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Paraneoplastic Hyponatremia [keywords]
- Paraneoplastic limbic encephalitis, an uncommon presentation of a common cancer: Case report and discussion. [Journal Article]
- Am J Case Rep 2013.:391-4.
Patient: Female, 59 Final Diagnosis: Paraneoplastic limbic encephalitis Symptoms: Seizure • memory changes • decreased concentration Medication: Chemotherapy Clinical Procedure: Cerebral images Specialty: Hematology • Oncology.Challenging differential diagnosis.Paraneoplastic neurological disorders (PND) are defined as remote effects on the nervous system that are not caused directly by the tumor, its metastases, or metabolic disruptions. This syndrome occurs in less than 1 per 10,000 patients diagnosed with a malignancy. Many antibodies are found in the central nervous system in PND, the most well known are Anti-Hu, Tr, CV2 Ta, Yo, Ri and amphiphysin. Paraneoplastic limbic encephalitis occurs due to involvement of the limbic system secondary to an autoimmune response to neurons of the brain provoked by the antibodies. Patients, thus, present with seizures, changes in mood, memory, and personality.Fifty-nine years-old female patient presented with seizures, decreased concentration and memory changes. Laboratory workup was remarkable for hyponatremia. Further workup included brain computerized tomography (CT) and magnetic resonance imaging (MRI), which suggested a diagnosis of encephalitis for limbic encephalitis. Anti-Hu, anti-Ma and NMDA-receptor antibodies were requested of which Anti Hu antibodies were positive. Transbronchial biopsy was obtained which confirmed the diagnosis of small cell lung cancer.A very high index of suspicion should thus be present when patients present with paraneoplastic abnormalities. It must be emphasized that limbic encephalitis (LE) occurs at an early stage of the disease development and therefore the detection of paraneoplastic LE can lead to a quicker identification of the underlying malignancy and a better outcome.
- Small cell gall bladder carcinoma complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) treated with mozavaptan. [Journal Article]
- BMJ Case Rep 2013.
Small cell gall bladder carcinoma (Scc-GB) is a very rare entity. Although some cases present with endocrine manifestations, paraneoplastic hyponatraemia has been reported in only one previous case. Recently, the antidiuretic hormone (ADH) receptor antagonist mozavaptan has become available. Herein we report a case with Scc-GB complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) treated with mozavaptan. A 47-year-old woman was referred to our hospital for hyponatraemia. Physical examination revealed elevated serum ADH, a gall bladder mass. She was clinically diagnosed with Scc-GB with SIADH as a paraneoplastic syndrome. Mozavaptan was used for SIADH. Serum sodium was quickly normalised after mozavaptan treatment. Two months later, metastasis to the subcutis of the abdominal wall was observed. The metastatic nodule was resected, and small cell carcinoma (Scc) was identified pathologically. Mozavaptan was effective for improvement of hyponatraemia in this patient with Scc-GB complicated with SIADH.
- Small cell neuroendocrine carcinoma of rectum with associated paraneoplastic syndrome: a case report. [Case Reports, Journal Article]
- P R Health Sci J 2013 Mar; 32(1):51-3.
Neuroendocrine carcinomas of the colon and rectum comprise fewer than 1% of all colorectal cancers. These aggressive tumors generally have a poor prognosis compared to that associated with colorectal adenocarcinoma. We describe herein the case of a 68-year-old female presenting with a bleeding rectal mass involving the anal canal, which case was associated with hyponatremia due to inappropriate serum levels of antidiuretic hormone. The histopathological examination was consistent with a small-cell neuroendocrine tumor. She was treated with combination chemotherapy and radiation therapy. The Syndrome of Inappropriate Antidiuretic Hormone (SIADH) was managed with vasopressin antagonists. After the completion of therapy, endoscopic ultrasound revealed evidence of residual disease, for which she underwent an abdominoperineal resection (APR). The patient died 4 months later of disease progression. To our knowledge, this is the first report of a small-cell neuroendocrine tumor involving the rectum and anal canal that presented with the paraneoplastic syndrome, SIADH.
- Juxtaglomerular cell tumor: multicentric synchronous disease associated with paraneoplastic syndrome. [Case Reports, Journal Article]
- J Clin Oncol 2013 May 10; 31(14):e240-2.
- Syndrome of inappropriate anti-diuretic hormone in non-small cell lung carcinoma: a case report. [Journal Article]
- Ecancermedicalscience 2012.:279.
Paraneoplastic syndrome (PNS) related to lung cancer is very common. However, the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is rare in non-small cell lung cancer (NSCLC). We are reporting the case of a 58-year-old female presenting with dyspnea, cough, weight loss, digital clubbing, and one week of haemoptysis. CT showed a mediastinal mass completely encasing her superior vena cava, causing significant narrowing of the trachea and right mainstem bronchus. Bronchoscopy and biopsy identified a non-resectable NSCLC. Palliative radiation therapy was initiated. The day after her first radiation treatment, the patient developed asymptomatic hyponatremia, confirmed to be SIADH by laboratory evaluation. NSCLC-associated SIADH has been reported only thrice over the past two decades and never following radiation therapy with clinical improvement. The patient was discharged home on fluid restriction after her respiratory status improved to continue outpatient radiation and chemotherapy. SIADH in the setting of NSCLC is discussed.
