ELK Department of Respiratory Diseases, Lindenberger Weg 27, 13125, Berlin, Germany.
BMC Pulm Med. 2013 Aug 29;13:55. doi: 10.1186/1471-2466-13-55.
Hyponatremia based on syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) is observed in up to 15% of patients with small cell lung cancer (SCLC). The electrolyte imbalance is associated with a high morbidity and mortality and often delays appropriate treatment. Management of hyponatremia proved to be challenging until new vasopressin-2 receptor antagonists such as tolvaptan became available. This is the first report which presents a prospective case series with an efficient management of hyponatremia including tolvaptan in ten patients with SCLC and severe SIADH (plasma sodium < 125 mmol/l).
Ten patients with SCLC and severe SIADH were followed after the onset of clinical symptoms of SIADH. Patients were chosen on the basis of histological proven diagnosis of SCLC and the clinical picture of a neurocognitive deficit caused by SIADH-related hyponatremia. All patient data were monitored for clinical improvement based on ECOG status, commencement of chemotherapy and correction of sodium levels.
The treatment followed a diagnostic and treatment algorithm and lead to a rapid and efficient correction of both clinical symptoms and plasma sodium level.
Based on this algorithm all patients started chemotherapy in time. Subsequently, the treatment with tolvaptan lead to an improvement of the ECOG-performance status. In addition, all patients benefit from the effective management of SIADH which omitted prolonged hospital stays and non-elective hospitalizations due to an unstable clinical condition due to severe hyponatremia. These observations add new insight to management of SIADH in thoracic oncology and are of interest for specialists in oncology, endocrinology and pulmonary medicine.
小细胞肺癌（SCLC）患者中多达 15%存在抗利尿激素分泌不当综合征（SIADH）导致的低钠血症。电解质失衡与高发病率和死亡率相关，并且经常延迟适当的治疗。直到新型血管加压素 2 受体拮抗剂（如托伐普坦）问世，低钠血症的管理才变得具有挑战性。这是首例报告，介绍了一项前瞻性病例系列研究，其中包括 10 例 SCLC 和严重 SIADH（血浆钠<125mmol/L）患者在内的低钠血症的有效管理，包括托伐普坦。
10 例 SCLC 和严重 SIADH 的患者在出现 SIADH 临床症状后进行随访。选择这些患者是基于组织学证实的 SCLC 诊断和由 SIADH 相关低钠血症引起的神经认知缺陷的临床表现。所有患者的数据均进行监测，以根据 ECOG 状态、开始化疗和纠正钠水平来评估临床改善。
该治疗遵循诊断和治疗算法，迅速有效地纠正了临床症状和血浆钠水平。
根据该算法，所有患者均及时开始化疗。随后，托伐普坦的治疗改善了 ECOG 表现状态。此外，所有患者均受益于 SIADH 的有效管理，这避免了由于严重低钠血症导致不稳定的临床状况而延长住院时间和非选择性住院。这些观察结果为胸科肿瘤学中的 SIADH 管理提供了新的见解，对肿瘤学、内分泌学和呼吸医学专家具有重要意义。
