MyMedR

Fulltext A case of persistent hyponatraemia due to reset osmostat

Rohana AG, Norasyikin AW, Suehazlyn Z, Ming W, Norlela S, Norazmi MK

Med J Malaysia, 2006 Dec;61(5):638-40.

We report a case of a 65 year old Malay lady with long-standing diabetes mellitus, who presented to our institution with a one month history of worsening neck pain and progressive upper and lower limb weakness. She was stable despite severe hyponatraemia which was initially treated as syndrome of inappropriate anti-diuretic hormone (SIADH). This was consistent with her underlying illness which was concluded as cervical tuberculosis (TB) with spinal cord compression. She underwent decompression and bone grafting. Despite continuous treatment her serum sodium levels remained low. There were no other problems with her adrenals or thyroid. A water loading and hypertonic saline perfusion test was performed and supported the diagnosis of reset osmostat. Her serum sodium remained below the normal range and she was discharged well.

Matched MeSH terms: Inappropriate ADH Syndrome/diagnosis*; Inappropriate ADH Syndrome/therapy

Fulltext Hyponatraemic encephalopathy as the initial presentation of Guillain-Barre syndrome

Ramanathan M

Med J Malaysia, 2008 Dec;63(5):426-7.

PMID: 19803310 MyJurnal

This report deals with an elderly lady with Guillain-Barre Syndrome (GBS), who presented with features of unusually severe hyponatraemia. The hyponatraemia was probably due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The hyponatraemia resolved with water restriction and infusion of hypertonic saline; GBS was treated with human immunoglobulin (IVIG). This patient's experience stresses the importance of monitoring serum sodium levels as hyponatraemia has been identified to be a marker of poor prognosis in GBS.

Matched MeSH terms: Inappropriate ADH Syndrome/complications; Inappropriate ADH Syndrome/diagnosis*; Inappropriate ADH Syndrome/drug therapy

Diabetes insipidus and syndrome of inappropriate antidiuretic hormone complicating pituitary surgery

Aboud SK, Yunus MR, Gendeh BS

Otolaryngol Head Neck Surg, 2011 Jun;144(6):1005-6.

PMID: 21493376 DOI: 10.1177/0194599810390899

Matched MeSH terms: Inappropriate ADH Syndrome/etiology*

Fulltext Syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome as uncommon paraneoplastic manifestations of renal malignancy - a geriatric experience: a case report

Nyanti L, Samsudin A, Tiong IK

J Med Case Rep, 2019 Jun 21;13(1):188.

PMID: 31221202 DOI: 10.1186/s13256-019-2122-8

BACKGROUND: Leser-Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome, and was eventually found to have renal malignancy.

CASE PRESENTATION: A 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs.

CONCLUSIONS: To the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser-Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.

Matched MeSH terms: Inappropriate ADH Syndrome/etiology*

Fulltext Syndrome of inappropriate antidiuretic hormone caused by continuous lumbar spinal fluid drainage after transphenoidal surgery

Norlela S, Azmi KN, Khalid BA

Singapore Med J, 2006 Jan;47(1):75-6.

PMID: 16397727

A 53-year-old acromegalic woman had cerebrospinal fluid rhinorrhoea following transphenoidal surgery for a pituitary microadenoma. A continuous lumbar spinal fluid drainage catheter was inserted and on the sixth postoperative day, she developed hyponatremia with features of syndrome of inappropriate antidiuretic hormone (SIADH) requiring hypertonic saline administration. Over-drainage is potentially hazardous and close biochemical monitoring is required. To our knowledge, this is the first reported case of SIADH caused by continuous lumbar drainage in an adult.

Matched MeSH terms: Inappropriate ADH Syndrome/diagnosis; Inappropriate ADH Syndrome/etiology*

Fulltext Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis

Loo KL, Ramachandran R, Abdullah BJ, Chow SK, Goh EM, Yeap SS

Southeast Asian J. Trop. Med. Public Health, 2003 Sep;34(3):636-40.

PMID: 15115143

A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.

Matched MeSH terms: Inappropriate ADH Syndrome/diagnosis

Dengue Encephalitis associated with symptomatic hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion

Ng WW, Cheong BMK

Med J Malaysia, 2021 03;76(2):261-263.

PMID: 33742642

A previously well 21-year-old girl presented to Hospital Teluk Intan, Perak, Malaysia with a short history of fever, vomiting and altered sensorium. She was diagnosed with dengue encephalitis as her dengue NS-1 antigen was positive and her cerebrospinal fluid (CSF) dengue polymerase chain reaction (PCR) was positive with serotype DENV-2. She also had severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) which caused an episode of seizure. She recovered well with supportive management. SIADH and dengue encephalitis should be considered as one of the differential diagnosis in patients presenting with fever and altered sensorium especially in dengue endemic countries like Malaysia.

Matched MeSH terms: Inappropriate ADH Syndrome

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