atrial-natriuretic-factor and Inappropriate-ADH-Syndrome

There is significant evidence to show that many patients with hyponatremia and intracranial disease who were previously diagnosed with SIADH actually have CSW. The critical difference between SIADH and CSW is that CSW involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. Attention to volume status in patients with hyponatremia is essential. The primary treatment for CSW is water and salt replacement. The mechanisms underlying CSW are not understood but may involve ANP or other natriuretic factors and direct neural influence on renal function. Future investigation is needed to better define the incidence of CSW in patients with intracranial disease, identify other disorders that can lead to CSW, and elucidate the mechanisms underlying this syndrome.

Topics: Animals; Atrial Natriuretic Factor; Brain Diseases; Diagnosis, Differential; Disease Models, Animal; Fluid Therapy; Humans; Hyponatremia; Inappropriate ADH Syndrome; Kidney Diseases

Normal aging is associated with changes in body composition, thirst perception, renal function, and the hormonal regulatory systems involved in the maintenance of water and sodium balance. The presence of many diseases and drugs common in the elderly can interact with the impaired homeostatic systems to result in clinically significant disturbances of water and sodium with accompanying symptoms, morbidity, and mortality. These disorders, which include dehydration, hypernatremia, hyponatremia, urinary frequency, and urinary incontinence can either be prevented or promptly recognized and appropriately treated by understanding the physiological changes and clinical circumstances which put the elderly person at increased risk for deranged water and sodium balance.

Topics: Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Female; Frail Elderly; Humans; Inappropriate ADH Syndrome; Male; Risk Factors; Water-Electrolyte Balance; Water-Electrolyte Imbalance

Topics: Atrial Natriuretic Factor; Biomarkers; Humans; Hyperaldosteronism; Hypothyroidism; Inappropriate ADH Syndrome; Vasopressins; Water-Electrolyte Balance

The term paraneoplastic syndrome refers to the ability of some tumors to produce signs and symptoms at a distance from the site of the primary tumor or its metastases. Paraneoplastic syndromes may develop before the diagnosis of carcinoma is made. Paraneoplastic syndromes associated with small cell lung cancer (SCLC) include endocrinologic abnormalities secondary to peptide hormone production, and neurologic sequelae due to autoantibody production. This article reviews the common paraneoplastic syndromes that may occur in patients with SCLC.

Topics: ACTH Syndrome, Ectopic; Atrial Natriuretic Factor; Carcinoma, Small Cell; Cerebellar Diseases; Encephalomyelitis; Humans; Inappropriate ADH Syndrome; Lambert-Eaton Myasthenic Syndrome; Lung Neoplasms; Paraneoplastic Syndromes; Retinal Diseases

Topics: Atrial Natriuretic Factor; Brain Injuries; Child; Diagnosis, Differential; Female; Fluid Therapy; Hemodynamics; Humans; Hyponatremia; Inappropriate ADH Syndrome; Infant; Male; Syndrome

Topics: Atrial Natriuretic Factor; Brain Diseases; Humans; Inappropriate ADH Syndrome; Postoperative Complications; Water-Electrolyte Balance

To report atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in patients with tuberculous meningitis (TBM) and acute encephalitis syndrome (AES), and evaluate their relationship with hyponatraemia.. Consecutive patients with TBM and AES were included in the study. Hyponatraemia was categorised as cerebral salt wasting (CSW), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and a miscellaneous group based on clinical and laboratory criteria. Serum ANP and BNP levels were measured upon hospital admission, at the time of diagnosis of hyponatraemia and upon correction of hyponatraemia. Outcome at 3 months was assessed using the modified Rankin scale (mRS) as good (mRS 2) and poor (mRS >2).. There were 67 patients with TBM and 77 with AES. Hyponatraemia was more common in TBM than in AES (65.7% vs. 27%, P < 0.01). Forty-one (63.1%) patients had CSW, 6 (9.2%) SIADH and 18 (27.7%) had miscellaneous causes of hyponatraemia. During hyponatraemia, ANP (180 ± 45 vs. 106 ± 32 pg/ml, P < 0.01) and BNP (263 ± 118 vs. 163 ± 91 pg/ml, P  0.01) levels were significantly increased compared with baseline, and remained high even after Na+ correction.. ANP and BNP levels were increased during hyponatraemia and remained high even after correction of hyponatraemia in TBM and AES, especially in patients with CSW. However, ANP and BNP levels could not be used to differentiate CSW from SIADH.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Child; Encephalitis; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Tuberculosis, Meningeal; Young Adult

