| A Case of SIADH Diagnosed by Repeated Water Load Tests in a Hyponatremic Patient with Radiologically Suspicious Thymoma |
| Ji-Won Ryu, M.D.1, Jin-Ju Kim, M.D.1, Yough-sun Ko, M.D.1, Ju-Hyun Lee, M.D.1, Joo-Hark Yi, M.D.1, Sang-Woong Han, M.D.1, Young-Ha, Oh M.D.2 and Ho-Jung Kim, M.D.1 |
Department of Internal Medicine1 and Pathology2
Hanyang University Guri Hospital, Guri, Korea |
| 증례 : 영상학적으로 흉선종이 의심되었으나 반복된 수분 부하 검사를 통해 진단된 항이뇨호르몬 부적절 분비 증후군 환자 1예 |
| 류지원1, 김진주1, 고영선1, 이주현1, 이주학1, 한상웅1, 오영하2, 김호중1 |
| 한양대학교 구리병원 내과1, 병리학과2 |
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| Abstract |
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The causes of hypo-osmolar hyponatremic patients without edema are mainly related to either SIADH (syndrome of inappropriate antidiuretic hormone secretion) or hypovolemia and the evaluation of extracelluar volume status can be a clue to differentiate between the two. As a diagnostic andtherapeutic tool, positive response to isotonic saline load test is recognized in favor of hypovolemic hyponatremia but there is a pitfall due to similar response in a subset of euvolemic hyponatremia, SIADH in case that combined with hypovolemia or accompanied by low sodium intake. In such case, water load test may provide more help for exact evaluation of hypovolemia and SIADH. Hereby, we report a case of a 74 year old patient with doubtful thymoma radiologically presented to emergency room with symptomatic severe hyponatremia (108 mEq/L) consistent with clinical and biochemical features of hypovolemia and positive response to initial isotonic saline infusion. However, episodes of hyponatremia recurred despite euvolemic status, which was diagnosed as SIADH by water load test. We initially considered thymoma as a cause of SIADH but its pathologic finding was a thymic cyst. And hyponatremia with hypovolemic feature recurred but the final diagnosis came out as idiopathic SIADH by repeated water load test. His hyponatremia was completely corrected by strict water restriction (<500 cc/day). |
| Key Words:
Hyponatremia, Hypovolemia, Syndrome of Inappropriate ADH (SIADH) Secretion, Thymoma, Thymic cyst |
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