Angiotropic B-cell lymphoma with hemophagocytic syndrome associated with syndrome of inappropriate secretion of antidiuretic hormone

 A case of angiotropic B-cell lymphoma associated with hemophagocytic syndrome (HPS) has been reported. In addition to fever, pancytopenia, hepatosplenomegaly, and lack of lymphadenopathy, unique clinical features, such as syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and pulmonary infarction, were manifested. Both soluble interleukin-2 receptor (sIL-2R) and IL-6 were elevated in the patient's sera in addition to an increase of serum lactate dehydrogenase and ferritin. In contrast, tumor necrosis factor-α and interferon-γ were within normal ranges. Serum antibodies against Epstein-Barr virus and cytomegalovirus showed a past infection pattern. An autopsy examination revealed systemic intravascular proliferation of lymphoma cells with a B-cell phenotype, confirming the diagnosis of angiotropic B-cell lymphoma. Moreover, SIADH was suggested to result from the infiltration of tumor cells into the pituitary gland. Triple association of angiotropic B-cell lymphoma, HPS and SIADH is quite rare. Therefore, the present case seems to be helpful for clarifying the mechanism for HPS of non-Hodgkin's lymphoma with B-cell origin. Received: 22 June 1999 / Accepted: 25 February 2000     

Renal handling of urate in the syndrome of inappropriate secretion of antidiuretic hormone

Three patients with the syndrome of inappropriate secretion of antidiuretic hormone had elevated uric acid clearances. Their uric acid clearances decreased markedly after the administration of pyrazinamide. Probenecid was given to two of them and it produced large increases in uric acid clearance. These data suggest that enhanced secretion in the renal tubules was responsible for the increased clearance of uric acid. This article provides evidence that hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone is due to increased tubular urate secretion.     

Syndrome of inappropriate secretion of antidiuretic hormone in patients with lymphoma-associated hemophagocytic syndrome

Summary We report three lymphoma patients in whom the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was observed during the course of lymphoma-associated hemophagocytic syndrome (LAHS). The clinical course was devoid of any known mechanism for SIADH which could be attributable to lymphoma or antineoplastic treatment. Alternatively, high serum levels of interleukin-1 and tumor necrosis factor-, which stimulate the secretion of antidiuretic hormone, may have contributed to the development of SIADH in our patients, who were receiving glucocorticoids. In conclusion, LAHS patients should be considered to be at high risk for SIADH.     

Utilité diagnostique de l’hypo-uricémie dans l’hyponatrémie par sécrétion inadéquate d’hormone antidiurétique

Purpose

Hypo-uricemia is still considered as a hallmark of the syndrome of inappropriate secretion of antidiuretic hormone.

Methods

We analyzed prospectively 98 hospitalized patients with hyponatremia (≤135 mmol/L), excluding those receiving diuretic treatment. Gold standard for the syndrome of inappropriate secretion of antidiuretic hormone combined plasma hypoosmolality, inappropriately concentrated urine, and normal volemia.

Results

A final diagnosis of inappropriate secretion of antidiuretic hormone was obtained in 55 patients. They were significantly hypo-uricemic (188 μmol/L [153–245], median [interquartile range]) versus 241 μmol/L, [179–333]; p < 0,02) but hypo-uricemia (≤240 μmol/L) performed poorly as a diagnostic test: 71 % sensitivity, 53 % specificity. Positive and negative likelihood ratios were 1,67 and 0,49, respectively.

Conclusions

The syndrome of inappropriate secretion of antidiuretic hormone is associated with a lower plasma uric acid concentration, but in routine clinical practice, contrary to what has been previously published, this difference is insufficient for hypouricemia to discriminate reliably between the syndrome of inappropriate secretion of antidiuretic hormone and other causes of hyponatremia.     

Rapid onset of syndrome of inappropriate antidiuretic hormone secretion induced by duloxetine in an elderly type 2 diabetic patient with painful diabetic neuropathy

Diabetic neuropathy is the most common diabetic complication. Duloxetine, a serotonin noradrenaline reuptake inhibitor (SNRI), is widely used for the treatment of diabetic painful neuropathy (DPN) because of the efficacy and safety profile. Syndrome of inappropriate antidiuretic hormone secretion, which is strongly associated duloxetine, is a rare but occasionally life‐threatening adverse effect. Here, we report a case of syndrome of inappropriate antidiuretic hormone secretion that rapidly developed after starting duloxetine in an elderly Japanese female type 2 diabetes mellitus patient. Furthermore, we discuss the possible relationship between the onset of syndrome of inappropriate antidiuretic hormone secretion and the gene polymorphism of cytochrome P450 isoform 1A2 and 2D6, both of which are responsible for duloxetine metabolism.     