Fluid restriction (FR), the first-line treatment for hyponatraemia due to the syndrome of inappropriate antidiuresis (SIAD), often does not lead to successful correction of hyponatraemia. Therefore, predictive markers of treatment response are desirable. We evaluated routinely measured serum (s) and urine (u) parameters, s-copeptin and s-mid-regional pro-atrial natriuretic peptide (s-MR-proANP), as possible predictors of FR response.. In this prospective observational study, we included patients with profound hyponatraemia (s-sodium <125 mmol L. Of 106 SIAD patients analysed, 82 underwent treatment with FR; 48 (59%) patients showed a successful response to FR and 34 (41%) were considered nonresponders. High levels of u-sodium and u-osmolality were significantly associated with nonresponse to FR [odds ratio (OR) 15.0, 95% confidence interval (CI) 2.4-95.8, P = 0.004 and OR 34.8, 95% CI 1.2-1038.8, P = 0.041, respectively). The association of u-sodium and nonresponse remained significant also after adjustment for diuretic use. Lower levels of s-MR-proANP were associated with nonresponse (OR 0.03, 95% CI 0.003-0.3, P = 0.004), whereas s-copeptin was not significantly associated with response to FR.. Easily measured laboratory parameters, especially u-sodium, correlate with therapeutic response and identify patients most likely to fail to respond to FR. Measurement of these parameters may facilitate early treatment choice in patients with SIAD.

Topics: Atrial Natriuretic Factor; Biomarkers; Glycopeptides; Humans; Hyponatremia; Inappropriate ADH Syndrome; Osmolar Concentration; Prospective Studies; Sodium; Urine

It is well documented in literature that a majority of small-cell lung cancers are associated with paraneoplastic phenomena. We report the case of a 63-year-old man diagnosed with small-cell lung carcinoma, in whom a severe hyponatremia and renal sodium loss with inappropriate antidiuresis were also found during a routine laboratory testing. Syndrome of inappropriate antidiuretic hormone secretion was first suspected in this patient, but another complex pathogenetic mechanism involving atrial natriuretic peptides could be associated, potentiating the deflation of the plasma sodium level. In our patient, the plasma-atrial natriuretic peptide base level, determined with a sensitive radioimmunoassay, was above the normal range (183 pg/mL; normal range, 50 pg/mL, +/- 10 pg/mL), and the antidiuretic hormone plasma level had an oscillatory pattern, varying between 5.5 pg/mL and 7 pg/mL (normal range, 0-4.7 pg/mL). We discuss the pathogenesis and clinical aspects of this association and the therapeutic options for these types of patients.

Topics: Arginine Vasopressin; Atrial Natriuretic Factor; Carcinoma, Small Cell; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Paraneoplastic Syndromes; Radiography; Radioimmunoassay; Sodium; Water-Electrolyte Imbalance

Atrial natriuretic peptide (ANP) has known natriuretic, diuretic, and vasodilatatory effects. It is synthesized and stored in the atrial cells. Stretching of the atrial muscle fibers during an increase in venous return sets a response of ANP release into the blood stream. High levels of ANP were measured in a number of lung diseases. Pneumonia in children is frequently accompanied by the hyponatremia of the syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH). High levels of ANP were found among patients with SIADH. Our objective was to determine if ANP plasma levels are altered in children with pneumonia, and to evaluate a possible correlation between severity of pneumonia and ANP levels. Blood samples from 28 children diagnosed with pneumonia were collected. Plasma ANP levels were determined by radioimmunoassay and compared to levels in 25 children without pneumonia. ANP levels in the pneumonia group (mean +/- SD, 16.02 +/- 11.69 pg/ml) increased significantly (P < 0.01) compared to levels in the control group (mean +/- SD, 7.44 +/- 9.29 pg/ml). Children in the pneumonia group also exhibited low levels of plasma sodium (mean +/- SD, 134.88 +/- 2.5 mmol/l) compared to levels in children without pneumonia (mean +/- SD, 139.77 +/- 4.15 mmol/l) (P < 0.01). There was no correlation between ANP plasma levels and severity of pneumonia. In conclusion, ANP levels in children with pneumonia, as in other lung diseases, are increased. High ANP levels may play a role in maintaining water and electrolyte equilibrium during a state of inappropriate ADH secretion accompanying pneumonia.

Topics: Atrial Natriuretic Factor; Child; Child, Preschool; Humans; Inappropriate ADH Syndrome; Pneumonia; Radioimmunoassay

Hyponatremia after cranial vault remodeling has been noted in a pediatric patient population. If left untreated, the patients may develop a clinical hypoosmotic condition that can lead to cerebral edema, increased intracranial pressure, and eventually, to central nervous system and circulatory compromise. The hyponatremia has traditionally been attributed to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH); however, in our patients the treatment has been resuscitation with normal saline as opposed to fluid restriction (the accepted treatment of SIADH), thus placing the diagnosis of SIADH in question. Patients who developed hyponatremia after intracranial injury or surgery were, until recently, grouped together as having SIADH. However, there are diagnosis and treatment differences between SIADH and another distinct but poorly understood disorder that is designated cerebral salt wasting syndrome (CSW). CSW is associated with increased urine output and increased urine sodium concentration and volume contraction, and it is frequently seen after a central nervous system trauma. We therefore developed a prospective study to evaluate the cause of the sodium imbalance.Ten consecutive pediatric patients who underwent intracranial surgery for various craniosynostotic disorders were postoperatively monitored in the pediatric intensive care unit for hemodynamic, respiratory, and fluid management. The first four patients were evaluated for electrolyte changes and overall fluid balance to determine the consistency with which these changes occurred. The remaining six patients had daily (including preoperative) measurement of serum electrolytes, urine electrolytes, urine osmolarity, serum antidiuretic hormone (ADH), aldosterone, and atrial natriuretic hormone (ANH). All patients received normal saline intravenous replacement fluid in the postoperative period. All of the patients developed a transient hyponatremia postoperatively, despite normal saline resuscitation. Serum sodium levels as low as 128 to 133 mEq per liter (normal, 137 to 145 mEq per liter) were documented in the patients. All patients had increased urine outputs through the fourth postoperative day (>1 cc/kg/h). The six patients who were measured had an increased ANH level, with a peak value as high as 277 pg/ml (normal, 25 to 77 pg/ml). ADH levels were low or normal in all but one patient, who had a marked increase in ADH and ANH. Aldosterone levels were variable. On the basis of t

