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BACKGROUND Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is relatively common in several cancers, such as small cell lung cancer. However, nedaplatin-induced SIADH is rare. We describe a case of SIADH mediated by nedaplatin. CASE SUMMARY A 54-year-old female with nasopharyngeal carcinoma was treated with nedaplatin and developed severe hyponatremia due to SIADH. The side effects were successfully treated by fluid restriction and sodium supplementation. CONCLUSION This case report highlights the importance of cautiously treating life-threatening hyponatremia in patients treated with nedaplatin.

Hyponatremia is the most common disorder of water and electrolyte balance encountered in clinical practice. Conditions associated with hyponatremia require hospitalization in 15–20% of cases. Hyponatremia is a predictor of poor outcome in a wide range of diseases and therefore requires an interdisciplinary approach. This problem leads to an increase in complications and the length of hospital stay and mortality. The review focuses on the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for approximately one third of all cases of hyponatremia and is more common in endocrinology than other fluid and electrolyte disorders along with central diabetes insipidus. The article presents modern approaches to the treatment of SIADH based on international clinical guidelines.

The use of tolvaptan to treat both euvolemic and hypervolemic hyponatremia has rapidly increased in recent years. However, data on its effects on children, especially newborns and infants, are limited. Here, we present a newborn who developed syndrome of inappropriate secretion of antidiuretic hormone following an intracranial hematoma drainage operation who was unresponsive to conventional treatments. The infant was successfully treated with tolvaptan, a competitive inhibitor of the vasopressin V2 receptor.

In a system already preconditioned by previous damage, as results of the cytokine release syndrome complicating the COVID‐19 disease, a small trigger may be sufficient to develop a SIADH complicating a GBS, even without a poor outcome.

Duloxetine is widely used for pain control and depressive syndromes. One of its potential side effects is syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Duloxetine-induced SIADH causes hyponatremia, which leads to a variety of symptoms and has previously been reported in the elderly. In the present case, we experienced a case of the rapid onset of SIADH in a super-elderly woman receiving low-dose duloxetine. Elderly patients tend to have lower duloxetine doses and an earlier onset than non-elderly patients. When hyponatremia occurs after duloxetine administration, duloxetine-induced SIADH should be considered, especially in high-risk elderly patients, regardless of the duloxetine dose or duration of treatment.

Sodium valproate is a drug used in neurological and psychiatric diseases and has side effects such as tremor, drowsiness, Reye-like syndrome, hepatic failure, thrombocytopenia, pancreatitis. Hyponatremia is another serious side effect of sodium valproate. Here, we report the case of a patient with hyponatremia associated with sodium valproate.

Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.

The purpose of this study was to determine the efficacy and safety of tolvaptan in Japanese patients with hyponatremia secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This multicenter, open-label, dose-escalation, phase III study enrolled Japanese patients (20-85 years old) with hyponatremia secondary to SIADH who were unresponsive to fluid restriction. Oral tolvaptan was administered for up to 30 days, initially at 7.5 mg/day, but escalated daily as necessary, based on the serum sodium concentration and safety, over the first 10 days until the optimal maintenance dose was determined for each patient (maximum 60 mg/day). The primary endpoint was the proportion of patients with normalized serum sodium concentration on the day after the final tolvaptan dose. Secondary endpoints included the mean change in serum sodium concentration from baseline on the day after the final dose. Sixteen patients (male, 81.3%; mean ± standard deviation age 71.9 ± 6.1 years) received tolvaptan treatment and 11 patients completed the study with one patient re-administered tolvaptan in the treatment period. Serum sodium concentrations normalized in 13 of 16 (81.3%) patients on the day after the final tolvaptan dose. The mean change in serum sodium concentration from baseline on the day after the final dose was 11.0 ± 4.3 mEq/L. Adverse events considered related to tolvaptan (10 [62.5%] patients) were generally of mild to moderate severity. Oral tolvaptan corrects hyponatremia in Japanese patients with SIADH with a similar efficacy and safety profile as that noted in non-Japanese patients.

