Syndrome of Inappropriate Antidiuresis Associated with Pancreatic Neuroendocrine Tumor: Case Report

Abstract BackgroundFunctional pancreatic neuroendocrine tumors (pNETs) rarely produce vasopressin. To the best of our knowledge, only one case of an ADH-producing pNET has been reported thus far. Here, we report a case of pNET producing vasopressin in a 78-year-old man with hyponatremia.Case presentationThe patient presented with anorexia 4 years ago, and the lowest serum sodium level was 121 mmol/L. Upon admission, serum osmolarity was 277 mOsm/kg·H2O, urine osmolarity was 465 mOsm/kg·H2O, urine sodium level was 82.5 mmol/L, and 24-hour urine sodium level was 140.25 mmol. There was no evidence of adrenal insufficiency or hypothyroidism. Syndrome of inappropriate antidiuresis (SIAD) was diagnosed on the basis of laboratory and clinical findings. The serum sodium level was maintained within the normal range after the oral administration of tolvaptan 7.5 mg. 68Ga-tetraazacyclododecanetetraacetic acid–DPhe1-Tyr3-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET-CT) showed a high uptake lesion measuring approximately 1 cm in diameter in the pancreatic body, and the possibility of the pNET was considered. The patient underwent surgery, and the immunohistochemical study showed that the tumor cells were positive for somatostatin receptors 2 (SSTR2) and vasopressin. The patient was weaned from tolvaptan post-surgery, and low-dose corticosteroids were started due to signs of relative adrenal insufficiency, which was probably related to heart failure and surgery. Serum sodium level was maintained within the normal range.ConclusionsThis case illustrates the potential ectopic production of vasopressin resulting in SIAD in pNETs, highlighting the adoption of 68Ga-DOTATATE PET-CT and vasopressin immunohistochemical staining in the evaluation of the etiology of SIAD.

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Effect of Rehydration With Normal Saline Versus Ringer Lactate on Serum Sodium Level of Children With Acute Diarrhea and Severe Dehydration: A Randomized Controlled Trial

Indian Pediatrics ◽

10.1007/s13312-020-1848-0 ◽

2020 ◽

Vol 57 (6) ◽

pp. 519-522 ◽

Cited By ~ 1

Author(s):

Md Naseem ◽

A. P. Dubey ◽

T. K. Mishra ◽

Raghvendra Singh

Keyword(s):

Randomized Controlled Trial ◽

Serum Sodium ◽

Normal Saline ◽

Acute Diarrhea ◽

Sodium Level ◽

Serum Sodium Level ◽

Controlled Trial ◽

Severe Dehydration ◽

Ringer Lactate ◽

Randomized Controlled

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Altered acceptance and rejection of NaCl in rats with diabetes insipidus

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1960.199.1.22 ◽

1960 ◽

Vol 199 (1) ◽

pp. 22-24 ◽

Cited By ~ 18

Author(s):

Libby F. Titlebaum ◽

John L. Falk ◽

Jean Mayer

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium ◽

Sodium Level ◽

Serum Sodium Level ◽

Extracellular Fluid ◽

Solution Concentration ◽

Lower Solution ◽

Extracellular Fluid Volume ◽

Internal Environment ◽

Nacl Solution

Groups of normal rats and animals with diabetes insipidus were tested on their relative acceptance and rejection of various concentrations of NaCl solution. Rats with diabetes inspidus drank more than normal rats in the hypotonic range. Their acceptance was maximal at a lower solution concentration than in the case of normal animals and relative rejection began at concentrations where normals ingested maximally. The results are discussed in relation to such factors in the internal environment as serum sodium level and extracellular fluid volume.

