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Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with multiple sclerosis

E Ishikawa1, S Ohgo, K Nakatsuru

  • 1Department of Internal Medicine, Miyazaki Medical College, Japan.

Japanese Journal of Medicine
|January 1, 1989
PubMed

Insights

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rarely associated with multiple sclerosis (MS). This case report details a patient with MS experiencing SIADH, suggesting a link between demyelination and ADH dysregulation.

Area of Science:

  • Neurology
  • Endocrinology

Background:

  • The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is infrequently associated with neurological disorders.
  • Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system.

Observation:

  • A 62-year-old female with neurological symptoms consistent with MS experienced recurrent episodes of hyponatremia and altered consciousness.
  • Laboratory findings during episodes included high antidiuretic hormone (ADH) levels, low plasma osmolality, concentrated urine, and elevated urinary sodium excretion (>20 mEq/day).
  • Brain imaging revealed periventricular lesions typical of MS, with normal appearance of the hypothalamus and pituitary gland.

Findings:

  • The patient's clinical presentation and laboratory results were consistent with SIADH.
  • The location of MS lesions in the periventricular region, functionally connected to the hypothalamus, suggests a causal link to ADH dysregulation.
  • Demyelinating processes in the periventricular region are proposed to abnormally influence ADH secretion, leading to SIADH in this MS patient.

Implications:

  • This case suggests a potential pathophysiological mechanism linking MS-related demyelination to SIADH.
  • Understanding this association may improve the diagnosis and management of SIADH in multiple sclerosis patients.
  • Further research is warranted to elucidate the precise mechanisms and rule out other contributing factors, such as increased intrathoracic pressure.

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