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Hyponatremia hypo-osmolarity in neurosurgical patients. “Appropriate secretion of ADH” and “Cerebral salt wasting syndrome”

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Summary

This prospective study is based on 256 patients with severe brain injury. Six patients (2.3%) developed the clinical picture of inappropriate secretion of antidiuretic hormone (SIADH): 3 in the first 3 days following the injury, 3 after more than a week. Their ADH plasmatic level were measured by radio-immunoassay. In the former, many factors, largely iatrogenic, can explain the increased secretion of ADH we found and which is then definitely “appropriate”. It should be prevented by fluid restriction. In the latter, we found adequately low ADH levels, when the hypo-osmolarity is taken into account. Here, the aetiology seems to be a renal salt loss, eventually in relation to a natriuric factor (e.g. atrial natriuretic factor), justifying the term: “Cerebral salt wasting syndrome”. With the resistance to fluid restriction, the treatment still remains a problem.

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References

  1. Auger RG, Zehr JE, Siekert RG, Segar WE (1970) Position effect on antidiuretic hormone. Arch Neurol 23: 513–517

    PubMed  Google Scholar 

  2. Bartter FC, Schwartz WB (1967) The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42: 790–806

    PubMed  Google Scholar 

  3. Born JD, Hans P, Legros JJ (1982) Incidence du syndrome de sécrétion inappropriée d'hormone antidiurétique chez le traumatisé cranien grave. Neurochirurgie 28: 213–221

    PubMed  Google Scholar 

  4. Born JD, Hans P, Smitz S, Legros JJ, Kay S (1985) Syndrome of inappropriate secretion of antidiuretic hormone after severe head injury. Surg Neurol 23: 383–387

    PubMed  Google Scholar 

  5. Bouzarth WF, Shenkin HA (1982) Is “cerebral hyponatraemia” iatrogenic? Lancet 1061–1062

  6. Brunner DB, Burnier M, Brunner HR (1983) Plasma vasopression in rats: effect of sodium angiotensin and catecholamines. Am J Physiol 244: H259–265

    PubMed  Google Scholar 

  7. De Wardener HE, Clarkson EM (1982) The natriuretic hormone: recent developments. Clin Sci 63: 415–420

    PubMed  Google Scholar 

  8. De Bold AJ, Borenstein HB, Veress AT, Sonnenberg H (1981) A rapid and potent natriuretic response to intravenous injection of atrial myocardial extracts in rats. Life Sci 28: 89–94

    PubMed  Google Scholar 

  9. Doczi T, Tarjanyi J, Hushka E, Kiss J (1982) Syndrome of inappropriate secretion of antidiuretic hormone after head injury. Neurosurgery 10: 685–688

    PubMed  Google Scholar 

  10. Fichmann MP, Bethune JE (1968) The role of adrenocorticoïds in the inappropriate antidiuretic hormone syndrome. Ann Intern Med 68: 806–820

    PubMed  Google Scholar 

  11. Fox JL, Falik JL, Shaloub RJ (1971) Neurosurgical hyponatremia: The role of inappropriate antidiuresis. J Neurosurg 34: 506–514

    PubMed  Google Scholar 

  12. Gaufin L, Skowsky WR, Goodman SJ (1977) Release of antidiuretic hormone during mass-induced elevation of intracranial pressure. J Neurosurg 46: 627–637

    PubMed  Google Scholar 

  13. George JM, Capen CC, Phillips AS (1972) Biosynthesis of vasopressin in vitro and ultrastructure of a bronchogenic carcinoma. J Clin Invest 51: 141–142

    PubMed  Google Scholar 

  14. Haupert GT, Carilli CT, Cantley LC (1984) Hypothalamic sodium transport inhibitor is a high affinity reversible inhibitor of Na-K-ATPase. Am J Phys 247: F 919-F 924

    Google Scholar 

  15. Imbert Y, Peroua JJ, Coomans D, Haissaguerre M, Henrion P, Leng B (1982) Sécrétion inappropriée d'hormone antidiurétique (SIADH) après traumatisme cranien. Sem Hôp Paris 58: 1151–1154

    Google Scholar 

  16. Jacobowitz DM, Skofitsch G, Keiser HR, Eskay RL, Zamir N (1985) Evidence for the existence of atrial natriuretic factorcontaining neurons in the rat brain. Neuroendocrinology 40: 92–94

