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1.
FASEB J ; 38(13): e23760, 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-38924449

RESUMEN

Hyponatremia is the most common disorder of electrolyte imbalances. It is necessary to develop new type of diuretics to treat hyponatremia without losing electrolytes. Urea transporters (UT) play an important role in the urine concentrating process and have been proved as a novel diuretic target. In this study, rat and mouse syndromes of inappropriate antidiuretic hormone secretion (SIADH) models were constructed and analyzed to determine if UTs are a promising drug target for treating hyponatremia. Experimental results showed that 100 mg/kg UT inhibitor 25a significantly increased serum osmolality (from 249.83 ± 5.95 to 294.33 ± 3.90 mOsm/kg) and serum sodium (from 114 ± 2.07 to 136.67 ± 3.82 mmol/L) respectively in hyponatremia rats by diuresis. Serum chemical examination showed that 25a neither caused another electrolyte imbalance nor influenced the lipid metabolism. Using UT-A1 and UT-B knockout mouse SIADH model, it was found that serum osmolality and serum sodium were lowered much less in UT-A1 knockout mice than in UT-B knockout mice, which suggest UT-A1 is a better therapeutic target than UT-B to treat hyponatremia. This study provides a proof of concept that UT-A1 is a diuretic target for SIADH-induced hyponatremia and UT-A1 inhibitors might be developed into new diuretics to treat hyponatremia.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Proteínas de Transporte de Membrana , Ratones Noqueados , Transportadores de Urea , Animales , Masculino , Ratones , Ratas , Modelos Animales de Enfermedad , Diuréticos/farmacología , Hiponatremia/tratamiento farmacológico , Hiponatremia/metabolismo , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/metabolismo , Proteínas de Transporte de Membrana/metabolismo , Ratones Endogámicos C57BL , Concentración Osmolar , Ratas Sprague-Dawley , Sodio/metabolismo
2.
Front Endocrinol (Lausanne) ; 15: 1382066, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38803472

RESUMEN

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is frequent in lung cancer patients. Here, we report a case with persistent hyponatremia, which suggested malignant SIADH and facilitated an early diagnosis of small cell lung cancer (SCLC). A combined radio-chemotherapy led to a partial remission and resolution of SIADH. An early relapse was indicated by reoccurring severe hyponatremia and increased copeptin levels, which were used as surrogate markers for the antidiuretic hormone (ADH). As palliative immunochemotherapy, together with fluid restriction and solute substitution, were unable to control hyponatremia, treatment with the ADH V2-receptor antagonist tolvaptan was initiated. Over time, the dose of tolvaptan needed to be increased, paralleled by a well-documented exponential increase of copeptin levels. In summary and conclusion, this is a rare case of a secondary failure to tolvaptan with unique documentary evidence of increasing copeptin levels. This observation supports the hypothesis that exceedingly high ADH levels may lead to competitive displacement of tolvaptan from the V2 receptor.


Asunto(s)
Antagonistas de los Receptores de Hormonas Antidiuréticas , Síndrome de Secreción Inadecuada de ADH , Neoplasias Pulmonares , Carcinoma Pulmonar de Células Pequeñas , Tolvaptán , Humanos , Tolvaptán/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/complicaciones , Carcinoma Pulmonar de Células Pequeñas/complicaciones , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Masculino , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Anciano , Insuficiencia del Tratamiento , Persona de Mediana Edad
3.
Indian J Pediatr ; 91(2): 188-190, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36757652

RESUMEN

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the common causes of euvolemic hyponatremia (serum Na+ < 135 mEq/L) in hospitalized children. It is characterized by increased serum ADH, leading to water retention via its action on V2 receptors in the distal renal tubules. Various conditions such as pain, the postoperative state, drugs, central nervous system infections, tumors, malformations, and pneumonia can predispose a person to SIADH. The conventional treatment of SIADH includes fluid restriction and salt supplementation. Occasionally, this may fail to control hyponatremia, mandating pharmacological therapy. V2-receptor antagonists are an FDA-approved therapy for adults with euvolemic and hypervolemic hyponatremia. However, there is limited experience with their use in the pediatric population. Here, the authors present a girl with corpus callosum agenesis with severe symptomatic hyponatremia due to SIADH who was successfully managed with the V2-receptor antagonist tolvaptan.


