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Syndrome of inappropriate secretion of antidiuretic hormone as an initial sign of primary central nervous system lymphomas in the hypothalamus

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Abstract

Background

Primary central nervous system lymphoma (PCNSL) rarely originates in the hypothalamus. Hypothalamic PCNSL can present with various symptoms specific to dysfunction of the hypothalamus, including consciousness disturbance, cognitive impairment, hypopituitarism, and diabetes insipidus (DI). However, it remains unclear whether syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can present as an initial sign of hypothalamic PCNSL.

Methods

Ninety-nine patients with PCNSL were diagnosed between January 2006 and December 2020 at our institutes. The initial symptoms and signs, hypothalamic–pituitary functions, serum sodium (Na) value, Karnofsky Performance Status (KPS) score on admission, and duration from onset to diagnosis were retrospectively investigated from the medical charts.

Results

Eight and 91 patients had hypothalamic PCNSL (hypothalamic group) and PCNSL located in other regions (control group), respectively. Patients’ pathological diagnoses were diffuse large B-cell lymphoma (97 patients) and intravascular lymphoma (two patients). Six patients presented with hyponatremia derived from SIADH or suspected SIADH, and one presented with DI. Statistically significant differences between the hypothalamic and control groups were detected only in the preoperative serum Na values and KPS scores.

Conclusion

SIADH can be an initial presentation of hypothalamic PCNSL. Early detection of hypothalamic PCNSL from SIADH may lead to proper management and improved prognosis.

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Data availability statement

The datasets generated for this study are available upon request to the corresponding author.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Masahiro Oishi, Yasuhiko Hayashi, Yasuo Sasagawa, Nozomu Oikawa & Mitsutoshi Nakada

  2. Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku, Ishikawa, 920-0293, Japan

    Yasuhiko Hayashi

Authors
  1. Masahiro Oishi
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  2. Yasuhiko Hayashi
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  3. Yasuo Sasagawa
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  4. Nozomu Oikawa
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  5. Mitsutoshi Nakada
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Contributions

MO designed the study, analyzed data, and wrote the paper. YH designed the study and co-wrote the paper. YS advised on the study and edited the paper. NO analyzed the data. MN supervised the study.

Corresponding author

Correspondence to Masahiro Oishi.

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Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the medical ethics committee at Kanazawa University (approval number: #2016-244 [2227]) and Kanazawa Medical University Hospital (approval number: #1556), and most participants provided written informed consent. Medical Ethics Committee of Kanazawa University waived the requirement of an informed consent considering the retrospective evaluation of patient data for the remaining patients, and written informed consent was not obtained from a relative/guardian. This study was performed in accordance with the Declaration of Helsinki and in compliance with requirements for retrospective studies on human subjects.

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Oishi, M., Hayashi, Y., Sasagawa, Y. et al. Syndrome of inappropriate secretion of antidiuretic hormone as an initial sign of primary central nervous system lymphomas in the hypothalamus. Acta Neurol Belg 123, 415–422 (2023). https://doi.org/10.1007/s13760-022-01985-2

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  • DOI: https://doi.org/10.1007/s13760-022-01985-2

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