Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Coproporphyria: Case Report and Review of Literature |
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| Affiliation: | 1. Department of Internal Medicine, Huron Hospital, Cleveland Clinic Health System, East Cleveland, Ohio.;2. Department of Endocrinology, Diabetes and Endocrine Center of Cleveland, Inc., Beachwood, Ohio.;1. Northern Illinois University, College of Health and Human Sciences, DeKalb, IL, United States;2. Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, United States;3. Ann & Robert H. Lurie Children''s Hospital of Chicago, Epilepsy Center, Northwestern Feinberg School of Medicine, Dept. of Pediatrics, Chicago, IL, United States;4. Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, United States;5. Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, United States;2. Pediatric Rheumatology, University Children`s Hospital Basel, University of Basel, Basel, Switzerland;3. Pediatric Cardiology & Congenital Heart Diseases, University Children''s Hospital Heidelberg, Heidelberg, Germany;4. Pediatric Cardiology, University Children`s Hospital Basel, University of Basel, Basel, Switzerland;5. Division of Clinical Pharmacology, Children''s National Health System, Washington, DC;1. Department of Agriculture and Fisheries, Queensland Government, University of the Sunshine Coast, Sippy Downs 4556, Australia;2. Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs 4556, Australia;3. School of Agriculture and Food Sciences, The University of Queensland, St Lucia 4072, Australia |
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| Abstract: | ObjectiveTo remind physicians to consider the hepatic porphyrias in the differential diagnosis of the syndrome of inappropriate antidiuretic hormone secretion.MethodsWe present a case report of a patient seen in the hospital for severe hyponatremia, who was discovered to have the syndrome of inappropriate antidiuretic hormone secretion attributable to coproporphyria. Results of laboratory tests of the patient and her family are presented.ResultsA 54-year-old woman was seen in the hospital because of severe hyponatremia accompanied by generalized seizures. Her serum sodium concentration was 112 mEq/L, with concomitant serum and urine osmolalities of 235 and 639 mOsm/kg, respectively. Renal, thyroid, and adrenal functions were normal. Brain, chest, abdominal, and pelvic imaging studies were negative for occult malignant disease. Urinary excretions of porphobilinogen and aminolevulinic acid were substantially elevated. Results of follow-up urine, plasma, and fecal porphyrin studies were consistent with coproporphyria. Results of porphyrin metabolic studies of the patient’s family showed normal findings in her parents and a minimally increased fecal coproporphyrin concentration and urinary uroporphyrin excretion in her sister.ConclusionAn endocrinology consultation is often requested for patients with hyponatremia. It is important to consider the acute hepatic porphyrias in the differential diagnosis, even though these are rare disorders and the family history may not always be helpful because of the high frequency of asymptomatic carriers. (Endocr Pract. 2007;13:164-168) |
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