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Hyponatraemia in a lady with a pelvic mass

Q1: What is the best explanation for her biochemical picture?
The biochemical results are compatible with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The patient displays the cardinal features of hyponatraemia, hypo-osmolality, and a urinary osmolality greater than that appropriate for the concomitant plasma hypotonicity, in the absence of any clinical evidence of fluid volume depletion. Normal function of the kidneys, adrenal and thyroid glands is a part of the definition.¹

Q2: List the possible causes
Drug related SIADH as a complication of CHOP chemotherapy is the most likely aetiology. Certain pharmacological agents can cause hyponatraemia and antidiuresis by releasing vasopressin, and others can cause it by potentiating ADH action. Cyclophosphamide and vincristine are the most likely causes of hyponatraemia in this setting. Given the clinical response to chemotherapy and the timing of the hyponatraemia, SIADH related to the neoplasm is considered less likely here. Furthermore, chemotherapy induced nausea, a potent stimulus of ADH release,² was not present in the current case.

Q3: What is the management?
Regardless . . . [Full text of this article]

Relevant Article

Hyponatraemia in a woman with a pelvic mass

K M Chow and C C Szeto
Postgrad. Med. J. 2003 79: 61. [Extract] [Full Text] [PDF]