SpringerLink
Log in

Syndrome of inappropriate antidiuretic hormone secretion in patients with aquaporin-4 antibody

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

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 via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lennon VA, Wingerchuk DM, Kryzer TJ et al (2004) A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 364(9451):2106–2112

    Article  CAS  PubMed  Google Scholar 

  2. 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):964–968

    Article  PubMed  Google Scholar 

  3. 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):88–97

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. 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):263–267

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Iorio R, Lucchinetti CF, Lennon VA et al (2011) Syndrome of inappropriate antidiuresis may herald or accompany neuromyelitis optica. Neurology 77(17):1644–1646

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. 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):599–602

    Article  PubMed  Google Scholar 

  7. You XF, Qin W, Hu WL (2011) Aquaporin-4 antibody positive neuromyelitis optica with syndrome of inappropriate antidiuretic hormone secretion. Neurosciences (Riyadh) 16(1):68–71

    Google Scholar 

  8. 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):1355–1359

    Article  PubMed  Google Scholar 

  9. Lotze TE, Northrop JL, Hutton GJ, Ross B, Schiffman JS, Hunter JV (2008) Spectrum of pediatric neuromyelitis optica. Pediatrics 122(5):e1039–e1047

    Article  PubMed  Google Scholar 

  10. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66(10):1485–1489

    Article  CAS  PubMed  Google Scholar 

  11. Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG (2007) The spectrum of neuromyelitis optica. Lancet Neurol 6(9):805–815

    Article  CAS  PubMed  Google Scholar 

  12. 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):2210–2216

    Article  PubMed  Google Scholar 

  13. 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):75–79

    Article  CAS  PubMed  Google Scholar 

  14. 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):96–102

    Article  CAS  PubMed  Google Scholar 

  15. Bartter FC, Schwartz WB (1967) The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42(5):790–806

    Article  CAS  PubMed  Google Scholar 

  16. Sakai N, Miyajima H, Shimizu T, Arai K (1992) Syndrome of inappropriate secretion of antidiuretic hormone associated with multiple sclerosis. Intern Med 31(4):463–466

    Article  CAS  PubMed  Google Scholar 

  17. Yildiz OK, Cevik S, Oztoprak I (2012) Consciousness disturbance and poikilothermia revealing brain involvement in neuromyelitis optica. Acta Neurol Belg 112(2):213–215

    Article  PubMed  Google Scholar 

  18. 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):679–682

    Article  CAS  PubMed  Google Scholar 

  19. Saleem SN, Said AH, Lee DH (2007) Lesions of the hypothalamus: MR imaging diagnostic features. Radiographics 27(4):1087–1108

    Article  PubMed  Google Scholar 

  20. 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):1075–1078

    Article  CAS  PubMed  Google Scholar 

  21. 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):287–288

    Article  PubMed  Google Scholar 

  22. 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):670–671

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang East Road, Guangzhou, 510260, Guangdong, China

    Shuxiang Pu, Youming Long, Yihua He, Fulan Shan, Yongxiang Fan, Jianrui Yin, Qingchun Gao & Gao Cong

  2. Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang East Road, Guangzhou, 510260, Guangdong, China

    Shuxiang Pu, Youming Long, Yihua He, Fulan Shan, Yongxiang Fan, Jianrui Yin, Qingchun Gao & Gao Cong

  3. Department of Neurology, The Fifth Affiliated Hospital of Guangzhou Medical University, 621# Gangwan Road, Guangzhou, 510700, Guangdong, China

    Ning Yang

Authors
  1. Shuxiang Pu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Youming Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ning Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yihua He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fulan Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yongxiang Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianrui Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Qingchun Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gao Cong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gao Cong.

Additional information

S. Pu and Y. Long are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pu, S., Long, Y., Yang, N. et al. Syndrome of inappropriate antidiuretic hormone secretion in patients with aquaporin-4 antibody. J Neurol 262, 101–107 (2015). https://doi.org/10.1007/s00415-014-7537-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-014-7537-y

Keywords

Search

Navigation