Asunto(s)
Insuficiencia Cardíaca , Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Adulto , Femenino , Niño , Humanos , Tolvaptán/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Agenesia del Cuerpo Calloso/complicaciones , Agenesia del Cuerpo Calloso/tratamiento farmacológico , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Vasopresinas/uso terapéutico
6.
Am J Case Rep ; 24: e942297, 2023 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-38085696

RESUMEN

BACKGROUND Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy that can involve various symptoms including psychosis. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) may be a complication in some neurological diseases. However, the simultaneous occurrence of subacute psychosis and SIADH as the manifestation of HE, observed in the present case, has rarely been reported. CASE REPORT A 72-year-old man was hospitalized with a 4-month history of abnormal behaviors, including talkativeness, stopping consumption of coffee and cigarettes, hoarding garbage, and sleep disorders. On physical examination, increased and incoherent speech with flight of idea and delusion were observed. The Mini-Mental State Examination score was 28/30. Laboratory findings included hyponatremia due to SIADH and a positive result for anti-thyroid and anti-NH2 terminal of alpha-enolase antibodies. Cerebrospinal fluid examination revealed only elevation of IL-6. Brain magnetic resonance imaging was unremarkable; however, (I-123)-iodoamphetamine single-photon emission computed tomography showed extensive hyperperfusion involving the brainstem and bilateral frontal and medial temporal lobes. Electroencephalography showed generalized slow waves, but there were no epileptiform discharges. After 2 courses of high-dose intravenous methylprednisolone followed by oral prednisolone, his symptoms improved. Based on the findings of clinical features and steroid responsiveness, he was diagnosed with HE. Oral prednisolone and antipsychotic drugs were decreased without a relapse and he was discharged to his home. CONCLUSIONS Although psychosis complicating SIADH is rare, HE should be considered in the differential diagnosis because of its treatment efficacy.


Asunto(s)
Encefalopatías , Síndrome de Secreción Inadecuada de ADH , Trastornos Psicóticos , Masculino , Humanos , Anciano , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/etiología , Encefalopatías/diagnóstico , Encefalopatías/tratamiento farmacológico , Encefalopatías/etiología , Metilprednisolona/uso terapéutico , Vasopresinas
7.
Endocr J ; 70(12): 1195-1205, 2023 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-37914256

RESUMEN

We aimed to survey the status of tolvaptan administration in routine clinical practice since the approval of a novel indication for treating syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in Japan. Data from a population of 3,152 patients aged ≥18 years and diagnosed with SIADH between July 1, 2020 and June 30, 2021 were extracted from a Japanese database. Tolvaptan was administered to 586 patients while 2,566 patients were followed up without tolvaptan. In the tolvaptan-treated group, the standard initial doses were 3.75 mg and 7.5 mg in 290 (49.5%) and 250 (42.7%) patients, respectively. The dose was increased in 112 (38.6%) and 71 (28.4%) and decreased in 8 (2.8%) and 46 (18.4%) of patients with 3.75 and 7.5 mg initial doses, respectively. Of the total 586 SIADH patients treated with tolvaptan, serum sodium concentrations were analyzed in 60 patients. In both treatment groups of 3.75 and 7.5 mg initial doses, the serum sodium concentration was elevated from the second day of treatment and reached 135 mEq/L on the fourth day, which was maintained for 2 weeks. Rapid correction of hyponatremia (>10 mEq/L increase in serum sodium concentration over 1 day or >18 mEq/L increase over 2 days) occurred in 26.7% patients with a 7.5 mg initial dose (4 of 15 patients) but not in the patients with a 3.75 mg initial dose (n = 16), suggesting that an initial dose of 3.75 mg of tolvaptan may be a better choice for the safe and proper correction of hyponatremia.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Humanos , Adolescente , Adulto , Tolvaptán/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Estudios Retrospectivos , Japón , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Benzazepinas/uso terapéutico , Sodio
8.
JAMA Netw Open ; 6(10): e2340313, 2023 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-37902751