Topics: Aldosterone; Atrial Natriuretic Factor; Child, Preschool; Craniosynostoses; Electrolytes; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Infant; Infusions, Intravenous; Male; Postoperative Complications; Prospective Studies; Resuscitation; Skull; Sodium; Sodium Chloride; Vasopressins

a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP).. Tertiary care pediatric intensive care unit (ICU) in a university hospital.. A prospective cross-sectional, observational study with factorial design.. Thirty patients > or = 10 yrs of age undergoing spinal fusion admitted to the ICU for postoperative care.. Patients underwent anterior, posterior, or both anterior/posterior spinal fusion. Blood was collected for serial measurements of ADH, ANP and serum electrolyte levels. Heart rate, blood pressure and central venous pressure were measured.. Thirty children were studied. Nineteen had idiopathic scoliosis, nine had neuromuscular scoliosis, one had Marfan's disease, and one had congenital scoliosis. Ten (33%) children met clinical criteria of SIADH. There was no difference in duration of surgery, blood loss, volume of iv fluid administration pre- and intraoperatively, or type of scoliosis between those who developed SIADH and those who did not. Hemodynamic variables were similar in both groups. ADH levels increased in both groups immediately postoperatively and at 6 hrs after surgery, but were much more elevated in those patients with SIADH. Patients with SIADH also had significantly higher ADH levels preoperatively. In relation to serum osmolality, ADH was considerably higher in those with SIADH compared with those who did not. Although ANP values tended to be higher in the group with SIADH, this did not reach statistical significance.. SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.

Topics: Adolescent; Analysis of Variance; Atrial Natriuretic Factor; Cross-Sectional Studies; Electrolytes; Female; Hemodynamics; Humans; Inappropriate ADH Syndrome; Intensive Care Units, Pediatric; Male; Postoperative Complications; Prospective Studies; Scoliosis; Sodium; Spinal Fusion; Vasopressins

We experienced four cases with hyponatremia due to SIADH, which seems to be related to inflammation. The plasma Na concentration decreased when the patients had fever and increased plasma CRP level. In such conditions, plasma vasopressin concentration (PAVP) and the plasma interleukin-6 (IL-6) concentration were increased. There was significant correlation between them. The animal experiments were carried out to investigate the role of interleukin in the development of SIADH. Intravenous administrations of IL-1 beta increased AVP, atrial natriuretic hormone (ANH) and ACTH. The changes in AVP and ACTH were abolished by the pretreatment with an intravenous administration of indomatacin. Moreover, the intracerebroventricular administration (ICV) of IL-1 beta also increased AVP, atrial natriuretic hormone (ANH) and ACTH. The pretreatment of indomatacin attenuated the changes in AVP and ACTH. The intravenous administration of IL-1 beta increased the urinary sodium excretion. The pretreatement of HS142-1, an ANH antagonist, abolished the increase in urinary sodium excretion induced by IL-1 beta. These results suggested that the interleukin play an important role in the development of SIADH associated with inflammation.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Animals; Atrial Natriuretic Factor; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Inflammation; Interleukin-1; Interleukin-6; Male; Rats; Rats, Sprague-Dawley; Vasopressins

We present a rare case of a 66-year-old woman with the syndrome of inappropriate antidiuresis (SIAD) accompanied by an empty sella whose symptoms were seen twice in the eight years after the administration of non-steroidal anti-inflammatory drugs (NSAID) or prochlorperazine. No diuresis or suppression of the plasma level of vasopressin (AVP) was observed after water loading upon cessation of the causative agents. Suppression of the renin-aldosterone system and a low plasma level of atrial natriuretic peptide (ANP) were observed during natriuresis. The plasma levels of AVP were increased after water loadings. Restriction of water intake ameliorated the symptoms and reduced hyponatremia. These findings suggest that NSAID or prochlorperazine caused overt SIAD twice in eight years. The water loading test itself stimulated the release of AVP and a suppression of the renin-aldosterone system played a more important role in natriuresis than ANP in this case.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Arginine Vasopressin; Atrial Natriuretic Factor; Diuresis; Empty Sella Syndrome; Female; Humans; Inappropriate ADH Syndrome; Magnetic Resonance Imaging; Natriuresis; Prochlorperazine; Recurrence; Renin-Angiotensin System

An old women was in an 8-year-period 9 times admitted to the hospital because of severe mental disturbances. The average serum sodium concentration was 126.25 +/- 2.43 mmol/l at the admissions; it increased to 139.44 +/- 1.40 mmol/l after intravenous infusion of hypertonic solutions accompanied with the disappearance of the mental disturbances. The patient was usually chronically hyponatremic due to the increased water intake and the insufficient water excretion. The latter was induced by the augmented vasopressin levels. The remarkable feature of the syndrome of inappropriate antidiuretic hormone secretion was its association with lowered blood level of atrial natriuretic factor accompanied by sodium, and volume depletion. Discontinuation of the exaggerated water intake resulted in the elimination of the permanent hyponatremia; no episode of water intoxication occurred during the last 3 and 1/2 years.

