The Mechanism of Hyponatremia in Pulmonary Tuberculosis

Shalhoub, Robert J.; Antoniou, Lucy D.

doi:10.7326/0003-4819-70-5-943

Cited by 29 publications

(10 citation statements)

References 26 publications

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“…A study including 28 adult CAP patients reported increased ADH levels and impairments in renal water excretion [6,38]. Similarly, in children with tuberculosis and respiratory syncytial virus (RSV) pneumonia, increased ADH levels were described and correlated with the degree of hypoxia and hypercapnia [5,39-44]. While, we also documented increased levels of CT-ProVasopressin in our study of CAP patients, there was no association of high ADH precursor levels and low sodium levels.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia and anti-diuretic hormone in Legionnaires’ disease

et al. 2013

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BackgroundMedical textbooks often list Legionnaires’ disease as a differential diagnosis of the syndrome of inappropriate secretion of anti-diuretic hormone (ADH) (SIADH), but evidence supporting this association is largely lacking. We tested the hypothesis whether hyponatremia in patients with Legionnaires’ disease would be caused by increased CT-ProVasopressin.MethodsWe measured CT-ProVasopressin and sodium levels in a prospective cohort of 873 pneumonia patients from a previous multicentre study with 27 patients having positive antigen tests for Legionella pneumophila.ResultsPatients with Legionnaires’ disease more frequently had low sodium levels (Na < 130 mmol/L) (44.4% vs 8.2%, p < 0.01), but similar mean CT-ProVasopressin levels (pmol/l) (39.4 [±7] vs 51.2 [±2.7], p = 0.43) as compared to patients with pneumonia of other etiologies. In patients with Legionnaires’ disease, CT-ProVasopressin levels showed a positive correlation with sodium (r = 0.42, p < 0.05). Independent of pneumonia etiology, CT-ProVasopressin correlated significantly with the pneumonia severity index (r = 0.56, p < 0.05), ICU admission (adjusted odds ratio per decile, 95% CI) (1.6, 1.2 - 2.0), and 30-day-mortality (1.8, 1.3 - 2.4).ConclusionWhile Legionnaires’ disease was associated with hyponatremia, no concurrent increase in CT-ProVasopressin levels was found, which argues against elevated ADH levels as the causal pathway to hyponatremia. Rather, Vasopressin precursors were upregulated as response to stress in severe disease, which seems to overrule the osmoregulatory regulation of ADH.

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Section: Discussionmentioning

confidence: 99%

Hyponatremia and anti-diuretic hormone in Legionnaires’ disease

et al. 2013

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“…It has been suggested (Shalhoub and Antoniou, 1969;Ebels, 1978;Leading Article, 1979) (Philip and Smith, 1973). Victor, Adams and Collins (1971) found the characteristic lesions in the supraoptic nuclei of the hypothalamus in 16-7% and in the paraventricular nucleus in 35 % of their patients with Wernicke's encephalopathy at post-mortem.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that the syndrome of inappropriate antidiuretic hormone secretion might occur in Wernicke's encephalopathy (Shalhoub and Antoniou, 1969;Ebels, 1978;Leading Article, 1979). However, the authors are unaware of published evidence for this although Ebels mentions he has such evidence in a patient.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate antidiuretic hormone secretion in Wernicke’s encephalopathy

Cooles

Borthwick

1982

Postgraduate Medical Journal

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“…Changes in plasma AVP levels and impaired water handling have been associated with diseases of various organ systems, including lung diseases [19]. Some pulmonary diseases, such as oat cell carcinoma or tuberculous pneumonia, may be accompanied by elevated plasma AVP by stimulating the release of AVP from the posterior pituitary and also by the direct production of AVP or an AVP-like substance from lung tissue [20, 21, 22, 23, 24, 25]. In status asthmaticus the increased plasma AVP levels were explained by bronchospasm leading to decreased pulmonary blood flow, decreased volume return to the left atrium, and stimulation of the atrial volume receptors regulating AVP release [26].…”

Section: Discussionmentioning

confidence: 99%

Multinucleated Arginine-Vasopressin Neurons in the Human Supraoptic Nucleus: A Hallmark of Pulmonary Pathology

et al. 2000

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The human supraoptic nucleus (SON) is the main production site of plasma arginine-vasopressin (AVP). The present study aimed to define the subpopulation of patients in which multinucleated SON neurons (MNN) are present. We determined the proportion of MNN in immunocytochemically defined SON AVP population and compared AVP mRNA levels in the SON of 29 patients with and without MNN. Interestingly, MNN appeared to be present in a high proportion in patients with pneumonia and other pulmonary pathologies (Pul P). The percentage of MNN in the SON of Pul P patients turned out to be age- and sex-dependent. In young women with Pul P their proportion was 10 times higher than in women without such a pathology and in young men with Pul P their frequency was 22 times higher than in other men. In those patients with the highest proportion of MNN, i.e. young females and males with Pul P, AVP mRNA expression in the SON was the lowest. In addition, young women (≤50 years old) had lower AVP mRNA levels than young men and than elderly women (>50 years old). In conclusion, our study suggests that multinucleated neurons are a hallmark of Pul P in the human SON and that this phenomenon may be accompanied by lower AVP production in young subjects.

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The Mechanism of Hyponatremia in Pulmonary Tuberculosis

Cited by 29 publications

References 26 publications

Hyponatremia and anti-diuretic hormone in Legionnaires’ disease

Hyponatremia and anti-diuretic hormone in Legionnaires’ disease

Inappropriate antidiuretic hormone secretion in Wernicke’s encephalopathy

Multinucleated Arginine-Vasopressin Neurons in the Human Supraoptic Nucleus: A Hallmark of Pulmonary Pathology

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