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Diagnosis and Treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion

Author: WangFang
Tutor: YinLiu
School: Dalian Medical University
Course: Oncology
Keywords: Syndrome of Inappropriate Antidiuretic Hormone Secretion small cell lung cancer loop diuretic
CLC: R734.2
Type: Master's thesis
Year: 2010
Downloads: 55
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Abstract


Objective:Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) refers to the hypersecretion of antidiuretic hormone (ADH) leading to water retention by all reasons., and its main representation is dilutional hyponatremia. SIADH is a kind of tumorous emergency with insidious course, and its most common reason is small cell lung cancer (SCLC). This article discusses the diagnosis of SIADH and differential diagnosis with hyponatremia by hypovolemia to diagnose and treat SCLC patients with SIADH.Methods:12 patients suffered from SCLC with SIADH were enrolled in the First Affiliated Hospital of Dalian Medical University, Oncology, from January 2000 to December 2009, there were 3 patients with mild hyponatremia (120mmol/l<PNa≤130mmol/l), while 7 patients with medium hyponatremia (110mmol/l<PNa≤120mmol/l)and 2 cases with severe hyponatremia (PNa≤110mmol/l).12 cases had the rise of NSE consistence, and 12 patients had the mass in lung through the CT scan,7 patients were confirmed by pathology. In this study, we gave them different doses of loop diuretics according to the different levels of hyponatremia. The detailed directions for use as follows:we gave 20-40mg loop diuretics by intravenous push from the first day to the third day to the patients with mild hyponatremia, 60-80mg loop diuretics by intravenous push from the first day to the fifth day to the patients with medium hyponatremia. For the patients with severe hyponatremia we gave 20-40mg loop diuretics by intravenous push from the first day to the third day and 60-100mg from the fourth day to the sixth day, 200mg furosemide by intravenous infusion from the seventh day to the ninth day. When the hyponatremia was cured, they accepted the EP chemotherapy regimen. The short-term efficacy was evaluated by Recist evaluation criteria after six cycles of EP chemotherapy.12 patients were also evaluated for the toxicities according to NCI-CTC 3.0. The data in this study was analyzed through the software of SPSS 17.0.Results:After the therapy as above, the symptoms of hyponatremia disappeared in 10 patients with mild to medium hyponatremia.,the symptoms relieved in 2 cases with severe hyponatremia.,the concentration of serum sodium maintained at about 130mmol/l in 10 patients with mild to medium hyponatremia after the diuretic therapy, while 127mmol/l in 2 patients with severe hyponatremia. After the diuretic therapy, the symptoms of hypona-tremia relieved, and the concentration of serum sodium varied in the escalating trend. Thus, hyponatremia by hypovolemia could be excluded. Then the diagnosis of SCLC with SIADH could be confirmed by tumor markers, the CT scan of chest and pathology. After the first cycle therapy of EP chemotherapy regimen, the concentration of serum sodium in 10 cases with mild to medium hyponatremia returned to normal. The concentration of serum sodium varied during 130-133mmol/l after one cycle chemotherapy and returned to normal after six cycle chemotherapy in 2 cases with severe hyponatremia. The results of the efficacy evaluation shows:2 cases with mild hyponatremia achieved CR; 5 of 7cases with medium hyponatremia achieved PR,and 2 of 7 cases achieved CR; 1 of 2cases with severe hyponatremia achieved PR, and 1 SD. Toxicities was evaluated as follows:1 case with mild hyponatremia had I degree of myelosuppression. Among the patients with medium to severe hyponatremia, there was 1 case suffering from I degree of myelosuppression,3 cases withⅡdegree of myelosup-pression, and 3 cases withⅣdegree of myelosuppression.Conclusions:1. SIADH has certain correlation with cancer.2. Most SIADH can be found in SCLC.3. Loop diuretic is effective in the therapy of SIADH. 4. Chemotherapy can cure SIADH by treating SCLC.5. Short-term curative effect is good in patients with mild hypona-tremia6. The chemotherapy toxicities are significant in patients with severe hyponatremia.

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