Relapsing Syndrome of Inappropriate Antidiuretic Hormone Production Responding to Tolvaptan Treatment in a Patient With a Micronodular Formation of the Posterior Pituitary Gland

 

 Permissions and Reprints

Summary

The syndrome of inappropriate ADH-secretion (SIADH) is a common cause of low sodium levels with diverse aetiology. Here, we report a case of a 41 years old male patient diagnosed with SIADH and a good response to Tolvaptan therapy. Of interest, as a potential unique cause, magnetic resonance imaging revealed a micronodular structure in the posterior pituitary, while no other common cause of SIADH could be identified. Hence, to the best of our knowledge, this is the first case of a Tolvaptan-responsive SIADH associated with a pituitary micronodular structure.

Publication History

Article published online:
26 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Ellison DH, Berl T. The syndrome of inappropriate antidiuresis. N Engl J Med 2007; 356: 2064-2072 DOI: 10.1056/NEJMcp066837.
  CrossrefPubMedGoogle Scholar
• 2 Mentrasti G, Scortichini L, Torniai M. et al. Syndrome of inappropriate antidiuretic hormone secretion (SIADH): Optimal management. Ther Clin Risk Manag 2020; 16: 663-672 DOI: 10.2147/TCRM.S206066.
  CrossrefPubMedGoogle Scholar
• 3 Castellanos LE, Gutierrez C, Smith T. et al. Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification. Pituitary 2022; 25: 201-209 DOI: 10.1007/s11102-021-01189-6.
  CrossrefPubMedGoogle Scholar
• 4 Sata A, Hizuka N, Kawamata T. et al. Hyponatremia after transsphenoidal surgery for hypothalamo-pituitary tumors. Neuroendocrinology 2006; 83: 117-122 DOI: 10.1159/000094725.
  CrossrefPubMedGoogle Scholar
• 5 Kanda M, Omori Y, Shinoda S. et al. SIADH closely associated with non-functioning pituitary adenoma. Endocr J 2004; 51: 435-438 DOI: 10.1507/endocrj.51.435.
  CrossrefPubMedGoogle Scholar
• 6 Smedegaard SB, Jørgensen JO, Rittig N. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and subsequent central diabetes insipidus: A rare presentation of pituitary apoplexy. Case Rep Endocrinol 2019; 2019: 7592648 DOI: 10.1155/2019/7592648.
  CrossrefPubMedGoogle Scholar
• 7 Gasparini S, Stein LM, Loewen SP. et al. Novel regulator of vasopressin secretion: Phoenixin. Am J Physiol Regul Integr Comp Physiol 2018; 314: R623-R628 DOI: 10.1152/ajpregu.00426.2017.
  CrossrefPubMedGoogle Scholar
• 8 Iovino M, Guastamacchia E, Giagulli VA. et al. Vasopressin secretion control: Central neural pathways, neurotransmitters and effects of drugs. Curr Pharm Des 2012; 18: 4714-4724 DOI: 10.2174/138161212802651607.
  CrossrefPubMedGoogle Scholar
• 9 Refardt J, Winzeler B, Christ-Crain M. Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clin Endocrinol 2019; 91: 22-32 DOI: 10.1111/cen.13991.
  CrossrefPubMedGoogle Scholar
• 10 Christ-Crain M. Vasopressin and copeptin in health and disease. Rev Endocr Metab Disord 2019; 20: 283-294 DOI: 10.1007/s11154-019-09509-9.
  CrossrefPubMedGoogle Scholar
• 11 Săcărescu A, Turliuc M-D, Brănișteanu DD. Role of copeptin in the diagnosis of traumatic neuroendocrine dysfunction. Neuropeptides 2021; 89: 102167 DOI: 10.1016/j.npep.2021.102167.
  CrossrefPubMedGoogle Scholar
• 12 Palmer BF, Clegg DJ. Electrolyte disturbances in patients with chronic alcohol-use disorder. N Engl J Med 2017; 377: 1368-1377 DOI: 10.1056/NEJMra1704724.
  CrossrefPubMedGoogle Scholar
• 13 Shibamoto A, Namisaki T, Suzuki J. et al. Clinical significance of gamma-glutamyltranspeptidase combined with carbohydrate-deficient transferrin for the assessment of excessive alcohol consumption in patients with alcoholic cirrhosis. Medicines (Basel) 2021; 8: 39 DOI: 10.3390/medicines8070039.
  CrossrefPubMedGoogle Scholar
• 14 Andresen-Streichert H, Müller A, Glahn A. et al. Alcohol biomarkers in clinical and forensic contexts. Dtsch Arztebl Int 2018; 115: 309-315 DOI: 10.3238/arztebl.2018.0309.
  CrossrefPubMedGoogle Scholar
• 15 Jastrzębska I, Zwolak A, Szczyrek M. et al. Biomarkers of alcohol misuse: Recent advances and future prospects. Prz Gastroenterol 2016; 11: 78-89 DOI: 10.5114/pg.2016.60252.
  CrossrefPubMedGoogle Scholar