Topics: Aged; Atrial Natriuretic Factor; Cognition Disorders; Drinking Behavior; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Vasopressins; Water Intoxication

Topics: Animals; Atrial Natriuretic Factor; Brain; Humans; Hyponatremia; Inappropriate ADH Syndrome; Kidney Failure, Chronic; Vasopressins; Water-Electrolyte Balance

Hyponatremia has been reported in up to one third of patients with intracranial disease and has frequently been associated with tuberculous meningitis, often complicated by hydrocephalus. The lowered plasma sodium levels were previously attributed to the syndrome of inappropriate secretion of antidiuretic hormone. A controlled prospective study of 24 patients with tuberculous meningitis and hydrocephalus was carried out. Analyses of serum electrolytes and cerebrospinal fluid were performed. Plasma and cerebrospinal fluid levels of atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) were measured by radioimmunoassay. Fifteen patients were found to be hyponatremic (plasma sodium < 130 mmol/L) and ANP levels of 12 to 1,488 pg/ml were present (median, 26 pg/ml). The remaining 9 patients had normal plasma sodium values between 130 and 145 mmol/L, and in these, plasma ANP values varied between 12 and 21.7 pg/ml (median, 12 pg/ml). The difference between these two groups was not statistically significant. (Control values from patients undergoing myelography were established to range between 12 and 40 pg/ml; median, 14.4 pg/ml.) ANP levels were undetectable in the cerebrospinal fluid in all. Plasma ADH levels in the hyponatremic group were between 7 and 159 pg/ml (median, 40 pg/ml). In the normonatremic group, plasma ADH levels of 25 to 250 pg/ml (median, 29 pg/ml) were obtained. (The controls ranged between 3.6 and 35 pg/ml; median, 10.4 pg/ml). In the hyponatremic group, there was a moderate negative correlation (r = -0.683) between plasma ANP and plasma sodium (P = 0.02). No correlation between plasma ADH and plasma sodium was found (r = -0.168; P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Natriuretic Factor; Blood-Brain Barrier; Humans; Hyponatremia; Inappropriate ADH Syndrome; Natriuresis; Neurologic Examination; Tuberculosis, Meningeal; Water-Electrolyte Balance

Plasma levels of arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) were measured in 15 patients with schizophrenic or schizoaffective disorders and 15 healthy volunteers during oral water loading at 20 ml/kg. In the patient group, plasma AVP was secreted even when plasma osmolality was below 270 mosmol/kg, although the sensitivity of AVP secretion response to osmolality was lower than in the controls. The ANP level was higher in the group of patients than in the controls. There was a negative correlation between plasma ANP and osmolality in the patients. We speculate that the volume expansion caused by inappropriate AVP secretion stimulated plasma ANP release and that the natriuresis resulting from the elevated plasma ANP level might contribute to hyponatremia.

Topics: Adult; Arginine Vasopressin; Atrial Natriuretic Factor; Blood; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Osmolar Concentration; Psychiatric Status Rating Scales; Radioimmunoassay; Schizophrenia; Sodium

Patients with lung cancer (n = 263) were studied to determine the relationship among ectopic production of atrial natriuretic factors (ANF) and arginine vasopressin (AVP), serum sodium, and patient outcome. Of 133, 21 (16%) patients with small cell lung cancer (SCLC) had hyponatremia (serum sodium, < 130 mmol/liter), compared to none of 130 (0%) patients with non-small cell lung cancer (P < 0.0001). Patients with extensive-stage SCLC and hyponatremia had shorter survival than patients with extensive stage SCLC and normal serum sodium values (P = 0.012). Of the 11 hyponatremic patients with SCLC and tumor cell lines available for study, 9 produced ANF mRNA, 7 of 11 produced AVP mRNA, and 5 of 11 produced both ANF mRNA and AVP mRNA. All 11 cell lines produced either ANF mRNA and ANF peptide or AVP mRNA and AVP peptide, or both. The quantity of AVP peptide in the tumor cell lines was more closely associated with hyponatremia in the patients (P = 0.0026, r2 = 0.28) than was the production of ANF peptide (P = 0.066, r2 = 0.12), although neither association was strong. All tumor cell lines studied from SCLC patients with hyponatremia produce ANF and/or AVP mRNA and peptides.

