Acute confusional state and hyponatraemia due to inappropriate antidiuretic hormone secretion in polyarteritis nodosa.

An acute confusional state, which developed in a patient with polyarteritis nodosa (PAN), proved to be secondary to inappropriate secretion of antidiuretic hormone and consequent hyponatraemia. This is a very unusual complication of PAN and may well reflect a direct stimulation of the supraoptic nuclei owing to cerebral vasculitis.     

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.     

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.     

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.     

Paroxetine-induced hyponatremia in an elderly man due to the syndrome of inappropriate secretion of antidiuretic hormone

We report an 82-year old man prescribed paroxetine who had hyponatremia and in whom the syndrome of inappropriate secretion of antidiuretic hormone was diagnosed. He had taken sulpiride for depressed mental status. However, he showed parkinsonism, which was an adverse effect from the treatment of sulpiride. Therefore sulpiride was changed to selective serotonin reuptake inhibitor, paroxetine 10mg daily. His depressed mental status deteriorated after paroxetine treatment started. His depression had not lessened after 12 days, and the dosage was increased to 20mg daily. On the 15th day after starting paroxetine, routine laboratory tests showed that his serum sodium level was 126 mEq/l. We recognized that his confusion and loss of appetite were symptoms of hyponatremia, rather than of worsening depression. Laboratory data revealed hyponatremia, low serum osmolarity (242 mOsm/kg) with a relatively high level of serum antidiuretic hormone, and concentrated urine (439 mOsm/kg). We diagnosed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), associated with paroxetine. The dosage of paroxetine was reduced gradually and the serum sodium level returned to normal on day 2 after medication ceased completely. Paroxetine produces fewer adverse effects than other types of antidepressants. However, its use can be associated with inappropriate secretion of antidiuretic hormone in the body and may lead to SIADH, which is characterized by hyponatremia, a potentially fatal condition that is typically asymptomatic until it becomes severe. SIADH is more likely in some populations, including the elderly. Serum sodium levels should be monitored closely, especially in elderly patients.     

Oncogenic osteomalacia and inappropriate antidiuretic hormone secretion due to oat-cell carcinoma

The syndrome of tumor-induced osteomalacia has been previously thought to occur only in association with mesenchymal tumors, although one report has linked prostatic carcinoma with the syndrome. We report the case of a patient who presented first with the clinical and biochemical features of the syndrome of inappropriate antidiuretic hormone secretion, and then oncogenic osteomalacia. The first syndrome was characterized by headaches, nausea, and vomiting; serum sodium determinations ranged between 107 and 118 meq/L with simultaneous urine spot sodium concentrations of 100 to 116 meq/L. The circulating antidiuretic hormone level was markedly elevated to 261.5 microU/mL. The osteomalacia was discovered incidentally when depressed serum phosphorus levels of 1.2 to 1.7 mg/dL were noted in association with 24-hour urine phosphorus excretion exceeding 1000 mg/24 h. Undecalcified tetracycline-labeled bone biopsy samples confirmed oncogenic osteomalacia. Only afterward was a small-cell carcinoma of the lung identified as the likely source of both of these syndromes.     

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.     

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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.     

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.     

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.     

Imaging of the sella in the syndrome of inappropriate secretion of antidiuretic hormone

Abstract. Objective . The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results either from ectopic production or inappropriate release of antidiuretic hormone from the neurohypophysis. Although magnetic resonance imaging (MRI) has provided new insights into the morphological changes of the hypophysis in health and disease, no previous studies have evaluated its use in SIADH. The aim of this study was to evaluate the MRI appearance of the neurohypophysis in patients with SIADH. Design . Retrospective case-control study. Setting . Tertiary care teaching hospital. Subjects . We studied retrospectively eight patients with SIADH who had been hospitalized in Boston's Beth Israel between 1984 and 1994 and who had MRI scans including the sella turcica. We also evaluated prospectively the MRIs of the heads of 23 consecutive control patients who had no pituitary pathology and no serum osmolality or electrolyte abnormalities. Interventions . Clinical evaluation as well as sagittal and axial T1-MR images. Main outcome measures . Presence or absence of the high intensity signal of the neurohypophysis. Results . In seven out of eight patients (87.5%) the normal high intensity signal of the neurohypophysis was not present. In one patient (12.5%), two interpreting radiologists disagreed about its presence. The high intensity signal was present in the neurohypophysis of 20 out of 23 controls (87.5%). Conclusions . Our data indicate an association of SIADH with the absence of the normal hyperintense signal of the neurohypophysis, confirming the usefulness of MRI as a tool to visualize ADH processing. These data also raise the possibility that the absence of the high intensity signal may be a useful diagnostic tool in cases of SIADH that are difficult to diagnose clinically. Additional studies to correlate this signal with various forms of SIADH will be needed.     

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.