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A young boy with recurrent headache, lethargy, and hyponatremia
Liyun Cao1, Elizabeth A Wagar1, Qing H Meng1
1Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
Background:
To investigate and differentiate the causes of hyponatremia in an 8-y old boy.
Methods:
An 8-y boy presented with headache, vomiting, and diplopia. Magnetic resonance imaging of the brain confirmed a mass in the pineal region. Pathology report demonstrated a mixed germ cell tumor with a yolk sac component. A multi-agent chemotherapy and radiation regimen was initiated. He developed hyponatremia, with sodium concentrations varying from 116 to 133 mEq/l.
Results:
Serum levels of sodium, chloride, phosphorous, uric acid, and osmolality were low. Serum α-fetoprotein, β-HCG, and lactate dehydrogenase were highly elevated. Urine sodium and osmolality were increased.
Conclusions:
These presentations suggest that the patient has cerebral salt-wasting syndrome caused by intracranial germ cell tumor. Recognition and differentiation of cerebral salt-wasting syndrome from other disorders are essential.
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