To investigate the clinical outcomes of patients with hyponatremia who received supportive treatment or tolvaptan plus supportive treatment and the effects of treatment and other variables on overall survival METHODS: This study included oncology patients who were hospitalized at two oncology centers between January 1, 2016 and December 31, 2019 for hyponatremia (sodium levels 135 mEq/L) and who received tolvaptan plus supportive treatment (n = 22) or supportive treatment only (n = 42).The median age of all the patients was 59 years (range 26-85) and 64.1% of the patients were male. There was no statistically significant difference between patients in the tolvaptan plus supportive treatment (TpST) group and the supportive treatment only (ST) group in terms of gender and age (p 0.05). In the TpST group, recovery days of the hyponatremia after treatment and the length of hospital stay was shorter and hyponatremia symptoms and hospital complications were less frequent compared to the ST group (p 0.05). There was no significant difference between the TpST group and the ST group in terms of overall survival (OS). OS was shorter in men who were non-responders to hyponatremia treatment and had recurrent hyponatremia. Multivariable analysis showed that normal sodium levels after treatment decreased the risk of death.In the treatment of hyponatremia in cancer patients, TpST was found to have more positive effects on blood sodium levels, length of hospital stay, hospital complications, and hyponatremia symptoms compared to ST. A decreased risk of death was observed in patients with normal sodium levels after treatment.

In less developed country like Bangladesh, perinatal asphyxia remains a major cause of death and disability. Disorders of electrolytes are one of the common derangements encountered in critically ill asphyxiated neonates. It may remain unrecognized leading to morbidity and mortality irrespective of the primary problem. Syndrome of inappropriate secretion of ADH (SIADH) causes hyponatraemia in perinatal asphyxia. Metabolic acidosis may further exaggerate hyponatraemia. Where as in hypernatraemia there is an absolute or relative deficit of water in relation to body sodium. Hyponatraemia and hypernatraemia may aggravate the neurological morbidity in asphyxiated infants. Metabolic acidosis may causes hyperkalamia. On the other hand respiratory acidosis may cause hypochloraemia and renal tubular damage in perinatal asphyxia may further cause loss of potassium leading to hypokalaemia. This study has been conducted to find out the pattern of electrolyte abnormalities in asphyxiated neonates. In the study out of 133 asphyxiated babies 40 (30.1%) were hyponatremic. Hypokalaemia observed in 8 (6.0%) asphyxiated babies. Hyperkalaemia was found in 28 (21.1%) asphyxiated neonates in this study. Immediate measurements of serum electrolyte followed by appropriate fluid and electrolytes therapy can reduce the overall morbidity and mortality in asphyxiated neonates.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 775-779

Highlights • A rare case of thymic neuroblastoma in an adult associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). • Histologically and hormonally confirmed for a thymic neuroblastoma in an adult associated with SIADH. • Long-term follow-up CT scans reveal his free of disease. • The thymic neuroblastoma is most effectively treated with surgical resection and follow-up examinations. • Complete surgical removal is considered to be one of options for treatment of this tumor that is clearly separated from the surrounding tissue with no invasion., Introduction Thymic neuroblastoma with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in adults is an extremely rare and malignant neoplasm. Although the tumor is known to grow rapidly and have a poor prognosis, its etiology is still uncertain. In 2009, we described a case of thymic neuroblastoma with SIADH. We report here the clinical course over the last 10 years. Presentation of case A 70-year-old Japanese male with a history of thymic neuroblastoma with SIADH was regularly followed up on an out-patient basis after complete surgical resection for more than 10 years. He remains free of the disease and asymptomatic. Discussion and conclusion Complete surgical removal is considered as one of the treatment options for this tumor if clearly separated from the surrounding tissue with no invasion.

Purpose of review The topic of hyponatremia is in a state of flux. We review a new approach to diagnosis that is superior to previous methods. It simplifies identifying the causes of hyponatremia, the most important issue being the differentiation of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (RSW). We also report on the high prevalence of RSW without cerebral disease in the general wards of the hospital. Recent findings We applied our new approach to hyponatremia by utilizing sound pathophysiologic criteria in 62 hyponatremic patients. Seventeen (27%) had SIADH, 19 (31%) had a reset osmostat, 24 (38%) had RSW with 21 having no evidence of cerebral disease, 1 had Addison's disease, and 1 was because of hydrochlorothiazide. Many had urine sodium concentrations (UNa) less than 30 mmol/l. Summary RSW is much more common than perceived in the general wards of the hospital. It is important to change the terminology from cerebral to RSW and to differentiate SIADH from RSW. These changes will improve clinical outcomes because of divergent therapeutic goals of water-restricting in SIADH and administering salt and water to a dehydrated patient with RSW. The present review will hopefully spur others to reflect and act on the new findings and different approaches to hyponatremia.

