Abstract
Case 1: A 45-year-old man, admitted for symptomatic hyponatremia, was diagnosed with advanced small-cell lung cancer and severe hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone. In addition to chemotherapy, the patient was treated with increased dietary salt intake (15 g/day), fluid restriction of 500 mL/day, and amino acid supplementation to maintain a urea load of 31 g/day. Due to the difficulty in changing his habit of drinking 2–3 L/day after discharge, tolvaptan was started. This resulted in correction of hyponatremia, which facilitated earlier discharge and improved his quality of life by eliminating the need for dietary restriction.
Case 2: An 88-year-old man with asymptomatic hyponatremia was admitted for assessment of pleural effusion. He was diagnosed with small-cell lung cancer with mild hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone. He was treated with best supportive care and dietary modification (salt intake of 15 g/day and fluid restriction of 400 mL/day). He found it difficult to comply with the dietary changes, and prolonged hospitalization was required for hyponatremia correction. Therefore, tolvaptan was initiated, which corrected his hyponatremia, and the patient was discharged.
In summary, tolvaptan results in stable correction of hyponatremia in patients with terminal small-cell lung cancer complicated by the syndrome of inappropriate secretion of antidiuretic hormone. Furthermore, it improves the quality of life of these patients by relieving the burden of strict dietary modifications and prolonged hospitalization.
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References
List AF, Hainsworth JD, Davis BW, Hande KR, Greco FA, Johnson DH. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer. J Clin Oncol. 1986;4:1191–8.
Sørensen JB, Andersen MK, Hansen HH. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. J Intern Med. 1995;238:97–110.
Castillo JJ, Vincent M, Justice E. Diagnosis and management of hyponatremia in cancer patients. Oncologist. 2012;17:756–65.
Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, Spitznagel EL, Piccirillo J. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539–44.
Burst V, Grundmann F, Kubacki T, Greenberg A, Rudolf D, Salahudeen A, Verbalis J, Grohé C. Euvolemic hyponatremia in cancer patients. Report of the Hyponatremia Registry: an observational multicenter international study. Support Care Cancer. 2017;25:2275–83.
Hansen O, Sørensen P, Hansen KH. The occurrence of hyponatremia in SCLC and the influence on prognosis: a retrospective study of 453 patients treated in a single institution in a 10-year period. Lung Cancer. 2010;68:111–4.
Yamamura Y, Nakamura S, Itoh S, Hirano T, Onogawa T, Yamashita T, Yamada Y, Tsuji- mae K, Aoyama M, Kotosai K, Ogawa H, Yamashita H, Kondo K, Tominaga M,, Mori T, Tsuji-moto G. OPC-41061, a highly potent human vasopressin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther. 1998;287:860–7.
Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C. SALT Investigators: Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355:2099–112.
Hermes A, Waschki B, Reck M. Hyponatremia as prognostic factor in small cell lung cancer—a retrospective single institution analysis. Respir Med. 2012;106:900–4.
Petereit C, Zaba O, Teber I, Lüders H, Grohé C. A rapid and efficient way to manage hyponatremia in patients with SIADH and small cell lung cancer: treatment with tolvaptan. BMC Pulm Med. 2013;13:55.
Jamookeeah C, Robinson P, O’Reilly K, Lundberg J, Gisby M, Ländin M, Skov J, Trueman D. Cost-effectiveness of tolvaptan for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion in Sweden. BMC Endocr Disord. 2016;16:22.
Guidance on Diagnosis and Treatment of Vasopressin. Hyperactivity (SIADH), (Revised in 2010). Research grant for Health Labor Sciences Research grant, research project on overcoming intractable diseases, research on interphrenia pituitary dysfunction (lead researcher: Yutaka Oiso).
Petereit C, Zaba O, Teber I, Grohé C. Is hyponatremia a prognostic marker of survival for lung cancer? Pneumologie. 2011;65:565–71. http://square.umin.ac.jp/kasuitai/doctor/guidance/SIADH.pdf. Accessed 27 March 2018.
Grohé C, Berardi R, Burst V. Hyponatraemia—SIADH in lung cancer diagnostic and treatment algorithms. Crit Rev Oncol Hematol. 2015;96:1–8.
Runkle I, Gómez-Hoyos E, Cuesta-Hernández M, et al. Hyponatraemia in older patients: a clinical and practical approach. Rev Clin Gerontol. 2015;25:31–52.
Kusuri-no-Shiori. (Drug information sheet), Otsuka Pharmaceutical Co., Ltd. SAMSCA tablets 7.5 mg (volume overload in heart failure and body fluid retention in hepatic cirrhosis). http://www.rad-ar.or.jp/siori/english/kekka.cgi?n=34699 (2018). Revised Oct 2018.
Kusuri-no-Shiori. (Drug information sheet), Otsuka Pharmaceutical Co., Ltd. SAMSCA tablets 7.5 mg (autosomal dominant polycystic kidney disease). http://www.rad-ar.or.jp/siori/english/kekka.cgi?n=34698 (2018). Revised March 2018.
Acknowledgements
The authors thank Aya Sakurai, a pharmacist of the Renal Disease Integrated Care Center of St. Marianna University School of Medicine Hospital, for managing data of this case report. We would like to thank Editage (http://www.editage.jp) for English language editing.
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Honoraria: Naoto Tominaga (Otsuka Pharmaceutical), and Yugo Shibagaki (Novartis pharma, Otsuka Pharmaceutical). Research funding: Yugo Shibagaki (Teijin Pharma, Otsuka Pharmasuitical, Takeda, Kyowa-Hakko Kirin).
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Kai, K., Tominaga, N., Koitabashi, K. et al. Tolvaptan corrects hyponatremia and relieves the burden of fluid/dietary restriction and hospitalization in hyponatremic patients with terminal lung cancer: a report of two cases. CEN Case Rep 8, 112–118 (2019). https://doi.org/10.1007/s13730-019-00375-7
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DOI: https://doi.org/10.1007/s13730-019-00375-7