Hyponatremia Secondary to Olfactory Neuroblastoma

Abstract

\s=b\A patient with a four-year history of unexplained hyponatremia was seen with recurrent nasal discharge and was found to have a typical olfactory neuroblastoma. The clinical laboratory diagnostic studies suggested that the patient's sodium deficiency was secondary to the syndrome of inappropriate antidiuretic hormone. Subsequent resection of the neoplasm led to resolution of the hyponatremia, suggesting that a (tumor-associated) humoral factor, such as vasopressin or a vasopressinlike substance, was responsible for the electrolyte disturbance. A search of the literature disclosed one previous case of vasopressin-secreting nasal neuroblastoma. (Arch Otolaryngol 1983;109:559-562) Olfactory neuroblastoma first de¬ scribed by Berger et al1 is an uncommon malignant tumor thought to arise from the neural crest cells of the superior nasal cavity. We describe herein the clinical course and pathologic findings of a patient with olfactory neuroblastoma who had a history of unexplained hypona¬ tremia. Surgical resection of the tumor led to correction of the sodium deficiency. The possible role of vasopressin or a vasopressinlike substance secreted by the tumor in production of this hyponatremia is discussed. REPORT OF A CASEA 33-year-old woman was initially seen by one of us (V.S.D.) with a two-year history of recurrent mucopurulent drain¬ age from the left side of her nose. This symptom, according to the patient, dated back to a bout of epistaxis that required nasal packing for control of bleeding. According to her, results of the physical examination of the nose and sinuses had been unremarkable during this period.Relevant history included von Willebrand's disease and a four-year history of unexplained hyponatremia. Serum sodium values were as low as 110 mmole/L, with corresponding serum and urine osmolalities of 235 mOsm/kg and 614 mOsm/kg, respectively. On one occasion, a diagnosis of psychogenic polydipsia was entertained, but the patient strongly denied excessive fluid consumption.Results of a general physical examina¬ tion were unremarkable. In particular, hypertension and edema were not detected. An anterior rhinoscopy disclosed a smooth polypoid mass, which appeared to arise from the left middle turbinate and oc¬ cluded the middle meatus. There was some crusting on the anterior surface of this mass, which did not occlude the nasal airway. A roentgenogram of the paranasal sinuses showed mucosal thickening of the left maxillary sinus.The patient was given 8 units of cryoprecipitate and was taken to the operating room, where a biopsy of the mass was undertaken and a pathologic diagnosis of olfactory neuroblastoma was made.Subsequently, sinus tomograms (Fig 1) and a computed tomography (CT) scan (Fig 2) disclosed a soft-tissue density mass cen¬ tered around the left middle turbinate and extending into the anterior ethmoid cells and maxillary sinus on the left side. Com¬ puted tomographic scans of the brain and abdomen were normal. Relevant clinical laboratory studies dis¬ closed the following values: sodium, 118...

Syndrome of Inappropriate Antidiuretic Hormone Secretion in Patients with Olfactory Neuroblastoma

“…All 3 of our patients were diagnosed months to years prior to the diagnosis of ONB. This was also the case in several of the previously noted case reports, in which patients had been diagnosed with SIADH for several years prior to the discovery of ONB 17,26 …”

Sinonasal neuroendocrine carcinoma in association with SIADH

“…The mechanism for this effect is unknown; however, it is thought that the pressor effect of ADH/AVP is the most likely cause. Five cases, including the patient in this report, demonstrated complete resolution of SIADH after treatment of the neoplasm 8–10, 12. In two cases, tumor analysis confirmed tissue AVP production 8, 9.…”

Elevated Arginine Vasopressin Levels in Squamous Cell Cancer of the Head and Neck

“…The SIADH was reversed by tumor resection in some cases reported, but an AVP or an AVP‐like substance was not reported to be detected in this tumor tissue 15,22 . Secretion of a neurotransmitter or a releasing factor for AVP by the tumor is another hypothesis.…”