The syndrome of inappropriate secretion of antidiuretic hormone associated with anaerobic thoracic empyema.

The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary diseases, including tuberculosis and bacterial and viral pneumonia: however, it has not been reported with anaerobic infections or empyema in the absence of pneumonia. We report a patient with empyema due to Bacteroides melaninogenicus, Bacteroides oralis, and Peptostreptococcus who developed the syndrome. Eight hours before the start of therapy, his serum sodium concentration was 127 mEq per liter; serum osmolality, 255 mOsm per kg; urine osmolality, 522 mOsm per kg; urinary sodium concentration, 39 mEq per liter. The creatinine clearance and the adrenocorticotropic hormone stimulation test were normal, and there was no evidence of dehydration. No other causes of the syndrome of inappropriate secretion of antidiuretic hormone were apparent. With drainage and antimicrobial drug therapy, the empyema cleared, and the syndrome resolved in 8 days. The patient has been well, without evidence of inappropriate secretion of antidiuretic hormone, for 9 months. Anaerobic infections and/or empyema without pneumonia can be associated with the syndrome of inappropriate secretion of antidiuretic hormone.     

Intravascular large B-cell lymphoma with preceding syndrome of inappropriate secretion of antidiuretic hormone

Intravascular large B-cell lymphoma (IVL) is a rare subtype of B-cell lymphoma presenting with neurological and dermatological lesions in addition to generalized symptoms such as fever and malaise. It may also be associated with variable manifestations of affected organs due to extranodal progression predominantly in the lumen of the small vessels. Here, we report a case of IVL with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as the sole manifestation at the initial presentation. The present case suggests that hormonal disturbances may progress in advance in IVL, before generalized symptoms develop.     

Olfactory esthesioneuroma manifesting as Schwartz-Bartter syndrome

INTRODUCTION: Olfactory esthesioneuroblastoma is an uncommon neuroectodermal tumor originating from the olfactory epithelium, which is rarely associated with hormone excess syndrome. EXEGESIS: Asymptomatic olfactory esthesioneuroblastoma was diagnosed in a 22-year-old man who presented a syndrome of inappropriate antidiuretic hormone secretion. Following surgery, the immunohistochemical analysis demonstrated the existence of neurophysin hormone in tumoral cells. CONCLUSION: This case provides evidence that olfactory esthesioneuroblastoma can be uncovered by inappropriate antidiuretic hormone secretion.     

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.     

Hypouricemia, inappropriate secretion of antidiuretic hormone, and small cell carcinoma of the lung

The hospital records of 106 patients with small cell carcinoma of the lung were reviewed to determine if hypouricemia accompanied hyponatremia (less than 130 mmole/L) and if coexistent hypouricemia and hyponatremia were predictive of the presence of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thirty-seven patients were excluded because of insufficient data or factors that would affect the uric acid level. Six of eight patients with SIADH had hypouricemia. The coexistence of hypouricemia and hyponatremia predicted SIADH reliably (6/6 patients), but hypouricemia alone had a low predictive value (46%) since it was seen in seven of 61 patients without SIADH.     

Syndrome of inappropriate antidiuresis in waldenström's macroglobulinemia

Hyponatremia due to the syndrome of inappropriate antidiuresis rather than due to isotonic hyponatremia from hyperproteinemia developed in a patient with Waldenström's macroglobulinemia. The patient was unable to excrete a water load normally despite suppression of antidiuretic hormone to normal levels. The temporal relationship between control of the tumor and resolution of the hyponatremia suggests that the tumor either produced a substance that enhanced the hydroosmotic effect of endogenous antidiuretic hormone or produced an antidiuretic substance immunologically different from antidiuretic hormone. The syndrome of inappropriate antidiuresis should be suspected in hyponatremic patients with Waldenström's macroglobulinemia.     

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.     

