The objective of this study was to analyze the frequency of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with positive aquaporin-4 (AQP4) antibodies and evaluate the relationship between SIADH and hypothalamic lesions in patients with NMO and NMO spectrum disorder (NMOSD). AQP4 antibodies were tested by an indirect immunofluorescence assay employing HEK-293 cells transfected with recombinant human AQP4. Clinical data of patients were analyzed retrospectively. In total, 192 patients with AQP4 antibodies were certified, of which 41 patients (21.4 %) were included in the present study. Six patients (14.6 %, 6/41) met the criteria of SIADH, of which hyponatremia was mild in one patient, and severe in five. Five patients experienced confusion or decreased consciousness. Four patients were diagnosed with NMO and two were diagnosed with recurrent optic neuritis. Magnetic resonance imaging showed 11 of 41 patients (26.8 %) had hypothalamic lesions. All patients with SIADH had hypothalamic abnormalities. Hyponatremia resolved in all patients after intravenous methylprednisolone and intravenous immunoglobulin therapy. SIADH is not rare in patients with NMO/NMOSD, especially in patients with lesions close to the hypothalamus.
This is a preview of subscription content, log in to check access.
This project was supported by Guangdong Natural Science Foundation (S2013010016262), the Science and Technology plan project of Guangdong Province (2012B031800240).
Conflicts of interest
The authors declare that no competing interests exist.
Lennon VA, Wingerchuk DM, Kryzer TJ et al (2004) A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 364(9451):2106–2112CrossRefPubMedGoogle Scholar
Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR, Lennon VA (2006) Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol 63(7):964–968CrossRefPubMedGoogle Scholar
Mesbah-Benmessaoud O, Benabdesselam R, Hardin-Pouzet H, Dorbani-Mamine L, Grange-Messent V (2011) Cellular and subcellular aquaporin-4 distribution in the mouse neurohypophysis and the effects of osmotic stimulation. J Histochem Cytochem 59(1):88–97PubMedCentralCrossRefPubMedGoogle Scholar
Nakajima H, Fujiki Y, Ito T, Kitaoka H, Takahashi T (2011) Anti-aquaporin-4 antibody-positive neuromyelitis optica presenting with syndrome of inappropriate antidiuretic hormone secretion as an initial manifestation. Case Rep Neurol 3(3):263–267PubMedCentralCrossRefPubMedGoogle Scholar
Nakano T, Fujimoto T, Fukuda Y, Takahashi T, Kanbayashi T (2011) Neuromyelitis optica with syndrome of inappropriate secretion of antidiuretic hormone and hypersomnia associated with bilateral hypothalamic lesions: a case report. Rinsho Shinkeigaku 51(8):599–602CrossRefPubMedGoogle Scholar
You XF, Qin W, Hu WL (2011) Aquaporin-4 antibody positive neuromyelitis optica with syndrome of inappropriate antidiuretic hormone secretion. Neurosciences (Riyadh) 16(1):68–71Google Scholar
Suzuki K, Nakamura T, Hashimoto K et al (2012) Hypothermia, hypotension, hypersomnia, and obesity associated with hypothalamic lesions in a patient positive for the anti-aquaporin 4 antibody: a case report and literature review. Arch Neurol 69(10):1355–1359CrossRefPubMedGoogle Scholar
Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66(10):1485–1489CrossRefPubMedGoogle Scholar
Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG (2007) The spectrum of neuromyelitis optica. Lancet Neurol 6(9):805–815CrossRefPubMedGoogle Scholar
Sato DK, Nakashima I, Takahashi T et al (2013) Aquaporin-4 antibody-positive cases beyond current diagnostic criteria for NMO spectrum disorders. Neurology 80(24):2210–2216CrossRefPubMedGoogle Scholar
Ishikawa E, Ohgo S, Nakatsuru K et al (1989) Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with multiple sclerosis. Jpn J Med 28(1):75–79CrossRefPubMedGoogle Scholar
Long Y, Qiu W, Lu Z et al (2012) Aquaporin 4 antibodies in the cerebrospinal fluid are helpful in diagnosing Chinese patients with neuromyelitis optica. Neuroimmunomodulation 19(2):96–102CrossRefPubMedGoogle Scholar
Bartter FC, Schwartz WB (1967) The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42(5):790–806CrossRefPubMedGoogle Scholar
Sakai N, Miyajima H, Shimizu T, Arai K (1992) Syndrome of inappropriate secretion of antidiuretic hormone associated with multiple sclerosis. Intern Med 31(4):463–466CrossRefPubMedGoogle Scholar
Yildiz OK, Cevik S, Oztoprak I (2012) Consciousness disturbance and poikilothermia revealing brain involvement in neuromyelitis optica. Acta Neurol Belg 112(2):213–215CrossRefPubMedGoogle Scholar
Viegas S, Weir A, Esiri M et al (2009) Symptomatic, radiological and pathological involvement of the hypothalamus in neuromyelitis optica. J Neurol Neurosurg Psychiatry 80(6):679–682CrossRefPubMedGoogle Scholar
Saleem SN, Said AH, Lee DH (2007) Lesions of the hypothalamus: MR imaging diagnostic features. Radiographics 27(4):1087–1108CrossRefPubMedGoogle Scholar
Takahashi T, Miyazawa I, Misu T et al (2008) Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: a herald of acute exacerbations. J Neurol Neurosurg Psychiatry 79(9):1075–1078CrossRefPubMedGoogle Scholar
Baba T, Nakashima I, Kanbayashi T et al (2009) Narcolepsy as an initial manifestation of neuromyelitis optica with anti-aquaporin-4 antibody. J Neurol 256(2):287–288CrossRefPubMedGoogle Scholar
Watanabe S, Nakashima I, Miyazawa I et al (2007) Successful treatment of a hypothalamic lesion in neuromyelitis optica by plasma exchange. J Neurol 254(5):670–671CrossRefPubMedGoogle Scholar
1.Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
2.Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of ChinaInstitute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
3.Department of NeurologyThe Fifth Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina