Papadimitriou Dimitrios T, Spiteri Anne, Pagnier Anne, Bayle Monique, Mischalowski Mariana Bohns, Bourdat Guylhène, Passagia Jean-Guy, Plantaz Dominique, Bost Michel, Garnier Philippe E
Division of Pediatric Endocrinology, Department of Pediatrics, Centre Hospitalier Universitaire, Grenoble, France.
J Pediatr Endocrinol Metab. 2007 Oct;20(10):1145-50. doi: 10.1515/jpem.2007.20.10.1145.
Acute hyponatremia, following neurosurgery, results from inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting (CSW). CSW is due to abnormally high atrial or brain natriuretic peptides (ANP, BNP), which block all stimulators of zona glomerulosa steroidogenesis, resulting in mineralocorticoid deficiency. A 3 year-old girl presented CSW at day 4, after resection of craniopharyngioma and hypophysectomy. Hyponatremia, hyperkalemia and high natriuresis occurred on day 8, with low renin and aldosterone and elevated BNP 120.3 ng/ml (undetectable before surgery). Fludrocortisone 100 microg/day controlled natriuresis and restored electrolytes within 24 hours. A 5 year-old boy presented CSW at day 6 after partial resection of optic glioma. Fludocortisone 100 microg/day restored electrolytes within 8 hours. ANP was elevated, 60.6 ng/l, aldosterone and renin were low. Fludrocortisone supplementation should be considered in CSW, as excessive natriuresis is controlled, and electrolytes are easily restored, avoiding life-threatening complications of this complex disorder.
神经外科手术后的急性低钠血症是由抗利尿激素分泌不当综合征（SIADH）或脑性盐耗综合征（CSW）引起的。CSW是由于心房或脑利钠肽（ANP、BNP）异常升高，它们阻断了肾小球旁器类固醇生成的所有刺激因素，导致盐皮质激素缺乏。一名3岁女孩在颅咽管瘤切除和垂体切除术后第4天出现CSW。第8天出现低钠血症、高钾血症和高钠尿症，肾素和醛固酮水平低，BNP升高至120.3 ng/ml（术前检测不到）。每天100微克氟氢可的松可控制钠尿，并在24小时内恢复电解质平衡。一名5岁男孩在视神经胶质瘤部分切除术后第6天出现CSW。每天100微克氟氢可的松在8小时内恢复了电解质平衡。ANP升高至60.6 ng/l，醛固酮和肾素水平低。对于CSW应考虑补充氟氢可的松，因为过量的钠尿得到控制，电解质易于恢复，可避免这种复杂疾病危及生命的并发症。