Topics: Arginine Vasopressin; Atrial Natriuretic Factor; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lung Neoplasms; Prognosis; Radioimmunoassay; Ribonucleases; RNA, Messenger; Sodium; Tumor Cells, Cultured

We describe a patient who presented with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2 months before clinical evidence of bronchogenic malignancy. Because of the potential for the ectopic production of atrial natriuretic peptide (ANP) to mimic SIADH, both hormones were measured in this hyponatremic patient to seek a possible marker of tumor activity. A hypertonic saline infusion at presentation revealed excessive osmotically decoupled secretion of arginine vasopressin but a normal ANP response.

Topics: Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Carcinoma, Small Cell; Humans; Inappropriate ADH Syndrome; Lung Neoplasms; Male; Saline Solution, Hypertonic

To describe a salt-wasting syndrome in children with central nervous system (CNS) insults and to differentiate it from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and diabetes insipidus so that it may be more readily diagnosed and treated.. Case reports.. Community teaching hospital.. Two inpatients with CNS insults (closed head trauma in one and seizure disorder, spastic diplegia, mental retardation, and hydrocephalus in the other).. Evidence of hyponatremia accompanied by elevated urine sodium concentration and excessive urine output.. Volume-for-volume urine replacement with 0.9% and/or 3% sodium chloride. Oral salt supplementation was required for brief periods to maintain normal plasma sodium concentration after discharge from the hospital.. Both patients had hyponatremia, high urine sodium concentrations, hypovolemia, and excessive urine output while receiving maintenance fluids. They also had elevated plasma atrial natriuretic hormone (ANH) concentrations, decreased aldosterone concentrations, and decreased [corrected] plasma renin activity for their degree of hyponatremia and negative fluid balance. Both patients maintained normal serum electrolyte concentrations with appropriate treatment.. These patients showed true salt wasting associated with acute or chronic CNS injury, with hormonal patterns consistent with "inappropriate" ANH secretion and distinct from the SIADH. It is important to distinguish cerebral salt wasting (CSW) from the two other major disturbances of water metabolism seen following CNS injury (ie, SIADH and diabetes insipidus), because incorrect diagnosis and treatment could greatly increase morbidity in CSW. The etiologic roles of ANH or brain natriuretic peptide in CSW need to be further elucidated.

Topics: Atrial Natriuretic Factor; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Sodium Chloride

We have examined the total number of admitted cases to clarify the pathogenesis of hyponatremia during the management of neurosurgical patients. We experienced 32 cases of hyponatremia during the past year by measuring the sodium balance and atrial natriuretic peptide (ANP) level. According to these two factors, we divided the cases into three groups. The first group shows normal ANP levels in spite of hyponatremia. Low administration of the sodium was thought to be the cause in these cases. The second group shows the elevated ANP levels with a positive sodium balance. Elevated circulatory volume due to the inadequate level of antidiuretic hormone and mild heart and/or kidney failures cause these conditions. Water restriction and/or diuresis were effective methods in the management of the cases. The last group shows the elevated ANP levels with a negative sodium balance. There is a statistically significant negative correlation between sodium balance and the ANP level. Marked natriuresis due to the elevated ANP causes the decrement of the circulatory volume in these cases. Pathogenesis of the last group is very important in the management of neurosurgical patients in an acute state, especially in subarachnoid hemorrhage cases. The decrement of the systemic circulatory volume would jeopardize the patient's neurological condition. In this group, water restriction that has been commonly recommended is contraindicated. Satisfactory water and sodium replenishment seems to be the best recommended treatment for this group.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Brain; Diuretics; Female; Fluid Therapy; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Postoperative Complications; Sodium; Sodium, Dietary

One autopsy case with small cell lung cancer and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is reported. Both plasma atrial natriuretic peptide (ANP) and arginine vasopressin (AVP) levels were high, and the presence of significantly high levels of ANP and AVP in tumor tissue was confirmed by gel chromatography and radioimmunoassay techniques. To the best of the authors' knowledge, this is the first case in which ectopic ANP production and its secretion into blood (leading to SIADH) were proved.

Topics: Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Carcinoma, Small Cell; Electrolytes; Female; Humans; Inappropriate ADH Syndrome; Lung Neoplasms; Paraneoplastic Endocrine Syndromes

Metabolic disturbances of Na, K, Ca and glucose as paraneoplastic syndrome were reviewed on the basis of recent progress of such areas. These abnormalities usually occur due to the production of hormones or other physiologically active substances by tumor tissues. Hyponatremia is the most common abnormality of Na metabolism in patients with cancers such as lung cancer, malignant lymphoma, thymoma and so on. Usual cause of hyponatremia as paraneoplastic syndrome is inadequate secretion of Antidiuretic Hormone (SIADH), which brings dilution hyponatremia associated with water intoxication. Recently hyponatremia due to abnormal secretion of atrial natriuretic peptide has been noted. Ca metabolism disturbance associated with cancer is usually observed as hypercalcemia and it is said that such hypercalcemia is seen in about 10% of cancer patients. Main cause of hypercalcemia associated with cancer is local osteolytic hypercalcemia (LOH) due to bone metastasis or humoral hypercalcemia of malignancy (HHM). The most common etiology of HHM is the production of Parathormone (PTH) related peptide (PTH-rP) massively secreted from cancer tissues. PTH-rP has been recently well investigated and its molecular, mRNA and gene structure have been already determined. The progress of this area is very rapid and PTH-rP will be assayed in the clinical laboratory in near future. As for glucose metabolism disturbance as paraneoplastic syndrome, hypoglycemia is the most common abnormality. This type of hypoglycemia has been noted in relation with excessive production of somatomedin.