RESUMEN

Importance: Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) are associated with significant mortality and morbidity. The effectiveness and safety of oral urea for SIADH are still debated. Objective: To evaluate the efficacy and safety of urea for the treatment of SIADH. Evidence Review: A systematic search of Medline and Embase was conducted for controlled and uncontrolled studies of urea for SIADH in adult patients. The primary outcome was serum sodium concentration after treatment. Secondary outcomes included the proportion of patients with osmotic demyelination syndrome (ODS), intracranial pressure, and resource use such as length of stay. Findings: Twenty-three studies involving 537 patients with SIADH were included, of which 462 were treated with urea. The pooled mean baseline serum sodium was 125.0 mmol/L (95% CI, 122.6-127.5 mmol/L). The median treatment duration with oral urea was 5 days. Urea increased serum sodium concentration by a mean of 9.6 mmol/L (95% CI, 7.5-11.7 mmol/L). The mean increase in serum sodium after 24 hours was 4.9 mmol/L (95% CI, 0.5-9.3 mmol/L). Adverse events were few, mainly consisting of distaste or dysgeusia, and no case of ODS was reported. Resource use was too infrequently reported to be synthesized. Conclusions and Relevance: In this systematic review of the use of urea in SIADH and despite the lack of randomized clinical trials, lower-quality evidence was identified that suggests that urea may be an effective, safe, and inexpensive treatment modality that warrants further exploration.


Asunto(s)
Enfermedades Desmielinizantes , Síndrome de Secreción Inadecuada de ADH , Adulto , Humanos , Urea/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Vasopresinas , Sodio
9.
Eur J Endocrinol ; 189(2): 252-261, 2023 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-37540987

RESUMEN

IMPORTANCE: The syndrome of inappropriate antidiuresis (SIAD) can be treated with oral urea; however, compliance is impaired by its poor palatability. OBJECTIVE: To investigate whether dietary proteins could increase plasma sodium levels through urea-induced osmotic diuresis. DESIGN: An open-label, proof-of-concept trial. SETTING: University Hospital of Basel, Switzerland, between October 2021 and February 2023. PARTICIPANTS: Outpatients with chronic SIAD. INTERVENTIONS OR EXPOSURES: Ninety grams of protein daily for 7 days in the form of protein powder, followed by 30 g of oral urea daily for 7 days after a wash-out period of ≥1 week. MAIN OUTCOMES AND MEASURES: The increase in sodium levels from baseline to the end of the 7-day protein supplementation. RESULTS: Seventeen patients were included. After 7 days of 90 g daily protein supplementation (n = 17), plasma sodium levels increased from 131 (129-133) to 133 (132-137), that is, by a median of 3 mmol L-1 (0-5) (P = .01). Plasma urea levels increased by 3 mmol L-1 (1.7-4.9) (P < .01), and urine urea to creatinine ratio increased by 21.2 mmol mmol-1 (6.2-29.1) (P < .01). After 7 days of 30 g oral urea (n = 10), plasma sodium levels increased from 132 (130-133) to 134 (131-136), that is, by a median of 2 mmol L-1 (1-3) (P = .06). Plasma urea levels increased by 5.8 mmol L-1 (2.7-9.2) (P < .01), and urine urea to creatinine ratio increased by 31.0 mmol mmol-1 (18.7-45.1) (P < .01). CONCLUSIONS AND RELEVANCE: Our findings suggest that protein powder increases plasma sodium levels in patients with chronic SIAD through protein-induced ureagenesis and osmotic diuresis. The effects are comparable with oral urea.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Humanos , Creatinina , Suplementos Dietéticos , Hiponatremia/terapia , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Polvos , Sodio , Urea
10.
J Vet Med Sci ; 85(10): 1047-1051, 2023 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-37587049

RESUMEN

A 1-year-old spayed female Miniature Schnauzer had chronic hyponatremia, accompanied by polyuria and polydipsia. Blood tests and urinalysis revealed severe hyponatremia, low plasma osmolality with euvolemia, and increased sodium excretion in urine. Hypothyroidism and hypoadrenocorticism were ruled out as causes. These findings led to the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Magnetic resonance imaging (MRI) showed dilation of the lateral ventricles, indicating severe hydrocephalus. Tolvaptan, a vasopressin V2 receptor antagonist commonly used in human SIADH, was administered along with water restriction. This treatment resulted in a consistent increase in plasma sodium levels without any adverse effects. This case report represents the first documented evidence of the therapeutic efficacy of tolvaptan in treating SIADH in a dog.


