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At least 19 recordsLinked to original sources

[Syndrome inappropriate ADH secretion after allogeneic hematopoietic stem cell transplantation: a case report and literature review].

OBJECTIVE: To study the syndrome of inappropriate ADH secretion (SIADH) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the possible etiology. METHODS: The clinical manifestation, laboratory examination, treatment and outcome of a patient with refractory anemia with excess blasts after allo-HSCT were presented. RESULTS: Hyperacute graft-versus-host disease (GVHD) was developed in the patient after allo-HSCT followed by severe hyponatraemia (lowest serum sodium 103.7 mmol/L), natriuresis, hypo-osmolality of plasma, hyper-osmolality of urine, coma and twitch at day 17 after allo-HSCT. SIADH was diagnosed. The clinical condition was improved after restriction of water and administration of hypertonic saline, but SIADH was not controlled completely. Afterwards, graft failure was developed. Hyperacute GVHD and graft rejection occurred again after the second transplant. The patient died of secondary infection. CONCLUSION: SIADH after allo-HSCT is a rare fatal acute complication of central nervous system. Numerous transplant-related causes are probably associated with the development of SIADH. Early accurate diagnosis and treatment promptly is of great importance.

Adolescent↗

Hyponatraemia and the inappropriate ADH syndrome in pneumonia.

We studied serum sodium, plasma osmolality and urinary sodium and osmolality on days 1, 3 and 5 of hospitalization of 100 children aged from 1 month to 12 years admitted with a diagnosis of pneumonia. Hyponatraemia (serum sodium concentration < or = 130 mmol/l) was found in 31 patients at the time of admission. The probable cause of hyponatraemia in 94% of cases was the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Symptoms and signs indicative of severe pneumonia were two to three times more frequent and the mean duration of tachypnoea, chest-wall retraction and hospital stay about one and a half times longer in children with hyponatraemia. Four children died (two on day 1, one on day 5 and one on day 8); all four had a serum sodium concentration < or = 125 mmol/l which persisted until death. Of the remaining 27 hyponatraemic children, serum sodium concentrations returned to normal on day 3 in 26, while in one hyponatraemia persisted until day 7. The recovery from hyponatraemia showed a good correlation with improvement in clinical signs of respiratory distress. The SIADH occurred in about one-third of the children hospitalized for pneumonia, and was associated with a more severe disease and a poorer outcome. Perhaps fluid restriction in these cases may improve the outcome.

Child↗

Occult pulmonary malignancy in syndrome of inappropriate ADH secretion with normal ADH levels.

Although the syndrome of inappropriate ADH secretion (SIADH) has many causes, principally pulmonary, central nervous system or neoplastic disease, and drugs, patients may present with SIADH in whom the etiology is not readily evident. We measured serum ADH levels in such an individual in both the eunatremic and water-loaded states and found levels to be undetectable despite failure to dilute the urine. A small oat cell pulmonary carcinoma was ultimately diagnosed with lung tomograms and cytology. Following a partial response to water restriction, demeclocycline was effective in producing a water diuresis that restored the serum sodium concentration to normal. Patients with clinical SIADH but low serum ADH levels can harbor a malignant or benign process that, notwithstanding the low ADH levels, may still remain responsive to demeclocycline, suggesting either neoplastic production of a biologically-active, immunologically-inactive ADH-like peptide, or increased renal tubular sensitivity to ADH.

Carcinoma, Small Cell↗

[Neonatal focal seizures and transitory inappropriate ADH secretion syndrome due to an infarction in the region of the middle cerebral artery].

Cerebral arterial infarction is a very rare condition during the neonatal period. In recent times, cerebral infarctions with an atypical bland course are reported in healthy, unsuspected newborns. For the first time, we saw focal seizures and a transient syndrome of inappropriate ADH secretion in a full-term, male newborn with an infarction of the middle cerebral artery as the first sign of this disorder. On the basis of these rare clinical manifestations, the literature about neonatal cerebral infarction is reviewed. The diagnostic possibilities and prognostic expectations are discussed. It is the aim of this case report to call attention to this rare disease in order to avoid a delay in diagnosis and therapy, even if the initial manifestations are atypical.

Cerebral Arteries↗