Ishii Tomoko, Ohtake Takayasu, Yasu Takeo, Kadotani Yasuhiro, Hayashi Shuji, Oka Machiko, Maesato Kyoko, Mano Tsutomu, Ikee Ryota, Moriya Hidekazu, Kobayashi Shuzo
Department of Nephrology and the Kidney and Dialysis Center, Shonan Kamakura General Hospital, Yamazaki, Kamakura, Japan.
Am J Kidney Dis. 2006 Jul;48(1):155-8. doi: 10.1053/j.ajkd.2006.03.078.
An 83-year-old Japanese woman was admitted to our hospital with severe hyponatremia (sodium, 108 mEq/L [108 mmol/L]), hypokalemia, hypochloridemia, hypocalcemia, hypophosphatemia, and hypouricemia. Despite low plasma osmolarity (232 mOsm/kg [232 mmol/kg]), urine osmolarity (320 mOsm/kg) was greater than that of plasma, and she had increased urinary sodium excretion (88 mEq/L [88 mmol/L]) and an unsuppressed high plasma level of antidiuretic hormone (ADH; 5.5 pg/mL [5.1 pmol/L]). These findings indicated that she had syndrome of inappropriate ADH secretion (SIADH). In addition, she had a generalized reabsorption defect of the proximal tubules, including decreased tubular reabsorption of phosphate, increased fractional excretion of uric acid, glycosuria despite a normal blood glucose level, and panaminoaciduria. Thus, combined SIADH and Fanconi syndrome was diagnosed. The cause was thought to be the antidepressant paroxetine, which is a selective serotonin reuptake inhibitor (SSRI). Several of the abnormal values resolved within 1 week after discontinuation of this drug. Although the precise mechanism responsible was not elucidated, we report an extremely rare case of combined SIADH and Fanconi syndrome, probably caused by short-term SSRI therapy.
一名83岁的日本女性因严重低钠血症（血钠108 mEq/L [108 mmol/L]）、低钾血症、低氯血症、低钙血症、低磷血症和低尿酸血症入住我院。尽管血浆渗透压较低（232 mOsm/kg [232 mmol/kg]），但尿渗透压（320 mOsm/kg）高于血浆渗透压，且尿钠排泄增加（88 mEq/L [88 mmol/L]），抗利尿激素（ADH）血浆水平未受抑制且较高（5.5 pg/mL [5.1 pmol/L]）。这些发现表明她患有抗利尿激素分泌不当综合征（SIADH）。此外，她存在近端肾小管的广泛性重吸收缺陷，包括肾小管对磷酸盐的重吸收减少、尿酸排泄分数增加、血糖水平正常但出现糖尿以及全氨基酸尿。因此，诊断为SIADH合并范科尼综合征。病因被认为是抗抑郁药帕罗西汀，它是一种选择性5-羟色胺再摄取抑制剂（SSRI）。停用该药物后1周内，部分异常值得到缓解。尽管具体机制尚不清楚，但我们报告了一例极罕见的SIADH合并范科尼综合征病例，可能由短期SSRI治疗引起。