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Serum Sodium Level on the Recurrence of Febrile Seizure within the Same Febrile Illness-Experience in a District Level Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v32i1.42734 ◽

2019 ◽

Vol 32 (1) ◽

pp. 39-45

Author(s):

M Luthfor Rahman ◽

Belal Hossain ◽

Belal Uddin ◽

Sanaul Haq Mia

Keyword(s):

Serum Sodium ◽

Febrile Seizure ◽

Sodium Level ◽

Serum Sodium Level ◽

Central Nervous System Infection ◽

Febrile Illness ◽

Febrile Seizures ◽

Febrile Episode ◽

Cross Sectional ◽

Recurrent Seizure

Introduction: Febrile convulsion is the most common seizure disorder in the pediatric age group. It occurs in 2-5% of children. A febrile seizure is a seizure accompanied by fever (temperature 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age. Aim: The study was conducted to see the effect of serum sodium level on the recurrence of febrile seizure during the same febrile illness. Materials and Method: A cross-sectional descriptive study which enrolled 65 children admitted with febrile seizures at 100 bed district hospital, Naogaon. They were divided in to two groups, those with a single seizure and the rest were children with more than one seizures. Serum sodium levels were estimated after stabilization of patients. The probability of recurrent febrile seizures and serum sodium level was analyzed. Results: Hyponatremia (serum sodium <135 mmol/l) was seen in 12(18.5%) of 65 children and the remaining 81.5% children had normal serum sodium level (serum sodium 135-145 mmol/l). Among the hyponatremia group all children developed more than one seizure during the same febrile episode. The mean serum sodium level in patients with single and recurrent seizure was 138.48±2.17mmol/l and 135.27±3.11mmol/(P<0.001). The relationship between the probability of a recurrent seizure and serum sodium level is statistically highly significant. Conclusion: Estimation of the seum sodium in children with febrile seizures help in deciding for admission in hospital as well as to predict seizure recurrence within the same febrile episode. TAJ 2019; 32(1): 39-45

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Continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia: A retrospective study of 13 cases

The International Journal of Artificial Organs ◽

10.1177/0391398819893381 ◽

2019 ◽

Vol 43 (6) ◽

pp. 416-421

Author(s):

Chen Huang ◽

Yirong Liu ◽

Li Li ◽

Hongbao Liu ◽

Peng Zhang

Keyword(s):

Serum Sodium ◽

Sodium Level ◽

Serum Sodium Level ◽

Reduction Rate ◽

Serum Levels ◽

Clinical Effects ◽

Sodium Reduction ◽

Replacement Fluid ◽

Hemodynamic Variables ◽

Sodium Replacement

Objectives: This study aimed to evaluate the clinical effects of continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia. Methods: A total of 13 severely burned patients with acute hypernatremia admitted to Xijing Hospital were included in this study. All patients received continuous veno-venous hemofiltration treatment in addition to conventional treatment. The original sodium level in the replacement fluid was set to be lower than the serum sodium level by 8 mmol/L and subsequently undergoes a reduction rate of 2.16 ± 0.18 mmol/L every 4 h. Patients’ clinical features, serum laboratory tests, hemodynamic variables, changes in sodium levels in serum, and replacement fluid during continuous veno-venous hemofiltration treatment were monitored. Results: Patients had an average total burn surface area of 66.69% ± 20.28%. Two patients died of systematic Pseudomonas aeruginosa infections, and 11 patients survived. After continuous veno-venous hemofiltration treatment, patients showed a significant reduction in the serum sodium level (168.91 ± 4.88 mmol/L vs 144.62 ± 2.98 mmol/L, p < 0.01). Likewise, the serum levels of urea and creatinine decreased from 24.8 ± 6.5 mmol/L to 14.9 ± 8.3 mmol/L and from 278.6 ± 155.3 μmol/L to 152.6 ± 29.7 μmol/L, respectively (p < 0.05). The patients also displayed improvements in the Acute Physiology and Chronic Health Evaluation II and Glasgow scores (p < 0.05) and showed a significant reduction in hemoglobin and serum albumin levels (p < 0.05), but no obvious change in levels of platelets, alanine aminotransferase, and aspartate aminotransferase (p > 0.05). Conclusion: Our results indicate that continuous veno-venous hemofiltration with gradient sodium replacement fluid is effective in treating hypernatremia in severely burned patients with the controllable sodium reduction rate and satisfactory clinical outcomes.

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