- A rare case of metastatic ductal type prostate adenocarcinoma presenting with syndrome of inappropriate secretion of antidiuretic hormone: a case report and review. [Case Reports, Journal Article, Review]
- J Cancer Res Ther 2012 Apr-Jun; 8(2):308-10.
Ductal adenocarcinoma of the prostate is a rare malignancy and it accounts for less than 1% of prostatic adenocarcinomas as a predominant pattern. In general, the prognosis for these patients is worse than those with typical adenocarcinoma of the prostate. SIADH is a rare paraneoplastic syndrome associated with classic and poorly differentiated acinar prostate adenocarcinoma. To our knowledge, this is the first case of paraneoplastic SIADH associated with ductal type prostate adenocarcinoma. The case highlights once again that the patients with metastatic prostate cancer who present with hyponatremia should get a diagnostic workup for SIADH done due to the potential fatal consequences of this paraneoplastic syndrome.
- Syndrome of inappropriate antidiuretic hormone secretion in patients with olfactory neuroblastoma. [Journal Article]
- Otolaryngol Head Neck Surg 2012 Jul; 147(1):147-51.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been reported as a paraneoplastic syndrome in many different types of malignancies. Several case reports of SIADH have been reported in patients with olfactory neuroblastoma (ONB), but the exact incidence is unknown. The purpose of this study was to review our experience with olfactory neuroblastoma and to identify all patients who had a history of SIADH prior to the diagnosis of ONB.Case series and chart review.Tertiary care university-affiliated medical center.A total of 21 patients presented to our institution with ONB between 1997 and 2009. All records were reviewed for a history of preoperative hyponatremia or SIADH.Three patients were identified who had a history of SIADH prior to the diagnosis of ONB. Immunohistochemical staining of the tumor specimens from the 3 patients with SIADH was positive for arginine vasopressin. SIADH resolved in all 3 patients after successful treatment of ONB.Although uncommon, SIADH can be the presenting symptom of ONB and should be considered during the workup for idiopathic SIADH.
- [Ectopic hormone secretion by neuroendocrine tumors]. [English Abstract, Journal Article]
- Internist (Berl) 2012 Feb; 53(2):145-51.
Ectopic hormone production is a rare complication in neuroendocrine tumors. Tumors producing corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) are most commonly observed, leading to the classical symptoms of Cushing’s syndrome. Additionally, a very low percentage of neuroendocrine tumors can produce growth hormone-releasing hormone (GHRH) leading to classical features of acromegaly. Moreover, ectopic antidiuretic hormone (ADH) secretion has been described in neuroendocrine tumors presenting as hyponatremia due to the syndrome of inappropriate ADH secretion. Other ectopic hormone secretions, such as paraneoplastic gonadotropin release are rarely observed. Ectopic hormone secretion is not usually associated with a detectable pituitary mass and diagnosis is based on the measurement of circulating peptides. This is frequently assisted by imaging techniques, such as somatostatin receptor scintigraphy. Therapeutically a curative approach is the primary goal but in advanced tumors palliative treatment aims to control symptoms with the help of specific antihormonal compounds, such as somatostatin analogues.
- Paraneoplastic syndrome of inappropriate antidiuretic hormone mimicking limbic encephalitis. [Case Reports, Comparative Study, Journal Article]
- Arch Neurol 2011 Dec; 68(12):1591-4.
To compare the features of paraneoplastic syndrome of inappropriate antidiuretic hormone with those of limbic encephalitis.Case study.Academic medical center.A 46-year-old woman with progressive memory impairment, hyponatremia, and seizures.Magnetic resonance imaging of the brain, fluoro-2-deoxyglucose positron emission tomography of the body, and immunohistochemical analysis of a resected tumor.Though the patient presented with clinical features of classic limbic encephalitis, magnetic resonance imaging, electroencephalogram, and cerebrospinal fluid analysis findings were unremarkable. Her chronic hyponatremia was ultimately found to be due to ectopic secretion of antidiuretic hormone by a neuroendocrine tumor with Merkel cell carcinoma phenotype.Patients presenting with memory impairment, seizures, and hyponatremia should undergo a thorough workup for occult malignancy. In addition to considering classic immune-mediated paraneoplastic limbic encephalitis, the ectopic secretion of antidiuretic hormone should be included in the differential diagnosis.
- Letter: Adenocarcinoma of the lung associated with pityriasis rubra pilaris. [Case Reports, Letter]
- Dermatol Online J 2011; 17(11):14.
We describe a case of pityriasis rubra pilaris refractory to conventional treatment, found to be associated with an unrecognized primary adenocarcinoma of the lung. Complete resolution of the eruption followed surgical resection of the tumor.