Syndrome of inappropriate antidiuresis in ovarian serous carcinoma with neuroendocrine differentiation

Syndrome of inappropriate antidiuretic hormone secretion associated with an ovarian immature teratoma: A case report and review of the literature

•

SIADH can be associated with an ovarian immature teratoma.

•

Medical management of SIADH improved but did not resolve the hyponatremia.

•

Complete resolution of the hyponatremia was only obtained after surgical debulking.

Pancreatic Neuroendocrine Tumor Producing Insulin and Vasopressin

The objective of the study is to report a rare case of pancreatic neuroendocrine tumor (pNET) producing insulin and vasopressin. We describe the clinical presentation and management of a metastatic pNET with refractory hypoglycemia and progressive severe hyponatremia. A 52-year-old patient had abdominal pain leading to the diagnosis of a tumor that was initially presumed to be splenic in origin. Investigations ultimately identified a pancreatic mass that on biopsy proved to be a pNET. Eventually, he developed extensive liver metastases, and with tumor progression, he manifested hypoglycemia and severe hyponatremia. He was managed with multiple therapies including somatostatin analogue, peptide-receptor-radionuclide-therapy (PRRT), diazoxide, and everolimus; none of these therapeutic modalities was successful in controlling functional and structural progression of the tumor. Ultimately, the pNET proved fatal and autopsy confirmed widely metastatic disease that stained strongly and diffusely for vasopressin, a feature not seen in the previous liver biopsy. This case illustrates the challenges of diagnosis and management of aggressive insulin-producing pNETs and highlights the potential concomitant ectopic production of vasopressin leading to refractory hyponatremia.

Syndrome of Inappropriate Antidiuretic Hormone after vinorelbine treatment

BACKGROUND

Among oncologic patients, Syndrome of Inappropriate Antidiuretic Hormone is a common cause of hyponatremia, a prevalent electrolyte disorder. There are many causes for Syndrome of Inappropriate Antidiuretic Hormone, including chemotherapy medications. To date, only three cases associating vinorelbine and Syndrome of Inappropriate Antidiuretic Hormone have been published.

CASE

A 47-year-old woman with stage IIIC serous ovarian adenocarcinoma developed life-threatening hyponatremia (124 mmol/L) after three cycles of vinorelbine. Assessment revealed Syndrome of Inappropriate Antidiuretic Hormone as the most likely culprit. Conservative managements including free fluid restriction normalized her sodium level and Syndrome of Inappropriate Antidiuretic Hormone resolved after vinorelbine discontinuation.

CONCLUSION

Vinorelbine can cause Syndrome of Inappropriate Antidiuretic Hormone. It is important to monitor sodium concentration during vinorelbine treatment to avoid serious neurological complications of hyponatremia and to improve patient's quality of life.

Cushing’s syndrome due to ovarian serous adenocarcinoma secreting multiple endocrine substances: a case report and immunohistochemical analysis

BACKGROUND

Although Cushing's syndrome arises from various neuroendocrine tumors secreting adrenocorticotropin (ACTH) ectopically, ovarian carcinoma rarely causes this syndrome.

CASE

A 66-year-old woman presented with facial swelling and skin pigmentation. She manifested hypercortisolemia, high plasma ACTH, and lack of dexamethasone suppression. MRI showed a solid ovarian tumor and resection of the tumor led to normalization of ACTH and cortisol levels. In addition, elevated serum vasopressin (ADH) and alpha-fetoprotein (AFP) were found, which were also normalized after removal of tumors. Pathological diagnosis was serous adenocarcinoma with neuroendocrine and hepatoid features. Immunohistochemistry detected immunoreactivity of chromogranin A, ACTH, ADH, and AFP in tumor cells.

CONCLUSION

This is a very rare case of successful treatment of Cushing's syndrome arising from an ovarian adenocarcinoma secreting multiple endocrine substances.

Syndrome of inappropriate secretion of antidiuretic hormone in malignancy

OBJECTIVES

To provide a review of pathophysiology, epidemiology, signs and symptoms, diagnosis, treatment, and nursing management of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignancy.

DATA SOURCES

Research reports, review articles, and book chapters relevant to SIADH.

CONCLUSIONS

The principle cause of hyponatremia in malignancy is SIADH. Early recognition and prompt treatment can prevent serious neurologic sequelae. Antineoplastic therapy and methods to correct hyponatremia constitute effective treatment strategies.

IMPLICATIONS FOR NURSING PRACTICE

Nurses play a major role in nursing assessment, appropriate interventions and symptom control, and promoting resolution of problems and optimal quality of life in patients with malignancy complicated by SIADH.