RESUMO
Because it is associated with mortality, hyponatremia is an important feature of pulmonary arterial hypertension. Its mechanisms remain unclear, although right heart failure resulting from pulmonary arterial hypertension may lead to systemic congestion and arterial underfilling. However, most patients with pulmonary arterial hypertension are clinically euvolemic and have no peripheral edema. Unlike patients with underlying heart disease, neurohumoral activation is not demonstrated in hyponatremic patients with pulmonary arterial hypertension, who show features of congestive heart failure only at later stages in their disease. Here, a case vignette is introduced, and the pathophysiology of hyponatremia in pulmonary arterial hypertension will be discussed. Syndrome of inappropriate antidiuresis (SIAD) appears to underlie hyponatremia in the initial phase of pulmonary arterial hypertension. The mechanisms by which various lung diseases can lead to SIAD remain an enigma.
RESUMO
Because it is associated with mortality, hyponatremia is an important feature of pulmonary arterial hypertension. Its mechanisms remain unclear, although right heart failure resulting from pulmonary arterial hypertension may lead to systemic congestion and arterial underfilling. However, most patients with pulmonary arterial hypertension are clinically euvolemic and have no peripheral edema. Unlike patients with underlying heart disease, neurohumoral activation is not demonstrated in hyponatremic patients with pulmonary arterial hypertension, who show features of congestive heart failure only at later stages in their disease. Here, a case vignette is introduced, and the pathophysiology of hyponatremia in pulmonary arterial hypertension will be discussed. Syndrome of inappropriate antidiuresis (SIAD) appears to underlie hyponatremia in the initial phase of pulmonary arterial hypertension. The mechanisms by which various lung diseases can lead to SIAD remain an enigma.
RESUMO
Bertolotti’s syndrome is the part of lumbosacral transitional vertebra and is a congenital anomaly of the axial spine. The syndrome is associated with changes in the sacrum or iliac crest and secondary arthritis and is often mistaken for ankylosing spondylitis (AS). The mechanism of pain in this disease is unclear, and treatments have not been accurately established. Here, we report two cases of Bertolotti’s syndrome in patients with severe back pain who were initially suspected to have AS and required interventional procedures. The two young adult patients developed symptoms similar to those of inflammatory back pain, and their symptoms did not improve with conventional treatment alone. Both patients underwent interventional management, and the symptoms improved. It may be clinically helpful to confirm the presence of Bertolotti’s syndrome in patients with suspected AS, and interventional therapy may be required in some cases.
