Breast Cancer Presenting with the Syndrome of Inappropriate Secretion of Antidiuretic Hormone after Simple Mastectomy.

Abstract

A 71-year-old womanshowed disorientation 7 days after simple mastectomy for right breast cancer. Computed tomography of the brain was normal. The level of serum sodium was very low (110 mEq//), while the urine sodium level was normal. The osmolality of urine was higher (342 mosmol/kg) than that of serum (220 mosmol/kg). These data suggested a syndrome of inappropriate secretion of antidiuretic hormone. A fluid restriction, infusion of hypertonic saline and administration of diuretics gradually increased the level of serum sodium. Subsequently, disorientation disappeared. This is a rare case of the syndromeof inappropriate secretion of antidiuretic hormonecaused by simple mastectomy, a relatively minor surgical procedure. (Internal Medicine 40: 911-914, 2001)

Syndrome of inappropriate secretion of antidiuretic hormone after endoscopic submucosal dissection for early gastric cancer

“…Recently there have been reports of SIADH in patients undergoing minor surgeries, such as laparoscopic cholecystectomy, appendectomy, and cataract extraction under local anesthesia [2][3][4][5][6][7][8][9][10][11][12]. In terms of endoscopic treatment, no case of SIADH has been reported, although several reports have shown patients with hyponatremia after preparation for colonoscopy [17][18][19].…”

“…Miller et al [27] reported findings of a large study of apparent idiopathic hyponatremia in an ambulatory geriatric population, which supports the hypothesis that aging is a risk factor for the development of SIADH-like hyponatremia in patients with no other apparent underlying etiology. Some authors have reported that elderly patients with a preoperative serum sodium concentration at the lower end of the normal range developed SIADH after relatively minor surgeries [3,8]. They believed it reasonable to recognize that their patients might be within a subset of elderly people at risk for developing SIADH without other risk factors, and that a relatively minor surgical procedure might have increased their patients' susceptibility to the syndrome.…”

“…The predominant mechanism of the decreased sodium levels is thought to be the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Recently there have been reports of symptomatic hyponatremia and SIADH in patients undergoing minor surgeries such as laparoscopic cholecystectomy and appendectomy [2][3][4][5][6][7][8][9][10][11][12], and several patients suffered permanent brain damage or death [6,7]. A delay in diagnosis appears to play a role in outcome, making early recognition and treatment critical [7].…”

Hyponatremia in Elderly Patients

“…All these changes associated with aging would provide the inclination to hyponatremia. The paper by Hashida et al (6) in the present issue describes a case of 7 1-year-old womanshowing the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after mastectomyfor breast cancer.…”