    PubMed  Google Scholar 

  17. Jamson R, Maffly RH (1976) The urinary concentrating mechanism. N Engl J Med 295: 1059–1067

    PubMed  Google Scholar 

  18. Joynt RJ, Feibel JH, Sladek CM (1981) Antidiuretic hormone levels in stroke patients. Am Neurol 9: 182–184

    Google Scholar 

  19. Landolt AM, Yaşargil MG, Krayenbuhl H (1972) Disturbances of the serum electrolytes after surgery of intracranial arterial aneurysms. J Neurosurg 37: 210–218

    PubMed  Google Scholar 

  20. Laragh JH (1985) Atrial natriuretic hormone, the renin-aldosterone axis, and blood pressure-electrolyte homeotasis. N Engl J Med 313: 1330–1340

    PubMed  Google Scholar 

  21. Lester MC, Nelson PB (1981) Neurological aspects of vasopression release and the syndrome of inappropriate secretion of antidiuretic hormone. Neurosurg 8: 735–740

    Google Scholar 

  22. Mather HM, Ang V, Jenkins JS (1981) Vasopressin in plasma and CSF of patients with subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 44: 216–219

    PubMed  Google Scholar 

  23. McLaurin R (1966) Metabolic changes accompanying head injury. Clin Neurosurg 12: 143–160

    Google Scholar 

  24. Moses AM, Miller M, Streeten DHP (1976) Pathophysiologic and pharmacologic alterations in the release and action of ADH. Metabolism 25: 697–721

    PubMed  Google Scholar 

  25. Needleman P, Adams SP, Cole BR, Currie MG, Geller DM, Michener ML, Saper CB, Schwartz D, Standaert DG (1985) Atriopeptins as cardiac hormones. Hypertension 7: 469–482

    PubMed  Google Scholar 

  26. Nelson PB, Seif SM, Maroon JC, Robinson AG (1981) Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone. J Neurosurg 55: 938–941

    PubMed  Google Scholar 

  27. Nelson PB, Seif S, Gutal J, Robinson AG (1984) Hyponatremia and natriuresis following subarachnoid hemorrhage in a monkey model. J Neurosurg 60: 233–237

    PubMed  Google Scholar 

  28. Nolph KD, Schrier RW (1970) Sodium potassium and water metabolism in the syndrome of inappropriate antidiuretic hormon secretion. Am J Med 49: 534–545

    PubMed  Google Scholar 

  29. Peter JP, Welt LG, Sims EAH, Orloff J, Needham J (1950) A salt wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63: 57–64

    PubMed  Google Scholar 

  30. Robertson GL, Mahr EA, Athar S, Sinha T (1973) Development and clinical application of a new method for radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest 52:2340–2352

    PubMed  Google Scholar 

  31. Saper CB, Standaert DG, Currie MG, Schwartz D, Geller DM, Needleman P (1985) Atriopeptin-immunoreactive neurons in the brain: presence in cardiovascular regulatory areas. Science 227: 1047–1049

    PubMed  Google Scholar 

  32. Schrier RW, Berl T, Anderson RJ (1979) Osmotic and non osmotic control of vasopressin release. Am J Physiol 236: F 321-F 332

    Google Scholar 

  33. Schwartz WB, Bennet W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23: 529–542

    PubMed  Google Scholar 

  34. Sorensen PS, Gjerris F, Hammer M (1985) Cerebrospinal fluid and plasma vasopressin during short-time induced intracranial hypertension. Acta Neurochir (Wien) 77: 46–51

    Google Scholar 

  35. Steinbock P, Thompson GB (1978) Metabolic disturbances after head injury: Abnormalities of sodium and water balance with special reference to the effects of alcohol intoxication. Neurosurgery 3: 9–15

    PubMed  Google Scholar 

  36. Twijnstra A, Minderhoud JM (1980) Inappropriate secretion of, antidiuretic hormone in patients with head injuries. Clin Neurol Neurosurg 82: 262–268

    Google Scholar 

  37. Walmsley RN, White GH (1984) Hyponatremia: A diagnostic problem. Clin Chemistry 30 (2): 322–328

    Google Scholar 

  38. White WA, Bergland RM 81972) Experimental inappropriate A.D.H. secretion caused by positive-pressure respirators. J Neurosurg 36: 608–613

    Google Scholar 

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Authors and Affiliations

  1. Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    F. Vingerhoets & N. de Tribolet

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  1. F. Vingerhoets
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  2. N. de Tribolet
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Vingerhoets, F., de Tribolet, N. Hyponatremia hypo-osmolarity in neurosurgical patients. “Appropriate secretion of ADH” and “Cerebral salt wasting syndrome”. Acta neurochir 91, 50–54 (1988). https://doi.org/10.1007/BF01400528

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