Syndrome of inappropriate secretion of antidiuretic hormone in Hodgkin's disease

A patient with clinical Stage IV Hodgkin's disease of the nodular sclerosis type demonstrated all features of the syndrome of inappropriate secretion of antidiuretic hormone. Electroencephalogram, radiography of the skull, and computerized tomography of the brain and cardiac, renal, thyroid, and adrenal function tests were all normal. It is suggested that the patient presents a rare case of Hodgkin's disease with inappropriate secretion of antidiuretic hormone.     

Normal diluting capacity in hyponatremic patients. Reset osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.

Four patients with chronic illnesses and stable hyponatremia and plasma hypotonicity had normal urinary diluting capacity, with excretion of greater than 80% of a standard water load (20 ml/kg) within 4 hours and maintenance of a urine osmolality less than 100 mosmol/kg, during sustained water diuresis. Administration of a chronic salt load did not correct the hyponatremia. However, it was stabilized after treatment of the underlying medical condition. These subjects may represent a true resetting of the osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.     

Syndrome of inappropriate antidiuretic hormone secretion disclosing a sinonasal neuroendocrine carcinoma: case report

We report a 74-year-old woman with histologically confirmed neuroendocrine carcinoma of the nasal cavity disclosing a syndrome of inappropriate antidiuretic hormone secretion (SIADH). Since SIADH is a paraneoplastic syndrome commonly associated with small cell lung cancer, an extra-pulmonary localisation of neuroendocrine carcinoma has to be investigated.     

Case report of hypopituitarism with suspected syndrome of inappropriate VP secretion (SIADH) due to a large aneurysm of the internal carotid in the sellar region

Hypopituitarism and hyponatremia, especially when severe, are infrequent findings particularly when the cause of hypopituitarism at presentation is unknown and untreated. Interestingly, hyponatremia is usually seen in elderly patients with hypopituitarism due to various causes. We present a case with unrecognized and untreated hypopituitarism due to a large aneurysm of the internal carotid artery in the sellar region causing the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).     

Chronic syndrome of inappropriate antidiuretic hormone secretion and hypertension in a patient with olfactory neuroblastoma. Evidence of ectopic production of arginine vasopressin by the tumor

A 28-year-old man with the chronic syndrome of Inappropriate antidiuretic hormone secretion and hypertension was found to have an olfactory neuroblastoma. We demonstrated evidence of elevated circulating arginine vasopressin levels, significantly elevated arginine vasopressin and vasopressin neurophysin levels in the tumor extract, and immunohistochemical staining for arginine vasopressin and vasopressin neurophysin in the tumor cells. The patient's clinical syndrome, including hypertension, resolved following subtotal removal of the tumor and radiation therapy. This study identified olfactory neuroblastoma as a definite cause of ectopic arginine vasopressin secretion causing the syndrome of inappropriate antidiuretic hormone secretion.     

Syndrome of inappropriate antidiuresis.

Since it was first recognized 35 years ago, the syndrome of inappropriate antidiuretic hormone (SIADH) secretion has become the most commonly recognized cause of hyponatremia among hospitalized patients. The syndrome is caused by excessive intake of fluids when urinary dilution is impaired by physiologically inappropriate secretion or administration of vasopressin or other antidiuretic hormones. Inappropriate secretion of the hormone may be ectopic by a malignancy or ectopic and can ensure from any of three different types of osmoregulatory defects. Rarely, there is no demonstrable defect in the osmoregulation of vasopressin. The excessive fluid intake may be due to inappropriate thirst but often is iatrogenic. The syndrome occurs in association with many diseases, particularly of the lungs and brain, and can also be caused by drugs or surgery. Its principal symptoms are neurologic and due to the associated hypo-osmolality of body fluids. Diagnosis requires exclusion of certain other hormonal or hemodynamic disorders that can also increase vasopressin or impair urinary dilution. Therapy differs depending on the severity and duration of the hyponatremia but is always based on cautiously raising plasma sodium by fluid restriction, infusion of hypertonic saline, or administration of drugs that block the antidiuretic effect of vasopressin.     

Inappropriate antidiuretic hormone secretion after high-dose thiotepa.

High-dose thiotepa has been successfully included in a variety of conditioning regimens for stem cell transplantation in hematological and solid neoplasms. Toxicity of high-dose thiotepa mainly manifests as profound myeloablation and some degree of liver damage. We report a case of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with primary CNS lymphoma who underwent therapy with high-dose thiotepa.     

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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.