Risk factors and causes of hyponatremia in patients after radiotherapy for head and neck cancer: A retrospective study

Pi, Yaxuan; Li, Yang; Shi, Zhongshan; Tang, Yamei

doi:10.1016/j.radmp.2021.01.002

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…[45][46][47] Animal studies have shown reduced lymphocyte function in models of hypothyroidism, which normalizes with the administration of thyroid hormone once a normal TSH is achieved. 48 Furthermore, hypothyroidism has been shown to be one of the leading causes of hyponatremia after radiotherapy for head and neck cancer, 49 either via decreased glomerular filtration rate (GFR) or via indirect suppression of antidiuretic hormone (ADH) release from the kidneys, preventing excess free water excretion. 50 Finally, thyroid hormone levels have been shown to correlate with blood glucose and lipid metabolism in type-2 diabetes 44 and modulate calcium transport in cardiac myocytes.…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

et al. 2023

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ObjectivesTo define the role of hypothyroidism and other risk factors for unplanned readmissions after surgery for head and neck cancer.Study DesignRetrospective cohort study.MethodsThe Nationwide Readmission Database (NRD) was used to identify patients who underwent surgery for mucosal head and neck cancer (oral cavity, oropharynx, larynx, and hypopharynx) between 2010 and 2017. Univariate and multivariate logistic regression were performed to determine patient, tumor, and hospital related risk factors for 30‐day readmission. Readmitted patients were stratified by preoperative diagnosis of hypothyroidism to compare readmission characteristics.ResultsFor the 131,013 patients who met inclusion criteria, the readmission rate was 15.9%. Overall, 11.91% of patients had a preoperative diagnosis of hypothyroidism. After controlling for other variables, patients with a preoperative diagnosis of hypothyroidism had 12.2% higher odds of readmission compared to those without hypothyroidism (OR: 1.12, 1.03–1.22, p = 0.008). Patients with hypothyroidism had different reasons for readmission, including higher rates of wound dehiscence, fistula, infection, and electrolyte imbalance. Among readmitted patients, the length of stay for index admission (mean 10.5 days vs. 9.2 days, p < 0.001), readmission (mean 7.0 vs. 6.6 days, p = 0.05), and total hospital charge were higher for hypothyroid patients ($137,742 vs. $119,831, p < 0.001).ConclusionHypothyroidism is an independent risk factor for 30‐day readmission following head and neck cancer resection. Furthermore, hypothyroid patients are more likely to be readmitted for wound complications, infection, and electrolyte imbalance. Targeted interventions should be considered for hypothyroid patients to decrease readmission rates and associated patient morbidity, potentially leading to earlier initiation of adjuvant treatment.Level of Evidence3 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

et al. 2023

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“…Numerous drugs are also associated with SIADH, like various antipsychotics, antidepressants, or chemotherapeutic drugs (1,3,4). Severity of hyponatremia symptoms depend on the degree and velocity of changes in plasma sodium levels and osmolality and may include weakness, lethargy, confusion, seizures, or even respiratory depression, paralysis, and death (1,5). Secondary adrenal insufficiency is caused by the insufficient adrenocorticotropic hormone (ACTH) production and cortisol secretion.…”

Section: Introductionmentioning

confidence: 99%

“…Secondary adrenal insufficiency is caused by the insufficient adrenocorticotropic hormone (ACTH) production and cortisol secretion. One of the risk fac-tors for its development is head or neck radiotherapy due to the radiation exposure of surrounding healthy tissues and consequent pituitary insufficiency (5). Normally, corticotropin releasing hormone (CRH) and ADH are both secreted from the same neurons in hypothalamus, and both hormones work synergistically to release ACTH from the adenohypophysis and ADH from the neurohypophysis (6).…”

Section: Introductionmentioning

confidence: 99%

Secondary adrenal insufficiency in patient with COVID-19 and head and neck cancer

Maleš¹,

Radić

Miličević

et al. 2022

Hrvat. čas. zdr. znan.

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Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is an endocrinological disorder which occurs when there is an evidence of continued antidiuretic hormone (ADH) secretion in the absence of an appropriate osmotic volume stimulus. Most commonly it is caused by different types of cancer or medications (eg. diuretics, antidepressants, antipsychotics...). Secondary adrenal insufficiency is caused by the insufficient adrenocorticotropic hormone (ACTH) secretion and cortisol production. In the hypocortisolism, the inhibitory mechanism on ADH secretion vanishes causing increased ADH secretion and leading to SIADH-like state. Both conditions, SIADH and hypocortisolism, manifest in euvolemic hyponatremia, however, its cause can be misdiagnosed and result in an inadequate treatment and potentially fatal outcome. Our case is about fifty-seven-year-old male patient who was treated with chemoradiotherapy for hematological malignancy of the oropharynx and who presented with severe hyponatremia se-veral times that almost ended fatally. Considering his malignant disease, patient was diagnosed with SIADH as a cause of hypona-tremia and was treated with hypertonic saline fluids and fluid intake restriction. However, after having suffered Covid-19 infection the patient was given glucocorticoids according to the protocol at the time. The sodium levels finally corrected, and the secondary adrenal insufficiency has been declared as the real cause of hyponatremia. SIADH is often thought to be the cause of hyponatremia in patients with malignant disease. However, SIADH represents a diagnosis of exclusion. Before making a final diagnosis, thyroid and secondary adrenal insufficiency must be ruled out. Moreover, secondary adrenal insufficiency imitates SIADH and results in euvolemic hyponatremia but the management and potential outcomes of these two conditions differ significantly. In patients who have been previously treated for malignancies with the treatment options that increase the risk of adrenal insufficiency (chemotherapy, neck or skull base radiotherapy, immunotherapy), adrenal reserve must be evaluated. If introduced, the glucocorticoid therapy should be carefully deescalated in these patients because of the risk of previously unrecognized adrenal insufficiency. This especially applies to conditions that include glucocorticoid therapy in the treatment protocol, such as Covid-19 infection.

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Risk factors and causes of hyponatremia in patients after radiotherapy for head and neck cancer: A retrospective study

Cited by 2 publications

References 19 publications

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

Secondary adrenal insufficiency in patient with COVID-19 and head and neck cancer

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