Asunto(s)
Enfermedades de los Perros , Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Perros , Femenino , Humanos , Animales , Tolvaptán/uso terapéutico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Hiponatremia/veterinaria , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/veterinaria , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Vasopresinas/uso terapéutico , Sodio , Benzazepinas/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico
11.
Endocrine ; 82(2): 390-398, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37507553

RESUMEN

PURPOSE: Tolvaptan, a selective vasopressin V2-receptor antagonist, is approved for the treatment of SIADH-related hyponatremia, but its use is limited. The starting dose is usually 15 mg/day, but recent clinical experience suggests a lower starting dose (<15 mg/day) to reduce the risk of sodium overcorrection. However, long-term low-dose efficacy and safety has not been explored, so far. Aim of our study is to characterize safety and efficacy of long-term SIADH treatment with low-dose Tolvaptan. METHODS: We retrospectively evaluated 11 patients receiving low-dose Tolvaptan (<15 mg/day) for chronic SIADH due to neurological, idiopathic and neoplastic causes. Plasma sodium levels were measured before and 1, 3, 5, 15 and 30 days after starting Tolvaptan and then at 3-month intervals. Anamnestic and clinical data were collected. RESULTS: Mean time spanned 27.3 ± 29.8 months (range 6 months-7 years). Mean plasma sodium levels were within normal range 1, 3 and 6 months after starting Tolvaptan as well as after 1, 2, 3, 5 and 7 years of therapy. Neither osmotic demyelination syndrome nor overcorrection were observed. Plasma sodium levels normalization was associated with beneficial clinical effects. Neurological patients obtained seizures disappearance, improvement in neurological picture and good recovery from rehabilitation. Neoplastic patients were able to start chemotherapy and improved their general condition. Patients did not show hypernatremia during long-term follow-up and reported mild thirst and pollakiuria. CONCLUSIONS: The present study shows that long-term low-dose Tolvaptan is safe and effective in SIADH treatment. No cases of overcorrection were documented and mild side effects were reported.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Humanos , Tolvaptán/efectos adversos , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/complicaciones , Antagonistas de los Receptores de Hormonas Antidiuréticas/efectos adversos , Estudios Retrospectivos , Benzazepinas/efectos adversos , Hiponatremia/etiología , Sodio/uso terapéutico
12.
Exp Clin Endocrinol Diabetes ; 131(9): 472-475, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37364592

RESUMEN

The syndrome of inappropriate ADH-secretion (SIADH) is a common cause of low sodium levels with diverse aetiology. Here, we report a case of a 41 years old male patient diagnosed with SIADH and a good response to Tolvaptan therapy. Of interest, as a potential unique cause, magnetic resonance imaging revealed a micronodular structure in the posterior pituitary, while no other common cause of SIADH could be identified. Hence, to the best of our knowledge, this is the first case of a Tolvaptan-responsive SIADH associated with a pituitary micronodular structure.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Neurohipófisis , Humanos , Masculino , Adulto , Tolvaptán , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Hiponatremia/etiología , Hiponatremia/complicaciones , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Benzazepinas , Vasopresinas
13.
G Ital Nefrol ; 40(1)2023 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-36883921

RESUMEN

Purpose: Tolvaptan (TVP), a vasopressin receptor antagonist, represents a therapeutic option in the syndrome of inappropriate anti-diuresis (SIAD). The aim of this study was to evaluate the effect of TVP to treat and solve hyponatremia in oncologic patients. Methods: 15 oncologic patients who developed SIAD have been enrolled. Patients receiving TVP belonged to group A, whereas group B was characterized by hyponatremic patients treated with hypertonic saline solutions and fluid restriction. Results: In group A, the correction of serum sodium was achieved after 3.7±2.8 days. In group B, the target levels were obtained more slowly, after 5.2±3.1 days (p: 0.01) than in group A. The hospital stay and incidence of re-hospitalization were higher in group B than in group A. In this latter, 37% of patients had hyponatremic relapses, notwithstanding the progressive increase of doses from 7.5 to 60 mg per day of TVP, revealing a complete lack of response to TVP. In these patients, a growth of tumor mass or new metastatic lesions has been revealed. Conclusion: TVP improved hyponatremia more efficiently and stably than hypertonic solutions and fluid restrictions. Positive consequences have been obtained about the rate of chemotherapeutical cycles concluded, hospital stay, rate of relapse of hyponatremia, and re-hospitalization. Our study also suggested potential prognostic information that could be deduced from TVP patients, in whom sudden and progressive hyponatremia occurred, despite TVP dosage increase. A re-staging of these patients to rule out tumor mass growth or new metastatic lesions is suggested.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Neoplasias Pulmonares , Humanos , Tolvaptán/uso terapéutico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/tratamiento farmacológico , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Pronóstico , Benzazepinas/uso terapéutico
14.
Hormones (Athens) ; 22(2): 343-347, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36656532