Topics: Atrial Natriuretic Factor; Calcium; Glucose; Humans; Hypercalcemia; Hyponatremia; Inappropriate ADH Syndrome; Paraneoplastic Syndromes; Potassium; Sodium

To examine a possible role for atrial natriuretic peptide (ANP) in water and sodium metabolism disturbances associated with abnormal vasopressin (AVP) secretion, we measured plasma ANP concentrations in 15 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and in 17 patients with central diabetes insipidus (DI). The mean plasma ANP concentration (30.2 +/- 10.4 pmol/L) in SIADH patients who had hyponatremia, plasma hypoosmolality, hyperosmolar urinary compared to plasma sodium levels, and increased plasma AVP levels relative to plasma osmolality was significantly higher than that in normal subjects (12.6 +/- 4.9 pmol/L), although there was a considerable individual variation in plasma ANP ranging from normal to clearly elevated levels (15.1-47.0 pmol/L). When hyponatremia was corrected by water restriction or demeclocycline administration, plasma ANP levels decreased significantly and fell into the normal range (12.5 +/- 4.3 pmol/L). DI patients who complained of polyuria and polydipsia and had hypoosmolar urine, normal or elevated plasma sodium concentrations, and decreased plasma AVP levels relative to plasma osmolality, on the other hand, had a significantly lower mean plasma ANP level (7.6 +/- 2.9 pmol/L) than normal subjects. There was, again, a considerable overlap between plasma ANP levels in individual DI patients (4.2-13.9 pmol/L) and those in normal subjects. Treatment with 1-desamino-8-D-arginine vasopressin resulted in a significant increase in the mean plasma ANP level (18.6 +/- 8.0 pmol/L). There were no significant correlations between plasma ANP and AVP levels in either group of patients. The results indicate that ANP secretion is modulated by changes in plasma volume consequent to abnormal AVP secretion, which may have a pathophysiological significance in maintaining volume homeostasis.

Topics: Adolescent; Adult; Aged; Atrial Natriuretic Factor; Blood Volume; Deamino Arginine Vasopressin; Demeclocycline; Diabetes Insipidus; Female; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Polyuria; Sodium; Vasopressins; Water-Electrolyte Balance

A patient is described with the syndrome of inappropriate antidiuresis (SIAD) and renal sodium retention secondary to a lymphoma. The basal atrial natriuretic peptide (ANP) level and the ANP response to volume expansion were normal (age adjusted) but the natriuretic effect of ANP was attenuated by an unidentified factor. The case emphasizes the dominance of circulating volume over plasma tonicity in the regulation of ANP secretion.

Topics: Aged; Aldosterone; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Volume; Female; Humans; Inappropriate ADH Syndrome; Kidney; Lymphoma, Non-Hodgkin; Osmolar Concentration; Renin; Sodium

The average plasma AVP in 12 cases of patients with overt myxedema was higher than that of normal controls (n = 5) before water loading, though there was no significant difference (P greater than 0.05). The plasma ANP levels were increased (P less than 0.05). After water loading the average plasma osmolality level of patients was lower, and the mean plasma AVP concentration of patients was not suppressed after loading. A disturbance in water clearance was demonstrated. The mean levels of plasma ANP and aldosterone were not markedly changed in patients before and after loading. These observations coincide with the changes of SIADH. Most of the above blood parameters were improved along with thyroid function in 9 patients who were restored to normal after replacement with desiccated thyroid.

Topics: Adolescent; Adult; Aldosterone; Arginine Vasopressin; Atrial Natriuretic Factor; Female; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Myxedema; Water-Electrolyte Balance

Topics: Aged; Atrial Natriuretic Factor; Depressive Disorder; Electroconvulsive Therapy; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male

Cases which present abnormality in water-electrolyte before and after operation of pituitary adenoma are occasionally reported. The authors have encountered a case in which neurological symptoms became aggravated abruptly with pituitary apoplexy after admission, hyponatremia was noted before operation and polyuria, not hypotonic urine was observed after operation. As a result of an endocrinological examination which may have an influence on water-electrolyte (ADH, aldosterone, ANP, etc.) the ADH level in hyponatremia before operation was high at 6.8 pg/ml; so, it was taken as SIADH. According to a study at the time of polyuria after operation, the ADH level was normal at 2.4 pg/ml, the ANP level was abnormally high at 140 pg/ml and the specific gravity of the urine was kept at 1.010 or more. So, polyuria was considered due to abnormally increased content of serum ANP. In polyuria due to abnormally increased content of serum ANP, the osmotic pressure of the urine is maintained relatively well, which is a clinical feature evidently different from diabetes insipidus. After operation for pituitary adenoma, water-electrolyte should be controlled with polyuria due to abnormally increased content of serum ANP in addition to diabetes insipidus taken into consideration.

