A Case of Syndrome of Inappropriate Secretion of Antidiuretic Hormone(SIADH) with Low Plasma Concentrations of Antidiuretic Hormone.

Sugama, Takako; Iseki, Kunitoshi; Sesoko, Shogo; Kawazoe, Nobuyuki; Takishita, Shuichi; Fukiyama, Koshiro

doi:10.2169/internalmedicine.31.246

“…14 In the remaining dog, the diminished VP response was accompanied by hyponatremia and hypo-osmolality under basal conditions. A form of SIADH with low VP concentrations due to production of a VP analogue or due to VP receptor upregulation 30,31 cannot be ruled out in this dog.…”

Section: Discussionmentioning

confidence: 91%

Vasopressin Response to Osmotic Stimulation in 18 Young Dogs with Polyuria and Polydipsia

Vonderen

¹

,

Kooistra

²

,

Timmermans-Sprang

³

et al. 2004

Veterinary Internal Medicne

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Common disorders of water homeostasis leading to polyuria include a variety of endocrine, metabolic, and renal disturbances. After exclusion of most of these conditions, the diagnostic dilemma of differentiating between central diabetes insipidus, primary polydipsia, and nephrogenic diabetes insipidus may remain. Here, we report on 18 young dogs with polyuria that had been present in most cases since the dogs were puppies. The conditions were categorized according to the plasma vasopressin (VP) response to hypertonicity. The VP response to osmotic stimulation was tested by IV infusion of 20% NaCl for 2 hours. The VP response in all dogs was abnormal. Three categories could be distinguished: an exaggerated response (n = 3), a subnormal response (n = 4), and a nonlinear response with high plasma VP concentrations unrelated to increases in plasma osmolality (n = 11). The VP response to hypertonicity did not consistently distinguish among different clinical entities. In the 9 dogs with variations in urine osmolality compatible with primary polydipsia, exaggerated, subnormal, and nonlinear responses were observed. Examination of the present data questions the generally accepted notion that VP measurements during hypertonic saline infusion are the "gold standard" for the diagnostic interpretation of causes of polydipsia and polyuria. Studies of the peripheral reflection in plasma of the pulsatile VP release in healthy and polyuric individuals, with and without osmotic provocation, should be performed.

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“…Actually, the ADH level is not essential for SIADH diagnosis, and cases have been reported with normal or low plasma ADH values, suggesting an increase in renal sensitivity to ADH. 1 Use of the Naranjo probability scale indicated a possible relationship between hyponatremia and esomeprazole therapy in this patient. 2 Spironolactone was unlikely to be associated with this adverse effect, since resolution of hyponatremia occurred after esomeprazole interruption despite continuation of spironolactone therapy (which, by increasing urinary sodium levels, can contribute to hyponatremia).…”

mentioning

confidence: 79%

Hyponatremia with consciousness disturbance associated with esomeprazole

Mennecier

¹

,

Ceppa

²

,

Gidenne

³

et al. 2005

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thyroid hormones (hypothyroidism), the woman had received no further medication. Zolpidem had been prescribed by several physicians and obtained from other sources until the intake was abruptly discontinued by the patient due to supply problems. Within 24 hours, 2 epileptic seizures were observed by relatives. A further generalized convulsion of about 6 minutes occurred in the emergency department and was terminated by administration of intravenous diazepam 10 mg. Her substance use history was significant for intermittent use of barbiturates and diazepam during adolescence due to an anxiety disorder (not further specified). Experiences of illegal drugs/alcohol or previous detoxification treatments were not reported (actual toxicology without abnormal findings).Six years previously, the patient had developed severe facial pain after excessive treatment of the skin with various external cleansing lotions of unknown composition. Presently, a symmetrical burning pain, including all sensory branches of the trigeminal nerve, with an intensity of 8 out of 10 on a visual analog rating scale (VAS) and persistence during the most part of the day was described. Trigger points were not mentioned, but there was increased sensitivity to cold and touch. Extensive examinations, including electrophysiologic and imaging techniques, were within the normal range. The symptomatology was considered painful polyneuropathy of neurotoxic genesis on the basis of excessive dermal treatment.Various treatment efforts in the past, including tricylic and other antidepressants, non-opioidergic and opioidergic analgesics, memantine, glucocorticoids, anticonvulsive agents, α-lipoic acid, lidocaine, benzodiazepines, and blockade of the superior cervical ganglion, were ineffective. However, the patient noted substantial pain relief (VAS score 1) with zolpidem therapy, which had been prescribed as temporary sleep medication starting with 10 mg/day. Over the past 2 years, the dose of zolpidem was gradually escalated by the patient to reach optimal pain relief.Detoxification was accomplished using a standardized 10-day tapering protocol of oxazepam (starting with 20 mg for 4 days) in combination with carbamazepine (starting with 200 mg for 3 days), which was successfully completed. 1,2 However, the pain reappeared and did not respond to any further treatment efforts.

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Vasopressin Response to Osmotic Stimulation in 18 Young Dogs with Polyuria and Polydipsia

Vonderen

¹

,

Kooistra

²

,

Timmermans-Sprang

³

et al. 2004

View full text Add to dashboard Cite

Common disorders of water homeostasis leading to polyuria include a variety of endocrine, metabolic, and renal disturbances. After exclusion of most of these conditions, the diagnostic dilemma of differentiating between central diabetes insipidus, primary polydipsia, and nephrogenic diabetes insipidus may remain. Here, we report on 18 young dogs with polyuria that had been present in most cases since the dogs were puppies. The conditions were categorized according to the plasma vasopressin (VP) response to hypertonicity. The VP response to osmotic stimulation was tested by IV infusion of 20% NaCl for 2 hours. The VP response in all dogs was abnormal. Three categories could be distinguished: an exaggerated response (n = 3), a subnormal response (n = 4), and a nonlinear response with high plasma VP concentrations unrelated to increases in plasma osmolality (n = 11). The VP response to hypertonicity did not consistently distinguish among different clinical entities. In the 9 dogs with variations in urine osmolality compatible with primary polydipsia, exaggerated, subnormal, and nonlinear responses were observed. Examination of the present data questions the generally accepted notion that VP measurements during hypertonic saline infusion are the "gold standard" for the diagnostic interpretation of causes of polydipsia and polyuria. Studies of the peripheral reflection in plasma of the pulsatile VP release in healthy and polyuric individuals, with and without osmotic provocation, should be performed.

show abstract

A Case of Syndrome of Inappropriate Secretion of Antidiuretic Hormone(SIADH) with Low Plasma Concentrations of Antidiuretic Hormone.

Cited by 3 publications

References 22 publications

Vasopressin Response to Osmotic Stimulation in 18 Young Dogs with Polyuria and Polydipsia

Vasopressin Response to Osmotic Stimulation in 18 Young Dogs with Polyuria and Polydipsia

Hyponatremia with consciousness disturbance associated with esomeprazole

Vasopressin Response to Osmotic Stimulation in 18 Young Dogs with Polyuria and Polydipsia

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