Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review

doi:10.3969/j.issn.1004-583X.2022.05.012

Abstract

Abstract:

Objective To provide evidences for clinical diagnosis and treatment of multiple system atrophy (MSA) complicated with the syndrome of inappropriate antidiuresis (SIAD) by exploring clinical features of the disease. Methods The clinical data, diagnosis & treatment process of a patient with MSA complicated with SIAD were retrospectively analyzed, and relevant literature was reviewed. Results The patient was a 58-year-old male with intermittent disturbance of consciousness accompanied by cough and sputum for more than 1 month, and then underwent the disease attack for 2 days. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: ①Severe hyponatremia; ②Pulmonary infection; ③ MSA. The patient was confirmed to have SIAD after supplementing relevant auxiliary examination and combining corresponding clinical manifestations. The patient's pulmonary infection was cured except for persistent hyponatremia after therapies including anti-infection, water fasting and sodium supplementation. Conclusion MSA may be the cause of SIAD, and pulmonary infection may be the susceptible factor of SIAD complicated with MSA. The control over water-sodium balance should be strengthened for patients with MSA, especially the cases complicated with pulmonary infection.

Key words: multiple system atrophy, syndrome of inappropriate antidiuresis, hyponatremia

CLC Number:

R587.1

Qiu Jianmei, Shen Hongxia, Wang Defeng. Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review[J]. Clinical Focus, 2022, 37(5): 451-454.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.05.012

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I5/451

Figures/Tables 2

References 18

[1]	Koga S, Dickson DW. Recent advances in neuropathology,biomarkers and therapeutic approach of multiple system atrophy[J]. J Neurol Neurosurg Psychiatry, 2018, 89(2):175-184. doi: 10.1136/jnnp-2017-315813 URL
[2]	Moritz ML. Syndrome of inappropriate antidiuresis[J]. Pediatr Clin North Am, 2019, 66(1):209-226. doi: 10.1016/j.pcl.2018.09.005 URL
[3]	Cuzzo B, Padala SA, Lappin SL. Physiology, vasopressin[EB/OL]. [2021-8-27]. https://pubmed2.ilibs.cn/books/NBK526069.
[4]	Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia[J]. Eur J Endocrinol, 2014, 170(3):G1-47. doi: 10.1530/EJE-13-1020 URL
[5]	Peri A, Giuliani C. Management of euvolemic hyponatremia attributed to SIADH in the hospital setting[J]. Minerva Endocrinol, 2014, 39(1):33-41. pmid: 24513602
[6]	Cuesta M, Garrahy A, Thompson CJ. SIAD:Practical recommendations for diagnosis and management[J]. J Endocrinol Invest, 2016, 39(9):991-1001. doi: 10.1007/s40618-016-0463-3 pmid: 27094044
[7]	Fanciulli A, Stankovic I, Krismer F, et al. Multiple system atrophy[J]. Int Rev Neurobiol, 2019, 149:137-192.
[8]	Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Diagnosis of multiple system atrophy[J]. Auton Neurosci, 2018, 211:15-25. doi: 10.1016/j.autneu.2017.10.007 URL
[9]	Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy[J]. Neurology, 2008, 71(9):670-676. doi: 10.1212/01.wnl.0000324625.00404.15 pmid: 18725592
[10]	Burns MR, McFarland NR. Current management and emerging therapies in multiple system atrophy[J]. Neurotherapeutics, 2020, 17(4):1582-1602. doi: 10.1007/s13311-020-00890-x URL
[11]	Nagumo K, Kita K, Kitano K, et al. Shy-Drager syndrome and the syndrome of inappropriate secretion of antidiuretic hormone[J]. Rinsho Shinkeigaku, 1992, 32(2):177-181.
[12]	Samukawa M, Hirano M, Sakanoto H, et al. Risks of inappropriate secretion of antidiuretic hormone in multiple system atrophy[J]. Mov Disord, 2011, 26(14):2572-2573. doi: 10.1002/mds.23904 URL
[13]	谢曼青, 张燕, 王含, 等. 多系统萎缩伴抗利尿激素分泌不当综合征三例临床分析[J]. 中国现代神经疾病杂志, 2017, 17(2):133-137.
[14]	苏停停, 刘洁, 高璐, 等. 多系统萎缩合并抗利尿激素不适当分泌综合征一例[J]. 中华内分泌代谢杂志, 2019, 35(6):511-514.
[15]	葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018:677.
[16]	Sahu A, Dube MG, Kalra SP, et al. Bilateral neural transections at the level of mesencephalon increase food intake and reduce latency to onset of feeding in response to neuropeptide Y[J]. Peptides, 1988, 9(6):1269-1273. pmid: 3247249
[17]	Sone H, Okuda Y, Bannai C, et al. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and Gerhardt syndrome associated with Shy-Drager syndrome[J]. Intern Med, 1994, 33(12):773-778. doi: 10.2169/internalmedicine.33.773 URL
[18]	Frouget T. The syndrome of inappropriate antidiuresis[J]. Rev Med Interne, 2012, 33(10):556-566. doi: 10.1016/j.revmed.2012.07.005 pmid: 22884285

患者编号	性别	年龄 (岁)	病史 (年)	诊断类型	血清钠 (mmol/L)	血浆渗透压 (mOsm/L)	尿渗透压 (mOsm/L)	24小时尿钠 (mmol/L)	合并症
1	男	53	2	MSA-C	122	258	945	209	肺炎
2	男	62	3	MSA-P	123	280	457	91	肺炎
3	男	59	4	MSA-C	118	-	-	144	肺炎
4	男	53	5	MSA-P	121	-	-	129	无
5	女	61	9	MSA-C	99	205	474	-	肺炎
6	男	52	4	MSA-P	127	262	319	-	无
7	男	67	11	MSA-P	124	255	420	-	心脏起搏器
8	男	52	10	MSA-C	120	246	381	-	发热
9	男	76	1.5	MSA-P	118	244	304	-	无
10	女	62	8	MSA-C	118	254	-	-	呼吸暂停
11	女	58	6	MSA-P	116	-	722	-	肾盂肾炎
12	男	67	11	MSA	124	268	500	-	呼吸暂停

患者编号	性别	年龄 (岁)	病史 (年)	诊断类型	血清钠 (mmol/L)	血浆渗透压 (mOsm/L)	尿渗透压 (mOsm/L)	24小时尿钠 (mmol/L)	合并症
1	男	53	2	MSA-C	122	258	945	209	肺炎
2	男	62	3	MSA-P	123	280	457	91	肺炎
3	男	59	4	MSA-C	118	-	-	144	肺炎
4	男	53	5	MSA-P	121	-	-	129	无
5	女	61	9	MSA-C	99	205	474	-	肺炎
6	男	52	4	MSA-P	127	262	319	-	无
7	男	67	11	MSA-P	124	255	420	-	心脏起搏器
8	男	52	10	MSA-C	120	246	381	-	发热
9	男	76	1.5	MSA-P	118	244	304	-	无
10	女	62	8	MSA-C	118	254	-	-	呼吸暂停
11	女	58	6	MSA-P	116	-	722	-	肾盂肾炎
12	男	67	11	MSA	124	268	500	-	呼吸暂停