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

Abstract

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.

Leser-Trelat Sign and Its Main Features: A Systematic Literature Review

“…SLT was first described in 1800 1,4,21 and is a tribute to the German surgeon Edmond Leser and the French Ulysse Trélat 4,5,24 . However, instead of QS, the sign was related to the appearance of multiple eruptive angiomas in cancer patients 2, 12,18,25,26 .…”

“…The most reported cancers associated with TLS occur in the gastrointestinal tract [2][3][4][5]11,12,[15][16][17][18][19] , such as adenocarcinoma of the stomach, colon and rectum. 7,15,16,23 , being more common in the stomach 15,19 .…”

“…Leser-Trélat sign (TLS) is a rare paraneoplastic syndrome characterized by the sudden eruption of multiple seborrheic keratoses (QS) in patients with underlying malignancy [1][2][3][4][5][6][7][8][9][10][11][12][13] hidden or known 14 . These benign skin lesions rapidly increase in number and size over a period of weeks to months.…”

Paraneoplastic Leser-Trélat Syndrome: Clinical Manifestations, Diagnosis and Treatment

“…По данным отечественной и зарубежной литературы более 50 % злокачественных новообразований, ассоциированных с СЛТ, составляют аденокарциномы желудка [12], толстой кишки, прямой кишки [13] и молочной железы [14], однако СЛТ был описан исследователями и при других злокачественных новообразованиях, включая рак легких [15,16], почек [17], меланому кожи [18], Т-клеточные лимфомы кожи [19]. В литературе описаны случаи, когда СЛТ развивался без ассоциации с какими-либо злокачественными новообразованиями [20], что ставит под сомнение принадлежность СЛТ к группе облигатных ДПС.…”

Eruptive seborrheic keratosis: A perilous clue

“…2 The association of the Leser-Trélat sign with malignancy is debatable, with suggestions that the sign may exist independent of an underlying occult malignancy or may be associated with nonmalignant conditions such as benign neoplasms, pregnancy, or human immunodeficiency virus infection. 3,4 The exact pathogenesis of the Leser-Trélat sign is unclear. One hypothesis attributes it to growth factors released by tumor cells, such as growth hormone, epidermal growth factor, and transforming growth factor alpha.…”