Chronic hyponatremia due to resetting of the osmostat in a patient with gastric carcinoma

Barry Wall, Joan T. Crofton, Leonard Share, C. Robert Cooke

Research output: Contribution to journalArticle

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Abstract

A 54-year-old schizophrenic patient who presented with hyponatremia and nephrotic-range proteinuria was subsequently discovered to have a gastric adenocarcinoma. Psychogenic water drinking, sodium depletion, and cardiac, adrenal, hepatic, and thyroid disease were excluded as causes of hyponatremia. The serum creatinine concentration was normal, and, although renal biopsy showed changes consistent with immune complex glomerulopathy, proteinuria remitted without treatment. Moderately severe hyponatremia persisted, and the diagnosis of gastric adenocarcinoma was made after the onset of early satiety 1 year later. Surgical exploration at the time of partial gastric resection revealed local metastatic lymph node involvement. Following the patient's uneventful recovery from surgery, studies of osmoregulation of vasopressin release and renal water handling were performed to determine the cause of chronic hyponatremia refractory to sodium chloride administration. Oral water loading studies revealed normal urinary diluting ability and appropriate suppression of plasma vasopressin concentrations. However, hypertonic sodium chloride infusion studies revealed a highly significant correlation between plasma osmolality and plasma vasopressin concentration, and a low osmotic threshold for vasopressin release based on linear regression analysis of the plasma vasopressin response to increasing plasma osmolality. Low osmotic threshold for vasopressin release was confirmed by exponential (log linear) and parabolic methods of data analysis. The findings in these studies are consistent with the typical features of the reset osmostat variant of the syndrome of inappropriate antidiuresis. To our knowledge, this is the first report of the occurrence of this syndrome in association with gastric adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)223-228
Number of pages6
JournalThe American Journal of Medicine
Volume93
Issue number2
DOIs
StatePublished - Jan 1 1992

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Hyponatremia
Vasopressins
Stomach
Carcinoma
Adenocarcinoma
Proteinuria
Sodium Chloride
Osmolar Concentration
Kidney
Osmoregulation
Water
Thyroid Diseases
Antigen-Antibody Complex
Drinking Water
Linear Models
Creatinine
Lymph Nodes
Sodium
Regression Analysis
Biopsy

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chronic hyponatremia due to resetting of the osmostat in a patient with gastric carcinoma. / Wall, Barry; Crofton, Joan T.; Share, Leonard; Cooke, C. Robert.

In: The American Journal of Medicine, Vol. 93, No. 2, 01.01.1992, p. 223-228.

Research output: Contribution to journalArticle

Wall, Barry ; Crofton, Joan T. ; Share, Leonard ; Cooke, C. Robert. / Chronic hyponatremia due to resetting of the osmostat in a patient with gastric carcinoma. In: The American Journal of Medicine. 1992 ; Vol. 93, No. 2. pp. 223-228.
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