Syndrome Of Inappropriate Secretion Research Articles

Physiologic control of two neurophysins in humans.

Two human neurophysins, nicotine stimulated neurophysin (NSN), and estrogen stimulated neurophysin (ESN) were assayed during physiologic maneuvers and pathologic states in man. NSN is thought to be associated with vasopressin and was elevated in some subjects by volume depletion, surgical stress, hypotension and hypertonic saline infusion. Overnight dehydration did not elevate NSN in spite of urinary concentration. NSN was elevated in some subjects with the syndrome of inappropriate secretion of antidiuretic hormone and when tested was unresponsive to administered water, alcohol or nicotine. ESN was elevated during estrogen administration, in pregnancy, in newborns and in patients with cirrhosis. NSN was also acutely increased at parturition. These data support the association of NSN with vasopressin although changes in NSN were found only with potent stimuli for vasopressin release. ESN may be associated with oxytocin but demonstration of this awaits knowledge of oxytocin physiology in humans.

Clinical, Biological and Pathogenic Features of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone<subtitle>A REVIEW OF 26 CASES WITH MARKED HYPONATRAEMIA</subtitle>

Twenty-six patients with the syndrome of inappropriate secretion of antidiuretic hormone were reviewed. The underlying diseases were bronchogenic carcinoma (12 cases); myxoedema (five cases); diseases of the nervous system (five cases); bronchopneumonia, carcinoma of the oesophagus, acute intermittent porphria and chlorpropamide therapy (each one case). Serum sodium levels ranged between 104 and 125 mEq per litre. Eighteen patients presented neurological manifestations, which in 14 were considered to be due to hyponatraemia. Neurological signs included disorders of consciousness (stage I and II coma), extrapyramidal signs, asterixis and epileptic seizures. An hyponatraemic coma was the first manifestation of the syndrome in five cases. In all cases where the EEG was recorded it showed non-specific signs of metabolic coma. The fundi never showed signs of intracranial hypertension. Blood urea and creatinine levels were invariably low in the euthyroid patients; these values were normal or elevated in patients with myxoedema and hyponatraemia. Hypokalaemia was frequent, and hypocalcaemia constant. In eleven cases an excess of water intake revealed the clinical syndrome: six patients were excessive beer drinkers and five had received extensive intravenous infusions. In one case the deleterious effect of diuretics was evident, and in another, the syndrome became evident during radiotherapy of an oesophageal tumour. Treatment of the syndrome was successful in all cases. A review of the literature concerning the various pathogenic mechanisms corresponding to the different underlying diseases is presented. The concept of aberrant hormonal production by a tumour is illustrated by an electron microscopic study.

Potassium depletion induced by vasopressin and overhydration in the rabbit.

1. In order to study the effect of overhydration on body potassium, experiments were performed on pair-fed rabbits, one of which was maintained continuously on vasopressin and given extra water (60-90 ml day-1 kg-1) for 6-8 days, while the other served as control. 2. Overhydrated rabbits excreted significantly more potassium (53%) in their urine than control rabbits and accumulated a mean potassium deficit of 65-0 mmol, significantly higher than the mean value of 37-1 mmol in the control rabbits. 3. In the overhydrated rabbits, potassium fell significantly in both erythrocytes, from 266 to 173 mmol/kg of dry cells, and also in muscle, from 435 to 341 mmol/kg of fat-free dry solids. Neither changed significantly in the control animals. 4. Overhydration in the presence of vasopressin leads to potassium depletion in the rabbit and a similar phenomenon might be expected in man. Potassium depletion due to overhydration might account for the hypokalaemia and reduction in exchangeable potassium observed in some patients with the syndrome of inappropriate secretion of antidiuretic hormone.

Letter: Water intoxication and psychosis.

Excerpt To the editor: In The October Issue (Ann Intern Med79:551-554, 1973) Dubovsky and associates reported the syndrome of inappropriate secretion of antidiuretic hormone associated with an acut...

ADH分泌異常症候群を合併した肺癌の一剖検例

ADH分泌異常症候群を合併した肺癌の一剖検例

Vincristine-induced syndrome of inappropriate secretion of antidiuretic hormone.

Vincristine-induced syndrome of inappropriate secretion of antidiuretic hormone.

肺癌によるADH異所性産生の一例

肺癌によるADH異所性産生の一例

Inappropriate Secretion of Antidiuretic Hormone

Dr. Rex L. Jamison, Chief, Renal Division, Jewish Hospital of St. Louis, and Assistant Professor of Medicine, Washington University School of Medicine: There is a great deal of interest in and new information about antidiuretic hormone (ADH), the mammalian hormone that controls the rate of water excretion. Along with research upon various aspects of this hormone, there has been a concomitant advance in recognition of a clinical syndrome first reported in 1957 by Schwartz and others entitled "Inappropriate Secretion of Antidiuretic Hormone,"1 the adjective "inappropriate" indicating that the hormone was being secreted despite the absence of the stimuli that we ordinarily associate with its release. We shall present a patient who may have had inappropriate secretion of ADH associated with her illness. I shall then discuss some aspects of the physiology of ADH. Dr. Robert Utiger will review the clinical syndrome of inappropriate secretion of the hormone, and Dr. Eduardo

Inappropriate antidiuresis and carcinoma of the lung: detection of arginine vasopressin in tumor extracts by immunoassay.

A case is described in which an undifferentiated (oat cell) carcinoma of the lung was associated with hyponatremia, natruresis and excretion of urine hypertonic to plasma. The electrolyte and osmolality abnormalities were corrected by water restriction and did not recur after pneumonectomy. By means of radioimmunoassay, extracts of the tumor were found to contain arginine vasopressin (or some very closely related pep tide) in amounts ranging from 8 to 427 μU/mg wet tissue weight. Extracts from uninvolved lung, lymph node, and from lung tumors of patients without this syndrome contained no detectable activity. Pituitary glands obtained at autopsy contained vastly greater quantities. These studies provide further evidence that the syndrome of inappropriate secretion of antidiuretic hormone associated with various malignant tumors is due to hormone production by the tumor.