Topics: Atrial Natriuretic Factor; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Pituitary Apoplexy; Polyuria; Postoperative Complications; Water-Electrolyte Imbalance

The authors describe a case of subarachnoid hemorrhage with hyponatremia accompanied by elevation of plasma atrial natriuretic peptide (ANP). The early phase of hyponatremia was classified as the syndrome of inappropriate secretion of antidiuretic hormone (ADH) due to subarachnoid hemorrhage. However, in the later phase, hyponatremia and natriuresis were accompanied by suppression of ADH while plasma ANP remained elevated. The patient was effectively treated with demeclocycline and hypertonic saline. The significance of ANP in the pathophysiology of increased natriuresis is discussed.

Topics: Aged; Atrial Natriuretic Factor; Demeclocycline; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Intracranial Aneurysm; Natriuresis; Saline Solution, Hypertonic; Subarachnoid Hemorrhage; Vasopressins

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.

Topics: Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Proteins; Cardenolides; Digoxin; Dopamine; Female; Heart Failure; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lithium; Liver Cirrhosis; Male; Middle Aged; Plasma Volume; Saponins

Studies were carried out to evaluate adaptive responses to water retention in an experimental model of the syndrome of inappropriate antidiuresis (SIAD). Hyponatraemia was induced by continuous s.c. infusions of the antidiuretic vasopressin analogue 1-deamino-[8-D-arginine]-vasopressin in rats ingesting a 5% (w/v) dextrose solution. After 48 h of sustained decreases in the plasma concentration of Na+ to 23-25% of normal levels, all body fluid compartments were significantly expanded: plasma volume estimated by changes in plasma protein concentration was increased by 26%, extracellular fluid volume estimated by 22Na volume of distribution was increased by 24%, and total body water estimated by 3H2O volume of distribution was increased by 16%. Despite marked increases in all body fluid compartment volumes, mean arterial blood pressure was only modestly increased to 110 +/- 2 mmHg in conscious hyponatraemic rats. Consistent with the sustained volume expansion, both basal and stimulated plasma renin activities were significantly suppressed in the hyponatraemic rats. Plasma vasopressin levels were similarly suppressed, and the hyponatraemic rats showed a striking absence of endogenous vasopressin secretion in response to marked intravascular volume depletion (15-45%) produced by s.c. administration of polyethylene glycol. Plasma concentrations of atrial natriuretic peptide were initially stimulated four- to fivefold above basal levels in response to the water-induced volume expansion, but by 48 h fell to ranges not significantly different from basal unstimulated levels, despite continued plasma and extracellular fluid volume expansion at that time. These results illustrate that multiple haemodynamic and hormonal adaptive responses occur with sustained dilutional hyponatraemia in rats, and suggests that these can be of sufficient magnitude to allow continued water retention without necessarily provoking either escape from antidiuresis or continued natriuresis. In contrast with previous studies in experimental animals in which hyponatraemia was maintained by continuous forced administration of hypotonic fluid, rats in this model reached a steady state with characteristics resembling many of those observed clinically in patients with SIAD.

Topics: Animals; Arginine Vasopressin; Atrial Natriuretic Factor; Body Fluid Compartments; Body Fluids; Body Water; Extracellular Space; Hyponatremia; Inappropriate ADH Syndrome; Male; Plasma Volume; Rats; Rats, Inbred Strains; Renin

A fullterm infant had fetal distress and stained amnion. He underwent an exchange blood transfusion at 12 hours after birth because of hyperbilirubinemia. He developed oliguria combined with high urine osmolality during the first 27 hours of life despite normal creatinine clearance. The diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was made on the basis of high urine osmolality, low plasma osmolality and elevated plasma arginine vasopressin (AVP) concentration. We determined the plasma atrial natriuretic peptide (ANP) concentration for the first 4 days of life. After 27 hours after birth, urine volume increased while plasma AVP concentration remained high. On the other hand, plasma ANP concentration gradually increased after 27 hours of life. We speculate that ANP may play an important role in producing the spontaneous diuresis in the newborn infant with SIADH.

Topics: Atrial Natriuretic Factor; Diuresis; Humans; Inappropriate ADH Syndrome; Infant, Newborn; Male

Topics: Aged; Antineoplastic Agents; Atrial Natriuretic Factor; Humans; Inappropriate ADH Syndrome; Lung Diseases; Male; Neoplasms; Vasopressins

The mechanisms responsible for the natriuresis encountered in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) are not fully understood. The present study explores the role of atrial natriuretic factor (ANF). Eight subjects unable to excrete ingested free water normally (three patients with SIADH and five healthy humans after intranasal administration of desmopressin) underwent a standard oral water loading test. Plasma ANF level and urinary sodium excretion increased during water retention, whereas plasma aldosterone value decreased later. The increment of urinary sodium excretion rate was significantly correlated with that of plasma ANF. In two patients with hyponatremia due to SIADH, plasma ANF levels were increased during the hyponatremic phase of their condition and decreased under water restriction. In one of them, marked natriuresis was observed when the plasma ANF level was high. It is concluded that secretion of ANF is acutely and chronically stimulated during water retention in SIADH and that ANF may be in part responsible for the natriuresis encountered in inappropriate antidiuresis.