We report a rare case of severe hyponatremia due to cisplatin-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a 74-year-old male with a history of squamous cell carcinoma of the tongue who presented with a five days history of worsening confusion. He was found to have severe hyponatremia. His clinical and laboratory findings were consistent with hyponatremia due to SIADH. He was treated with fluid restriction and salt tablets after which his serum sodium markedly improved. Drugs including diuretics, antidepressants, antipsychotics are well known to cause hyponatremia. Cisplatin is a very common antineoplastic drug for solid tumors. Clinicians need to have prompt recognition of this rare side effect of cisplatin to prevent life-threatening hyponatremia.

Introduction: Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly used medications for hypertension. Rarely, ACE inhibitors have the potential to cause a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Case presentation: A 70-year-old woman with > 10 years ACE inhibitor therapy with normonatremia suddenly developed severe SIADH when she took a liquid diet in the uneventful perioperative period, with hemodynamic stability and no surgical complications. She promptly recovered from SIADH subsequent to discontinuing the ACE inhibitor therapy and changing her diet. Therefore, it was assumed that excess antidiuretic hormone secretion due to an ACE inhibitor and free water load from the liquid diet contributed to hyponatremia in our patient. Conclusion: Patients treated with an ACE inhibitor can latently experience inappropriate secretion of antidiuretic hormone, and rapidly develop severe hyponatremia together with additional factors affecting water or salt homeostasis regardless of the length of the administration duration. Clinicians should monitor serum sodium levels in such patients not only just after the initiation of ACE inhibitors but also upon the appearance of those factors.

Purpose: Normal or elevated thyrotropin (TSH) levels in the presence of elevated thyroxine is defined as syndrome of inappropriate secretion of TSH. The two main clinical conditions that can lead to this syndrome are TSH-secreting adenoma (TSHoma) and resistance to thyroid hormone. Establishing the correct diagnosis is crucial in order to decide on the most appropriate treatment option. Herein, we present the data of seven patients who were hospitalized for the differential diagnosis of the two clinical entities. Material and Method: Our database was reviewed for patients diagnosed with syndrome of inappropriate secretion of TSH in our hospital between 2010 and 2014. After exclusion of the other rare causes, seven patients who were hospitalized for the differential diagnosis of TSHoma and resistance to thyroid hormone were included. Results: The final diagnosis was resistance to thyroid hormone in four patients, TSHoma in two and equivocal in one. Two patients diagnosed with TSHoma were operated and had positive staining with TSH. Both of the TSHoma cases had macroadenoma on pituitary magnetic resonance imaging and visual field defect, while two of four patients with resistance to thyroid hormone had microadenoma. Alpha-subunit/TSH molar ratio was above 1 in all patients diagnosed with TSHoma while it exceeded 1 in two patients with the final diagnosis of resistance to thyroid hormone. Thyrotrophin-releasing hormone stimulation test revealed a blunted response in all patients with TSHoma and a positive response in all with resistance to thyroid hormone. Discussion: Differential diagnosis of resistance to thyroid hormone and TSHoma can be a clinical challenge and requires complex hormone testing and imaging methods. Since incidental pituitary tumors are not rare, presence of an adenoma should not rule out the diagnosis of resistance to thyroid hormone.

PurposeTSH-secreting pituitary adenomas are rare pituitary tumors. An efficient treatment is essential to limit the mortality and morbidity in untreated patients. The aim of this study is to summarize the evidence about the postoperative outcomes and management of this rare pathology.MethodsA systematic search and meta-analysis of surgical series was performed.ResultsOur analysis included 23 articles (536 patients). No sex difference was observed and mean age at diagnosis was 45years. Hyperthyroidism was reportedly clinical in 67% and biochemical in 90% of patients. Co-secretion of other pituitary hormones was present in 42% of cases. Macroadenomas were found in 79% of patients, showing in 44% and 30% of cases respectively extrasellar extension and cavernous sinus invasion. The pooled rate of postoperative biochemical remission was 69.7% and a gross total resection (GTR) was observed in 54% of patients. The extent of resection was significantly increased in microadenomas (p

Complications after hepatic artery embolization are usually minor and transient. We report a patient with pancreatic neuroendocrine tumor with hepatic metastases that repeatedly developed clinical findings of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) with hyponatremia (sodium less than 130 mEq/L), low plasma osmolarity (lower than 275 mOsm/kg) and high urine osmolarity (above 500 mOsm/kg) after every session of hepatic artery embolization.