RESUMEN

BACKGROUND: SLGT-2 inhibitors have recently been investigated as a promising therapy for syndrome of inappropriate antidiuresis (SIAD). However, to our knowledge, no report has been published about their use for this indication in the long term. CASE PRESENTATION: We report the case of a 68-year-old male with type 2 diabetes and chronic SIAD, in whom serum sodium levels were not adequately controlled by urea monotherapy. Other treatment options were not viable due to inefficacy or adverse effects. The initiation of empagliflozin, in addition to urea, led to the full normalization of serum sodium. Reduction and subsequent discontinuation of urea were attempted upon patient request, but this resulted in a relapse of hyponatremia. Nevertheless, stable normonatremia was again achieved and maintained for more than 6 months after re-establishing a combination therapy with empagliflozin and urea. CONCLUSIONS: SGLT2 inhibitors might represent an effective treatment for SIAD, even in the long term. Specific clinical trials are needed to confirm this result.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Masculino , Humanos , Anciano , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Urea/uso terapéutico , Sodio
15.
J Pediatr Endocrinol Metab ; 36(4): 430-434, 2023 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-36420541

RESUMEN

OBJECTIVES: Classic treatment for syndrome of inappropriate antidiuretic hormone (SIADH) is fluid restriction. However, this is not ideal for infants who need large fluid volumes to ensure adequate caloric intake for growth. The use of urea has not been thoroughly studied in children. CASE PRESENTATION: This infant had SIADH complicated by poor growth, solitary central incisor, and NF1. Following failed attempts to correct hyponatremia with fluid restriction and other therapeutics, urea normalized sodium levels and allowed liberalization of formula volumes, which resulted in improved weight gain. CONCLUSIONS: Urea is a safe, cost-effective, long-term treatment for SIADH in infants who are unable to fluid restrict due to caloric goals.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Neurofibromatosis 1 , Niño , Lactante , Humanos , Hiponatremia/etiología , Hiponatremia/complicaciones , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Urea , Incisivo , Neurofibromatosis 1/complicaciones , Vasopresinas
17.
Front Endocrinol (Lausanne) ; 14: 1309657, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38288467

RESUMEN

Background: Syndrome of inappropriate antidiuresis (SIAD) is one of the most frequent causes of euvolemic hyponatremia (serum sodium levels < 135 mEq/L) and it represents more than 35% of hyponatremia cases in hospitalized patients. It is characterized by an inappropriate vasopressin (AVP)/antidiuretic hormone (ADH) secretion, which occurs independently from effective serum osmolality or circulating volume, leading to water retention via its action on type 2 vasopressin receptor in the distal renal tubules. Corpus callosum agenesis (CCA) is one of the most common congenital brain defects, which can be associated to alterations in serum sodium levels. This report presents a rare case of chronic hyponatremia associated with SIAD in a woman with CCA, whose correction of serum sodium levels only occurred following twice-daily tolvaptan administration. Case presentation: A 30-year-old female was admitted to our hospital for non-acute hyponatremia with dizziness, headache, distal tremors, and concentration deficits. She had profound hyponatremia (Na 121 mmol/L) with measured plasma hypo-osmolality (259 mOsm/Kg) and urinary osmolality greater than 100 mOsm/Kg (517 mOsm/Kg). She presented clinically as normovolemic. After the exclusion of other causes of normovolemic hyponatremia, such as hypothyroidism and adrenal insufficiency, a diagnosis of SIAD was established. We have ruled out paraneoplastic, inflammatory, and infectious causes, as well as ischemic events. Her medical history showed a CCA and frontal teratoma. We administered tolvaptan initially at a low dosage (15 mg once a day) with persistence of hyponatremia. Therefore, the dosage was first doubled (30 mg once a day) and then increased to 45 mg once a day with an initial improvement in serum sodium levels, although not long-lasting. We therefore tried dividing the 45 mg tolvaptan administration into two doses of 30 mg and 15 mg respectively, using an off-label treatment schedule, thus achieving long-lasting serum sodium levels in the low-normal range associated with a general clinical improvement. Conclusions: This report underlines the importance of the correct diagnosis, management and treatment of SIAD, as well as the need for further studies about the pharmacokinetics and pharmacodynamics of vasopressin receptor antagonists.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Humanos , Femenino , Adulto , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Tolvaptán/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Sodio
18.
Neuropsychopharmacol Rep ; 42(3): 387-390, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35733329

