Postoperative free water administration is associated with dysnatremia after congenital heart disease surgery in infants

Pediatric adrenocortical carcinoma complicated by uric acid nephrolithiasis: a unique case report

BACKGROUND

Adrenocortical carcinoma (ACC) is an exceedingly rare malignancy in children, typically presenting with Cushing's syndrome due to excessive hormone secretion. The occurrence of uric acid nephrolithiasis in pediatric ACC patients is exceptionally uncommon.

CASE PRESENTATION

We report the case of a 5-year-old boy who exhibited symptoms of Cushing's syndrome over a period of 10 months, including rapid weight gain, moon face, and increased chest and back hair growth. Laboratory tests revealed elevated cortisol, 17-hydroxyprogesterone, and testosterone levels. Imaging studies identified a 6.6 × 5.6 cm mass in the left adrenal gland, which was confirmed as ACC through biopsy and immunohistochemistry. One day prior to the scheduled adrenalectomy, the patient developed renal colic due to multiple kidney stones, as evidenced by emergency CT scans showing bilateral nephrolithiasis and a stone in the left upper ureter with mild hydronephrosis. Postoperatively, the patient spontaneously expelled brick-red uric acid stones. With glucocorticoid replacement therapy, his hormonal levels and clinical symptoms normalized within a year. A four-year follow-up revealed no recurrence of ACC or urolithiasis, and his hormonal parameters remained within normal ranges.

CONCLUSION

This case highlights the rare association between ACC and uric acid nephrolithiasis in children. The spontaneous passage of uric acid stones provides insights into the link between stone formation and metabolic disorders, emphasizing the need for comprehensive endocrine and metabolic assessments in pediatric ACC management.

Postoperative hypernatremia is associated with worse brain injuries on EEG and MRI following pediatric cardiac surgery

Objectives

Dysnatremia is a common electrolyte disturbance after cardiopulmonary bypass (CPB) surgery for congenital heart disease (CHD) and a known risk factor for adverse neurological events and clinical outcomes. The objective of this study was to evaluate the association of dysnatremia with worse abnormal EEG patterns, brain injuries detected by magnetic resonance imaging (MRI) and early adverse outcomes.

Methods

We monitored continuous EEG in 340 children during the initial 48 h following cardiac surgery. Demographics and clinical characteristics were recorded. Sodium concentrations were measured in the arterial blood gas analysis every 6 h. Hyponatremia and hypernatremia were classified by the average of sodium concentrations over 48 h. Postoperative cerebral MRI was performed before hospital discharge.

Results

In our patient cohort, dysnatremia was present in 46 (13.5%) patients. Among them, hyponatremia occurred in 21 (6.2%) and hypernatremia in 25 (7.4%). When compared to patients with normonatremia, hyponatremia was not associated with EEG abnormalities and early adverse outcomes (Ps ≥ .14). In hypernatremia group, the CPB time was significantly longer and more frequent use of DHCA (Ps ≤ .049). After adjusting for time, CPB time and the use of DHCA, hypernatremia was significantly associated with worse EEG abnormalities (including background, seizures and pathological delta brushes), more severe brain injuries on MRI (Ps ≤ .04) and trended to be associated with longer postoperative mechanical ventilation time (P = .06).

Conclusion

Hypernatremia and hyponatremia were common in children after cardiac surgery. Hypernatremia, but not hyponatremia, was significantly associated with worse EEG abnormalities and more severe brain injuries on MRI and extended postoperative mechanical ventilation time.