Syndrome of inappropriate secretion of antidiuretic hormone(SIADH) in a patient with multiple sclerosis.

Abstract

Association of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH)with multiple sclerosis (MG) is very rare, although many other disorder of the nervous system have been reported to be associated with this syndrome; there is only one case report in the literature. Wedescribe here a patient with the syndrome associated with MS.A 62-year-old womanhad a variety of neurologic symptoms,where clinical course was typical of MS.Transient episodes of hyponatremia and disturbance of consciousness occurred repeatedly with deterioration of MS. The concentration of antidiuretic hormone (ADH)was high whereas the plasma osmolality was low in the presence of concentrated urine, during the episodes of hyponatremia. Urinary Na excretions exceeded 20 mEq/day. Computed tomography and magnetic resonance imaging revealed lesions in the brain, especially in the periventricular region. The hypothalamus and pituitary appeared normal by these imaging methods. Since the periventricular region surrounds and may be functionally connected to the hypothalamus which plays the central role in the regulation of ADHsecretion, it was concluded that association of SIADHand MSin this patient was not coincidental, and that demyelinating processes in the periventricular region exerted an abnormal influence on ADH secretion resulting in SIADH. Contribution of other mechanisms as increased intrathoracic pressure, however, could not be excluded completely.

Acute Combined Central and Peripheral Demyelination Showing Anti-Aquaporin 4 Antibody Positivity

“…Several studies have reported cases of MS and NMO with SIADH (18)(19)(20)(21)(22)(23)(24). In the majority of these reported cases, demyelinating lesions in the hypothalamus have been detected on brain MRI.…”

A rare case of hyponatremia from a hypothalamic lesion in a patient with multiple sclerosis

“…Neurologic findings Medications [1] Myelopathy, blindness None listed [2] Quadriparesis, coma None listed [3] Optic neuritis Carbamazepine, amitriptyline [4] Optic neuritis, cervical myelopathy Sulbactam/cefoperazone [5] Spastic paraparesis Cefuroxime, omeprazole [6] Memory impairment, hyperthermia, hypersomnolence None listed…”

Hypothermia in Multiple Sclerosis: Beyond the Hypothalamus? A Case Report and Review of the Literature

“…Cerebral salt wasting syndrome (CSW) and Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH) both present with hyponatraemia and hyposmolality and while SIADH was suspected in this case, it was not formally confirmed. Irrespective of hypothermia, SIADH had been previously reported in MS and associated with the presence of periventricular and/or hypothalamic lesions [ 19 , 20 ].…”