Topics: Adult; Aged; Atrial Natriuretic Factor; Deamino Arginine Vasopressin; Female; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Natriuresis; Renin-Angiotensin System; Water; Water-Electrolyte Balance

This study explored whether atrial natriuretic hormone (ANH) might be involved in the escape from salt and water retention that occurs in patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Sixteen patients with low serum Na+ concentrations [123 +/- 1 (+/- SE) mmol/L] were studied. Each patient excreted urine that was hyperosmolar (mean, 391 +/- 4 mosmol/kg) in relation to serum osmolality (mean, 258 +/- 4 mosmol/kg). Sodium excretion (81 +/- 20 mmol/L) also was inappropriate to the low serum Na+ level. The probable causes of SIADH were head trauma (4), pneumonia (5), lung cancer (3), and chlorpropamide therapy (4). In the nontumor patients, plasma and/or urinary vasopressin (AVP) concentrations were in the normal range, but inappropriate for serum osmolality. Urinary AVP values of 50 pg/mL or more (greater than 46 pmol/L) were found in the three tumor patients. The mean plasma ANH concentration was 6-fold higher than that in normal subjects [296 +/- 51 vs. 51 +/- 13 pg/mL (100 +/- 20 vs. 17 +/- 4 pmol/L); P less than 0.01]. Six SIADH patients were studied again after brief (1-3 days) water restriction. Although serum osmolality increased in each, their plasma AVP concentrations decreased very little, and urinary AVP excretion and plasma ANH did not change. These results indicate that plasma ANH levels are markedly increased in patients with SIADH. Their increased ANH secretion may antagonize water retention resulting from the inappropriate AVP secretion.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Electrolytes; Female; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Osmolar Concentration; Vasopressins; Water-Electrolyte Balance

Topics: Atrial Natriuretic Factor; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Natriuresis

Topics: Adult; Aged; Atrial Natriuretic Factor; Diabetes Insipidus; Humans; Inappropriate ADH Syndrome; Middle Aged; Pituitary Gland, Posterior; Renin-Angiotensin System; Vasopressins

Continuous intravenous infusion of rat atrial natriuretic peptide (rANP) was carried out for 60 min in urethan-anesthetized rats. Plasma rANP (PANP) levels during 0, 12.5, and 50 ng/min rANP infusion reached 20.9 +/- 3.4, 61.2 +/- 12.3, and 228 +/- 30.6 pg/ml, respectively. Urinary sodium excretion (UNaV) remained unchanged during the 0 and 12.5 ng/min rANP infusion. In contrast, the 50 ng/min rANP infusion resulted in a 5.6-fold increase in UNaV without significant changes in plasma aldosterone levels and glomerular filtration rate. Isotonic saline infusion (116 microliter/min for 60 or 120 min) caused a significant increase in UNaV. UNaV in an experimental model of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was 5.0 times greater than in control animals. PANP levels in 60- or 120-min saline-infused and SIADH rats were 46.3 +/- 6.7, 39.0 +/- 9.0, and 35.6 +/- 3.2 pg/ml, respectively. These values were significantly higher than control values but failed to achieve a level at which natriuresis occurred during the infusion of rANP. These results suggest that endogenous ANP may not play a critical role in the induction of acute natriuresis in volume-expanded states, although it could be partially involved in such a natriuretic response.

Topics: Aldosterone; Animals; Atrial Natriuretic Factor; Blood Volume; Glomerular Filtration Rate; Inappropriate ADH Syndrome; Male; Natriuresis; Rats; Rats, Inbred Strains

Topics: Adrenal Insufficiency; Atrial Natriuretic Factor; Blood Pressure; Cushing Syndrome; Humans; Hyperaldosteronism; Hypertension, Malignant; Hyperthyroidism; Hypothyroidism; Inappropriate ADH Syndrome

A 62-year-old man with small cell carcinoma (oat cell type) of the lung who had hyponatremia and renal sodium loss with inappropriate antidiuresis is reported. Plasma levels of arginine vasopressin (AVP) were not elevated inappropriately. Plasma levels of atrial natriuretic peptide (ANP), however, were high, and increased after water loading and hypertonic saline infusion. The renin-aldosterone axis was normal, as were adrenal, thyroid, and renal functions. Water restriction to 500 to 700 ml/d resulted in a rise in serum sodium. Analysis of the tumor tissue failed to demonstrate the presence of AVP or ANP. The findings (1) suggest that hyponatremia and renal sodium loss with inappropriate antidiuresis observed in the patient is due to an antidiuretic substance distinct from AVP, and (2) point to the possibility that hypersecretion of ANP may play a role in the pathophysiology.

Topics: Arginine Vasopressin; Atrial Natriuretic Factor; Carcinoma, Small Cell; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lung Neoplasms; Male; Middle Aged; Saline Solution, Hypertonic; Water

Topics: Atrial Natriuretic Factor; Humans; Inappropriate ADH Syndrome; Male; Middle Aged

Topics: Aged; Atrial Natriuretic Factor; Extracellular Space; Humans; Inappropriate ADH Syndrome; Male; Sodium

Topics: Aged; Atrial Natriuretic Factor; Female; Humans; Inappropriate ADH Syndrome