Syndrome of Inappropriate Secretion of Antidiuretic Hormone Following Intra-thoracic Cisplatin.

Abstract

A case of malignant thymomawith pure red cell aplasia (PRCA)complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following intrathoracic cisdichlorodiammine platinum (CDDP) administration is reported. A 59-year-old Japanese woman who presented with severe general fatigue was diagnosed with PRCAassociated with a thymoma, based on the findings of a bone marrow biopsy, computed tomography of the chest, and the existence of anti-acetylcholine receptor antibodies. She underwenta thymectomyafter frequent blood transfusions.This was followed by intrathoracic CDDPadministration, because of pleural dissemination. Nine days following chemotherapy, her serum sodium concentration was found to be 104 mM,while her consciousness was drowsy with severe fatigue and vomiting. This hyponatremic state was diagnosed as SIADHinduced by CDDPinfusion into the thoracic space, based on the hypo-osmolality of her serum, the hyper-osmolality of her urine, and an inappropriate level of plasma vasopressin. (Internal Medicine 35: 290-294, 1996)

Severe Hyponatremia Due to Inappropriate Secretion of Antidiuretic Hormone following Pleurodesis

“…Furthermore, as reported in other cases of SIADH or syndrome of inappropriate diuresis (SIAD) associated with pleuritis, the hyponatremia improved and serum ADH returned to normal level as pleuritis recovered during a three-month follow-up (1,5,6 …”

Endocrine sequelae of cancer and cancer treatments

“…SIADH has long been associated with cancer therapy [12]. Cytotoxic treatments that may cause SIADH include vinca alkoids, cisplatin, cyclophosphamide, and melphalan [13,[26][27][28][29][30]. Syndrome of inappropriate antidiuretic hormone (SIADH) may also present as an endocrine paraneoplastic syndrome.…”

Syndrome of Inappropriate Secretion of ADH (SIADH) Following Cisplatin Administration in a Pulmonary Adenocarcinoma Patient with a Malignant Pleural Effusion.

“…In both patients, who had ovarian carcinoma, hyponatremia and convulsions occurred two days following the initiation of chemotherapy, which is a similar timescale as that seen in our patient. Pulmonary diseases such as pneumonia and pleuritis may result in SIADHby damaging the intrathoracic ADH-inhibitory vagal tracts that mediate the baroreceptor reflex via the intrathoracic space (20,21). Otsuka et al (20) also reported SIADHinduced by intrathoracic CDDPinfusion in a patient with pleuritis due to thymoma.…”

“…Pulmonary diseases such as pneumonia and pleuritis may result in SIADHby damaging the intrathoracic ADH-inhibitory vagal tracts that mediate the baroreceptor reflex via the intrathoracic space (20,21). Otsuka et al (20) also reported SIADHinduced by intrathoracic CDDPinfusion in a patient with pleuritis due to thymoma. In the present case, the presence of pleural effusion may induce pharmacokinetic changes of CDDP,due to prolonged retention of CDDPin pleural effusion (22).…”