Syndrome of Inappropriate Secretion of Antidiuretic Hormone due to Malignant Thymoma
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The authors present the case of a 51-year-old female with a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to a malignant thymoma. Laboratory examinations of the patient showed hyponatremia, plasma hypoosmolarity in the presence of concentrated urine and normal urine excretion of sodium. CT revealed a mass lesion in the mediastinum. A biopsy of the mediastinal mass was performed and the diagnosis of thymoma with SIADH was established. This is a rare description of a malignant thymoma associated with SIADH.Objective To study clinical features of head trauma with syndrome of inappropriate antidiuretic hormone secretion.Methods Retrospective analysis of clinical features of 8 patients of head trauma with syndrome of inappropriate secretion of antidiuretic hormone treated in our department in the past 10 years.Results Eight patients of head trauma with syndrome of inappropriate secretion of antidiuretic hormone showed following clinical features: hyponatremia,low plasma osmotic pressure,the ratio of osmotic pressure of urine and plasma osmotic pressure 1. Six patients have been cured and 2 patients died.Conclusion Pathogenesis and management of head trauma complicated with syndrome of inappropriate antidiuretic hormone secretion are different from that of hyponatremia.Early diaglosis and therapy reduce morbidity and mortality.
Head trauma
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We describe a rare case of thymic neuroblastoma with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 60-year-old male patient was admitted to our hospital for further examination and treatment of anterior mediastinal tumor found at a regular health check-up. On examination there was hyponatremia, decrease in plasma osmolarity and elevation of plasma antidiuretic hormone (ADH) level. Thus, he underwent total thymectomy under the diagnosis of thymoma with SIADH. The tumor was located in the right lobe of the thymus and the final diagnosis was thymic neuroblastoma. To our knowledge, this is the first reported case of thymic neuroblastoma in which production of ADH by tumor cells is demonstrated immunohistochemically. This case highlights the need to consider functional activity of thymic neuroblastoma and complete resection of the tumor is warranted for treatment.
Thymectomy
Mediastinal tumor
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Hyponatremia is the most common electrolyte derangement occurring in hospitalized patients. The study presents a case of severe hyponatremia (range 93.2 mEq/l) in 67-year-old women presented weakness and neurological abnormalities. Laboratory tests showed additional electrolyte abnormalities such as hypokaliemia, hypomphosphatemia and hypomagnesemia. The cause of syndrome of inadequate antidiuretic hormone secretion (SIADH) in reported patient was lung carcinoma.
Electrolyte Disorder
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HYPONATREMIA occurs commonly in patients with severe intracranial disease or head injury who are maintained on a normal intake of water. Such patients typically have hyperosmotic urine and urine-to-serum osmolal ratios greater than one. These findings could result from dehydration and sodium loss. However, when they occur in hydrated patients, particularly those who have received an adequate intake of sodium, it is assumed that the blood level of antidiuretic hormone (ADH) is elevated; a dilute urine, therefore, cannot be elaborated and, if the water intake is maintained at the usual level, hyponatremia occurs. This series of events was termed the "syndrome of inappropriate antidiuretic hormone secretion" (SIADH) by Schwartz et al1in 1957. Since that time, an impressive body of direct and indirect evidence has shown that the blood ADH level is elevated in these circumstances. It is generally believed that the lesion producing the intracranial disease
Position (finance)
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Objective To study the clinical characters and the nursing points of patients with syndrome of inappropriate antidiuretic hormone secretion combined severe craniocerebral injury. Method Retrospective analyzed the clinical documents of 13 patients with syndrome of inappropriate antidiuretic hormone secretion combined severe craniocerebral injury. Results The most patients with syndrome of inappropriate antidiuretic hormone secretion combined severe craniocerebral injury have disorder of consciousness. There were essential differences between this disease and the syndrome of cerebral hyponatremia. Conclusion The key nursing points include: limited the water intake strictly, strengthen the nursing about skin and the limbs and survey the blood sodium and the urine sodium.
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Objective To study clinical significance of distinction of different types of central hyponatremia through the change of serum level of antidiuretic hormone and atrial natriuretic peptide after sever craniocerebral injury.Methods The serum level of antidiuretic hormone and atrial natriuretic peptide were observed in 152 hyponatremia patients undergone sever craniocerebral injury.We distinguished syndrome of inappropriate antidiuretic hormone secretion from cerebral salt wasting syndrome through concentration curve,and pertinent treatment.Results In 112 cases of syndrome of inappropriate antidiuretic hormone,the serum level of antidiuretic hormone increased after attack,and arrived the peak(170±25 pg/ml) after 72 hours,then descend.At the same time,the serum level of atrial natriuretic peptide increased after attack,and arrived the peak(280±15 pg/ml) after 36 hours,then descend.In 49 cases of cerebral salt wasting syndrome,the serum level of antidiuretic hormone increased after attack,and arrived the peak(135±23 pg/ml) after 72 hours,then descend.At the same time,the serum level of atrial natriuretic peptide increased after attack,and arrived the peak(440±35 pg/ml) after 48 hours,then descend.Conclusion Though the concentration curve of antidiuretic hormone and atrial natriuretic peptide,we can distinguish syndrome of inappropriate antidiuretic hormone secretion from cerebral salt wasting syndrome.The correct differential diagnosis and seemly treatment are beneficial for decreasing misdiagnosis and patients'prognosis.
Atrial natriuretic peptide
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Objective: Fluoxetine is widely prescribed for depressed patients. Hyponatrenia secondary to inappropriate secretion of antidiuretic hormone has been reported in a few cases associated with routine use of fluoxetine, especially in elderly patients. The mechanism has been postulated to be linked to the inappropriate secretion of antidiuretic hormone. Serum concentrations of antidiuretic hormone and fluoxetine have not been reported in previously published reports. Case Report: We report two new cases of severe and reversible hyponatremia associated with routine use of fluoxetine therapy in two elderly women. Fluoxetine-induced inappropriate secretion of antidiuretic hormone was confirmed by elevated serum concentrations of antidiuretic hormone and fluoxetine
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The authors present the case of a 51-year-old female with a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to a malignant thymoma. Laboratory examinations of the patient showed hyponatremia, plasma hypoosmolarity in the presence of concentrated urine and normal urine excretion of sodium. CT revealed a mass lesion in the mediastinum. A biopsy of the mediastinal mass was performed and the diagnosis of thymoma with SIADH was established. This is a rare description of a malignant thymoma associated with SIADH.
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We describe the association of malignant thymoma with the syndrome of inappropriate antidiuretic hormone secretion and myasthenia gravis. Hyponatremia has not been reported associated with those tumors and our case should alert physicians about the potential for a life-threatening complication.
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