notably the subfornical organ (SFO)] (Bichet, 2019). This condition is reversed as soon as volemia is restored: hyponatremia is corrected within hours, unlike withdrawal of drugs inducing SIADH, in which optimal water dilution recovery usually takes several days or weeks. Therefore, diuretics will be beyond the scope of this review.     

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??Abstract??Hyponatremia??the most commonly encountered electrolyte abnormality in clinical practice??increases morbidity itself.As a main risk factor for hyponatremia??the syndrome of inappropriate antidiuretic hormone secretion has complicated and complex etiology.The resultant clinical manifestations are significantly associated with the severity and duration of hyponatremia.Accordingly??its early detection and right diagnosis can decrease misdiagnosis and eventually mortality.Clinically??timely and correct diagnosis as well as individualized treatment plan is desired for such patients.Vasopressin receptor antagonists??anticipated as a more effective method to treat hyponatremia herald the beginning of a new era in the management of syndrome of inappropriate antidiuretic hormone disorders.