Maternal hyponatraemia in labour is a recognised consequence of inappropriate fluid management, both as a result of administration of hypotonic intravenous fluid and increased maternal oral fluid intake. Other less common causes of hyponatraemia in labour include inappropriate secretion of antidiuretic hormone (ADH), exogenous administration of oxytocin, reset osmostat and sodium depletion. Patients with hyponatraemia are often asymptomatic, or display non-specific symptoms such as headache, lethargy and confusion. If hyponatraemia remains undetected, symptoms can progress to seizures, coma and death. Maternal hyponatraemia in labour may also cause a corresponding hyponatraemia in the foetus/neonate. We present two recent cases of severe symptomatic maternal hyponatraemia in labour where a birthing pool was utilised, and hypothesise how birthing pool use may increase the likelihood of developing hyponatraemia.

BACKGROUND: Tolvaptan effectively corrects hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), but undesired overcorrection can occur. We hypothesized that pre-therapy parameters can predict the rapidity of response to tolvaptan in SIADH. STUDY DESIGN: Multicenter historical cohort study. SETTING & PARTICIPANTS: Adults with SIADH or congestive heart failure (CHF) treated with tolvaptan for a serum sodium (sNa) ≤ 130 mEq/L at 5 US hospitals. PREDICTORS: Demographic and laboratory parameters. OUTCOMES: Rate of change in sNa. MEASUREMENTS: Spearman correlations, analysis of variance, and multivariable linear mixed effects models. RESULTS: Twenty-eight patients with SIADH and 39 patients with CHF treated with tolvaptan (mean baseline sNa 120.6 and 122.4 mEq/L, respectively) were studied. Correction of sNa >12 mEq/L/d occurred in 25% of SIADH patients compared to 3% of those with CHF (p

Hyponatremia is the most common electrolyte abnormality observed in clinical practice and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is diagnosed in nearly 40% of the hospitalized hyponatremic patients. We present a case report of herpes zoster infection causing a severe hyponatremia/hypokalemia. This rare association between SIADH and varicella-zoster virus infection is described in only few case in the literature. In our case report, the associated hypokalemia was not related to the use of diuretics but, probably, dependent on the frank serum hyposmolality able to induce an aldosterone release.

Background Congenital Hyperinsulinism (CHI) is caused by inappropriate secretion of insulin which leads to severe hypoglycaemia in infants and children causing hypoglycaemic brain injury if not managed promptly. There is no designated centre in the country providing highly specialised expert input in adults with Hyperinsulinism. It was recognised that some young people at GOSH were discharged to local adult endocrinologist/diabetologist with little or no CHI experience and no multidisciplinary team input and support. The aim of our project was to develop and implement CHI transition clinics and resources to support patients, parents/carers and healthcare professionals. Methods The patients that are older and imminently needed transitioning were seen in the clinic first. A joint multi-disciplinary CHI transition clinic takes place for 13–20 years old patients. The clinic takes place once a month at the Royal London Homeopathic Hospital on Friday afternoons. The clinic would have multi-disciplinary team this includes paediatric and adult endocrinologist, psychologist, clinical nurse specialists and dietitian. Information on pre and post clinic outcome and PedsQL were collected during the clinic appointment. Results Over 6 months, we held 6 transition clinics, with 25 patients seen. Qualitative and Quantitative data has been collected and patient feedback is very positive. Resources for patients and healthcare professionals have been created to support the transition process. Conclusion Transition from paediatric to adult care is a very import part of the patient journey. Transition needs to be planned and structured to meet the needs of individual patients and should include a multi-disciplinary team. Caring for the mental and social wellbeing of the patient is just as important as their clinical needs. Patients and parents have found the transition clinic to be very useful. We will use the qualitative data collected to continually improve the patient experience and build our resource toolkit.

Guillain-Barre Syndrome (GBS) is an inflammatory polyradiculoneuropathy which is known to produce syndrome of inappropriate Secretion of Antidiuretic Hormone (SIADH). However, the hyponatremia is usually seen after the onset of weakness. Here, we report a case of SIADH that presented with hyponatremic seizures which preceded the onset of GBS by ten days.