RESUMEN

BACKGROUND: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common side effect in patients treated with SSRIs and venlafaxine, while there is little information on SIADH in the treatment of duloxetine for pain. CASE PRESENTATION: The patients were an 83-year-old Japanese male and a 71-year-old Japanese female. Several years earlier, they complained of pain. Accidentally, blood tests revealed hyponatremia of 110 mmol/L and 108 mmol/L 35 days and 40 days after initiating duloxetine 20 mg/day, respectively. The hyponatremia of both patients recovered after switching from duloxetine to mianserin. CONCLUSION: We conclude that asymptomatic SIADH was induced by use of duloxetine. Psychiatrists should be aware of this syndrome.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Anciano , Anciano de 80 o más Años , Depresión/tratamiento farmacológico , Clorhidrato de Duloxetina/efectos adversos , Femenino , Humanos , Hiponatremia/inducido químicamente , Hiponatremia/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/inducido químicamente , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Masculino , Mianserina/efectos adversos , Dolor , Clorhidrato de Venlafaxina/efectos adversos
19.
Sci Rep ; 12(1): 10266, 2022 06 17.
Artículo en Inglés | MEDLINE | ID: mdl-35715573

RESUMEN

The aim of this work is to examine our experience in the use of urea in patients with SIADH. Observational retrospective analysis of 48 patients with SIADH that have been treated with urea in a third-level hospital. Pre-post analysis of serum sodium levels. The 48 patients with SIADH had a median age of 78.5 (range 26-97 years). The serum sodium nadir was 119.8 ± 5.0 mmoL/L and at the beginning of treatment 125.6 ± 4.1 mmoL/L. The patients continued the treatment for a mean time of 2.95 ± 6.29 months, being the treatment still active in 4 patients. In all patients there was an improvement in serum sodium, being the final serum sodium at the end of treatment 134.4 ± 4.9 mmoL/L (p < 0.01). This improvement was observed from the first week. Adverse events were only detected in 2 patients with mild digestive symptomatology and 2 patients refused the treatment due to the low palatability of the urea. There was an economic cost reduction of 87.9% in comparison with treatment with tolvaptan. Urea has shown to be a safe and cost-effective option for the treatment of hyponatremia caused by SIADH.


Asunto(s)
Síndrome de Secreción Inadecuada de ADH , Adulto , Anciano , Anciano de 80 o más Años , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Benzazepinas/uso terapéutico , Humanos , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Persona de Mediana Edad , Estudios Retrospectivos , Sodio , Resultado del Tratamiento , Urea/uso terapéutico , Vasopresinas/uso terapéutico
20.
Endocrinol Diabetes Nutr (Engl Ed) ; 69(3): 160-167, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35396114

RESUMEN

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.


Asunto(s)
Hiponatremia , Síndrome de Secreción Inadecuada de ADH , Anciano , Femenino , Humanos , Hiponatremia/diagnóstico , Hiponatremia/epidemiología , Hiponatremia/etiología , Hipovolemia/complicaciones , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/etiología , Masculino , Náusea/complicaciones , Dolor , Nutrición Parenteral Total/efectos adversos , Estudios Prospectivos
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