Severe Paraneoplastic Hyponatremia and Hypoosmolality in a Patient with Small-Cell Lung Carcinoma: Syndrome of Inappropriate Antidiuretic Hormone Secretion Versus Atrial Natriuretic Peptide or Both?

Rădulescu, Dan; Bunea, Delia; Pripon, Sorin; Duncea, C.; Radulescu, Letitia I.

doi:10.3816/clc.2007.n.022

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…Tumour types commonly associated with SIADH are small-cell lung cancer (SCLC), (10-15% of cases are associated with SIADH), squamous cell carcinomas of the head and neck, and lymphomas [ 11 ]. Excess release of atrial natriuretic peptide (either as a stress response or a paraneoplastic phenomenon is another possible mechanism for hyponatraemia in cancer patients [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Resolution of severe hyponatraemia is associated with improved survival in patients with cancer

et al. 2015

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BackgroundHyponatraemia is a common finding in patients with cancer, and has been shown to be associated with poor prognosis in different settings. We have analysed the impact of severe hyponatraemia in patients with cancer.MethodsA retrospective review of all patients admitted to a specialist cancer hospital with a plasma sodium of less than 115 mmol/l and a diagnosis of malignancy was undertaken. Patient and tumour characteristics were analysed as well as impact of hyponatraemia management on overall survival and number of lines of cancer treatment received.Results57 patients were identified. 84% had advanced Stage 3 or 4 cancer and approximately 85% with data available had symptoms attributable to hyponatraemia. Mean length of hospital stay was 12 days, and overall survival (OS) was 5.1 months. Plasma sodium level corrected in 56% of patients and here OS was 13.6 months compared to 16 days in those whose sodium did not correct (p < 0.001). Those whose sodium corrected were more likely to receive further lines of anti-cancer treatment.ConclusionsSevere hyponatraemia in cancer is associated with very poor survival, but correction of the sodium level leads to additional treatment and significantly greater overall survival (although it is not possible to determine if this is due to specific therapy of the hyponatraemia or the resolving hyponatraemia reflects an improvement in the clinical condition). Aggressive treatment of hyponatraemia may allow more anti-cancer treatment and improve survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1156-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Resolution of severe hyponatraemia is associated with improved survival in patients with cancer

et al. 2015

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“…La correction a été rapide du fait de l'hospitalisation en soins intensifs Quelques cas similaires ont pu être retrouvés dans la littérature. Certains ont référencé des cas d'hyponatrémies secondaires à l'administration de cisplatine dans le cadre d'un CPC [4][5][6]. Vanhees et al [7] interprètent le SIADH post-chimiothérapie dans le CPC comme une conséquence de la libération d'ADH lors de la lyse cellulaire.…”

Section: Discussionunclassified

Hyponatrémie sévère sous chimiothérapie du carcinome à petites cellules

Garoute¹,

Plouvier²,

Iacob³

et al. 2015

Revue des Maladies Respiratoires

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“…plasma levels of ANP have also been found to be elevated in patients with lung carcinoma and elevated plasma levels of ADH 1,22,30 . A recent case report presented a patient with SCLC, elevated levels of ANP, and elevated levels of ADH that varied in an oscillatory manner 31 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Hyponatremia of malignancy – An alternative mechanism? Syndrome of inappropriate atrial natriuretic peptide (SIANP)

2014

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Discuss this article AbstractEuvolemic hyponatremia in the setting of lung cancer is most commonly due to the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). However, a subset of patients with small cell carcinoma and hyponatremia also have elevated levels of atrial natriuretic peptide (ANP), which is produced by some small cell tumors. We report the case of a 64-year-old man with a limited-stage small cell carcinoma of the lung undergoing chemoradiation therapy, who was admitted to hospital with a pulmonary embolism. Two months earlier, at the time of diagnosis with lung cancer, he had a hypotonic, euvolemic hyponatremia, presumed to be caused by SIADH. At that time, his serum sodium readily normalized with fluid restriction and ADH-antagonist therapy with demeclocycline. However, during his second admission, the hyponatremia was refractory to treatment: his sodium level slowly declined from 138 mmol/L to a nadir of 118 mmol/L, despite early initiation of fluid restriction and maximal doses of demeclocycline. Laboratory values revealed a low but inappropriately non-zero level of ADH but also an inappropriately low level of aldosterone and an elevated level of ANP, suggesting that SIADH might not be the only contributor to the hyponatremia. While a causal link between ectopic ANP production and hyponatremia has never been established, an inappropriately high level of ANP can directly decrease sodium re-absorption in the proximal convoluted tubule of the kidney and increase glomerular filtration rate (GFR), resulting in greater excretion of sodium and water. In addition, high circulating levels of ANP can inhibit aldosterone secretion, potentially resulting in further sodium wasting. Here, the elevated ANP and inappropriately low aldosterone suggested the possibility that the refractory hyponatremia, although initiated by SIADH, was further worsened by an ANP-mediated natriuresis and suppression of aldosterone response.

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Severe Paraneoplastic Hyponatremia and Hypoosmolality in a Patient with Small-Cell Lung Carcinoma: Syndrome of Inappropriate Antidiuretic Hormone Secretion Versus Atrial Natriuretic Peptide or Both?

Cited by 8 publications

References 9 publications

Resolution of severe hyponatraemia is associated with improved survival in patients with cancer

Resolution of severe hyponatraemia is associated with improved survival in patients with cancer

Hyponatrémie sévère sous chimiothérapie du carcinome à petites cellules

Case Report: Hyponatremia of malignancy – An alternative mechanism? Syndrome of inappropriate atrial natriuretic peptide (SIANP)

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