Their recognition may reveal an occult neoplasia to the oncologist when occur as early manifestations of neoplasiathey can mimic a metastatic disease or, on the contrary, they can mask the complications of a cancer. Also, they may aggravate the clinical condition of the pacient, sometimes becoming lethal.
We chose to discuss the syndrome of inappropriate antidiuretic hormone secretion SI-ADH from the group of paraneoplastic syndromes, for at least two considerations: the first is the large number of cytostatics that can cause these syndromes, and the other is the clinical characteristics of SI-ADH, that have as a particularity the absence of signs and symptoms in early stages and the severity of neurological manifestations in advanced stages — coma and death.
The present article aims at: knowing the physiopathological mechanism of SI-ADH, the main associated neoplasia, the recognition of the clinical and paraclinical signs, the main criteria of diagnosis and differential diagnosis, gastric cancer hyponatremia the principles of treatment.
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Keywords Schwartz-Bartter syndrome, symptoms, chemotherapy Rezumat Sindroamele paraneoplazice reprezintă un capitol foarte important în gastric cancer hyponatremia oncologiei medicale, iar recunoaşterea acestora îi poate releva gastric cancer hyponatremia oncolog o neoplazie ocultă atunci când aceste sindroame apar ca manifestări precoce ale neoplaziei ori pot mima boala metastatică sau, dimpotrivă, pot masca complicaţiile unui cancer şi, nu în ultimul rând, pot complica starea clinică a pacientului, devenind uneori letale.
Am ales să dezbatem, din grupul sindroamelor paraneoplazice, sindromul secreţiei inadecvate de antidiuretic SI-ADHdin cel puţin două considerente: primul este numărul mare al citostaticelor care pot determina acest sindrom, iar al doilea este reprezentat de tabloul clinic al SI-ADH, ce are ca particularitate sărăcia semnelor şi simptomelor în fazele incipiente şi gravitatea manifestărilor neurologice şi a injuriei asupra sistemului nervos central, ducând gastric cancer hyponatremia comă şi deces, în stadiile avansate.
Metastatic gastric cancer: New targeted agents in metastatic gastric cancer
Articolul de faţă îşi propune: cunoaşterea mecanismului fiziopatologic al SI-ADH, cunoaşterea principalelor neoplazii asociate, recunoaşterea semnelor gastric cancer hyponatremia şi paraclinice, cunoaşterea principalelor criterii de diagnostic, a diagnosticului diferenţial şi a principiilor de tratament.
Cuvinte cheie sindromul Schwartz-Bartter simptome chimioterapie Introduction Paraneoplastic syndromes are a heterogeneous group of signs and symptoms associated with the evolution of malignant disease, but which are not the direct effect of the primary tumor, adenopathy or metastasis.
The syndrome of inappropriate antidiuretic hormone secretion (Schwartz-Bartter syndrome)
These may precede or may develop in parallel with the neoplastic disease, and the effective treatment of neoplasia may lead to the disappearance of these syndromes. However, the patients with immune or neurological etiology are not predictably resolved after the treatment of the malignancy.
Associated malignancies. Also, cases of secondary SI-ADH have been described after surgical manipulations in bronchial-pulmonary cancer puncture, lobectomy, pneumomectomy.
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Other malignancies that associate SI-ADH are: mesothelioma, lymphoma, Ewing sarcoma, thymomas, primary brain tumors, head and neck cancer, digestive gastric, duodenal, pancreatic and genito-urinary cancers bladder, prostate, uterus. Regardless of the type and location of neoplasia, the syndrome can be determined by tumor lysis syndrome due to injury of the kidneys.
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Schwartz-Bartter syndrome consists of: increased urinary osmolality, elevated urinary sodium, low serum osmolality, in a euvolemic patient, without edema, who is not hypotensive, with no renal, cardiac, adrenal, and thyroid dysfunction, and in the absence of diuretic treatment.
This syndrome is much more common than the number of cases cited in the literature. Clinical characteristics.
Most patients are asymptomatic. When it becomes manifest, the central nervous system toxicity is present, which is directly proportional to the intensity of the manifestations, so that in the initial stage patients suffer from fatigue, anorexia, headache, and discreet alteration of mental status.
Sindromul secreţiei inadecvate de hormon antidiuretic (sindromul Schwartz-Bartter)
As the syndrome progresses, it associates delirium, convulsions, coma que es papiloma pie rarely death; therefore, it is one of the oncological emergencies. Bio-humoral changes are expressed by the dilutional hyponatremia constantnatriuresis, urine hyperosmolarity, and serum hypoosmolality.
The differential diagnosis is made with: laboratory hyponatraemia, hyponatraemia associated with volume depletion as in vomiting, fluid sequestration, diarrhea, excessive sweating. Schwartz-Bartter syndrome and chemotherapy In some rare cases, chemotherapy may reveal, contribute or aggravate this syndrome.
Chemotherapeutic agents whose usage may cause or aggravate this gastric cancer hyponatremia are: cyclophosphamide, vincristine, vinorelbine, vinblastine, imatinib, interferon alpha and gamma, and methotrexate.
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It was the first drug to show a ADH-like effect, in More recent studies have shown a direct toxic effect of cyclophosphamide or of its metabolites on renal collecting ducts, causing excessive water retention. Vinca alkaloids. One of the proposed mechanisms is its neurotoxic effect, by stopping the cells of the posterior hypothalamus in the metaphase, causing cell membrane rupture and the release of inadequately high concentrations of antidiuretic hormone.
Curr Health Sci Gastric cancer hyponatremia ; 45 2 : Article En MEDLINE ID: mdl Colorectal cancer CRC is considered a major global health concern due to an increasing number of new cases and cancer-related deaths each year, strong link to gastric cancer hyponatremia habits prevalent in middle and high-income countries and limited therapeutic options especially in locally-advanced and metastatic settings. To counter this growing problem, the scientific community has strived to underpin the major molecular mechanisms behind the aggressive phenotype displayed by CRC and also develop new agents to selectively target and inhibit these core drivers. This evolution has allowed the separation of patients according to different risk groups in concordance with epidemiological parameters alongside novel biomarkers such as gene alterations, protein overexpression and aberrant signaling pathways.
Another hypothesis is the direct tubular destruction in the proximal convoluted tubule, affecting the tubular reabsorption of phosphorus and chloride, resulting in a decrease in the concentration of these electrolytes in gastric cancer hyponatremia blood, associated with SI-ADH hyponatraemia.
Hyponatremia is a well-known direct complication of the administration of cytotoxic drugs. Therefore, routine monitoring of electrolytes plasma concentrations is required. Treatment 1.
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Removal gastric cancer hyponatremia the tumor. In case of severe hyponatraemia with neurological manifestations, the treatment with hypertonic saline solution is instituted.
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- Medicamente pentru tratarea giardiozei
Isotonic saline solution has no effect in increasing the plasmatic sodium levels. Salt tablets may be administered, their effect being potentiated by the administration of loop diuretics. The administration of vasopressin receptor antagonists increases the diuresis, without interfering with sodium and potassium excretion, but it is recommended to avoid V2 receptor antagonists due to increased thirst sensation and high cost.
Conflict of interests: The authors declare no conflict of gastric cancer hyponatremia. Bibliografie Gross P. Ther Adv Endocrinol Metab.
Sindromul secreţiei inadecvate de hormon antidiuretic (sindromul Schwartz-Bartter)
Pillai BP et al. Syndrome gastric cancer hyponatremia inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder. Indian J Endocrinol Metab.