Abstract
A 76-year-old patient was admitted with dizzy spells and fainting. Laboratory analysis indicated the syndrome of inappropriate antidiuresis, which was further characterized as type C (“reset osmostat”). Extended workup revealed a hormone - inactive pituitary macroadenoma. After complete transsphenoidal resection, serum sodium levels and plasma and urinary osmolality promptly normalized. Except for the gonadal axis, the anterior pituitary functions remained intact. There was no adenoma recurrence over a five-year follow-up, and repetitive testing on ad libitum fluid intake showed normal sodium concentrations. Thus, the pituitary macroadenoma represents the sole detectable cause for the syndrome of inappropriate antidiuresis in this patient.
Key words
pituitary adenoma - cancer - hormones
References
-
1
Bartter FC, Schwartz WB.
The syndrome of inappropriate secretion of antidiuretic hormone.
Am J Med.
1967;
42
790-806
-
2
Cusick JF, Hagen TC, Findling JW.
Inappropriate secretion of antidiuretic hormone after transsphenoidal surgery for pituitary tumors.
N Engl J Med.
1984;
311
36-38
-
3
Diederich S, Franzen NF, Bahr V, Oelkers W.
Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases.
Eur J Endocrinol.
2003;
148
609-617
-
4
Ellison DH, Berl T.
Clinical practice. The syndrome of inappropriate antidiuresis.
N Engl J Med.
2007;
356
2064-2072
-
5
Fehn M, Lohmann F, Ludecke DK, Rudorff KH, Saeger W.
Ganglioglioma of the neurohypophysis with secretion of vasopressin.
Exp Clin Endocrinol Diabetes.
1998;
106
425-430
-
6
Feldman BJ, Rosenthal SM, Vargas GA, Fenwick RG, Huang EA, Matsuda-Abedini M, Lustig RH, Mathias RS, Portale AA, Miller WL, Gitelman SE.
Nephrogenic syndrome of inappropriate antidiuresis.
N Engl J Med.
2005;
352
1884-1890
-
7
Greiss KC, Moses AM, Krieger DT.
Pituitary adenoma associated with inappropriate antidiuretic hormone secretion.
Acta Endocrinol (Copenh).
1974;
76
59-66
-
8
Hollinshead WH.
The Interphase of Diabetes Insipidus.
Mayo Clin Proc.
1964;
39
92-100
-
9
Hung SC, Wen YK, Ng YY, Yang WC.
Inappropriate antidiuresis associated with pituitary adenoma-mechanisms not involving inappropriate secretion of vasopressin.
Clin Nephrol.
2000;
54
157-160
-
10
Kern PA, Robbins RJ, Bichet D, Berl T, Verbalis JG.
Syndrome of inappropriate antidiuresis in the absence of arginine vasopressin.
J Clin Endocrinol Metab.
1986;
62
148-152
-
11
Levy A, Lightman SL.
Diagnosis and management of pituitary tumours.
BMJ.
1994;
308
1087-1091
-
12
Palmer BF.
Hyponatraemia in a neurosurgical patient: syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting.
Nephrol Dial Transplant.
2000;
15
262-268
-
13
Robertson GL.
Antidiuretic hormone. Normal and disordered function.
Endocrinol Metab Clin North Am.
2001;
30
671-694
-
14
Robertson GL.
Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis.
Am J Med.
2006;
119
36-42
-
15
Robertson GL, Mahr EA, Athar S, Sinha T.
Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma.
J Clin Invest.
1973;
52
2340-2352
Correspondence
Dr. J. Rutishauser
Clinic of Internal Medicine
Hospital Center
Vogelsang 84
2501 Biel/Bienne
Switzerland
Telefon: +41/32/324 34 38
Fax: +41/32/324 34 36
eMail: j.rutishauser@unibas.ch