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Oto Y, Murakami N, Nakagawa R, Itoh M, Nagai T, Matsubara T. Three pediatric cases of symptomatic hyponatremia in Prader-Willi syndrome. J Pediatr Endocrinol Metab 2022; 35:1302-1305. [PMID: 35822720 DOI: 10.1515/jpem-2022-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A recent large retrospective cohort study of cases of hyponatremia in Prader-Willi syndrome (PWS), conducted at nine reference centers, showed that severe hyponatremia was rare in PWS (0.5%); furthermore, all cases involved adults. Here, we describe three pediatric cases of severe hyponatremia in PWS, with neurological symptoms. CASE PRESENTATION The cases involved two girls and one boy, and only one patient showed uniparental disomy. All patients had hyponatremia during infancy and presented with clinical symptoms, such as convulsions. All three patients improved with intravenous fluids and fluid restriction, with no sequelae. CONCLUSIONS We report three pediatric cases of symptomatic hyponatremia of unknown cause in PWS. In patients with PWS, especially those with neurological symptoms such as convulsions, it is necessary to take hyponatremia into consideration.
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Affiliation(s)
- Yuji Oto
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobuyuki Murakami
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryo Nakagawa
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Masatsune Itoh
- Department of Pediatrics, Kanazawa Medical University, Kanazawa, Japan
| | | | - Tomoyo Matsubara
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Coupaye M, Pellikaan K, Goldstone AP, Crinò A, Grugni G, Markovic TP, Høybye C, Caixàs A, Mosbah H, De Graaff LCG, Tauber M, Poitou C. Hyponatremia in Children and Adults with Prader-Willi Syndrome: A Survey Involving Seven Countries. J Clin Med 2021; 10:jcm10163555. [PMID: 34441851 PMCID: PMC8396837 DOI: 10.3390/jcm10163555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
In Prader–Willi syndrome (PWS), conditions that are associated with hyponatremia are common, such as excessive fluid intake (EFI), desmopressin use and syndrome of inappropriate antidiuretic hormone (SIADH) caused by psychotropic medication. However, the prevalence of hyponatremia in PWS has rarely been reported. Our aim was to describe the prevalence and severity of hyponatremia in PWS. In October 2020, we performed a retrospective study based on the medical records of a large cohort of children and adults with PWS from seven countries. Among 1326 patients (68% adults), 34 (2.6%) had at least one episode of mild or moderate hyponatremia (125 ≤ Na < 135 mmol/L). The causes of non-severe hyponatremia were often multi-factorial, including psychotropic medication in 32%, EFI in 24% and hyperglycemia in 12%. No obvious cause was found in 29%. Seven (0.5%) adults experienced severe hyponatremia (Na < 125 mmol/L). Among these, five recovered completely, but two died. The causes of severe hyponatremia were desmopressin treatment for nocturnal enuresis (n = 2), EFI (n = 2), adrenal insufficiency (n = 1), diuretic treatment (n = 1) and unknown (n = 1). In conclusion, severe hyponatremia was very rare but potentially fatal in PWS. Desmopressin treatment for nocturnal enuresis should be avoided. Enquiring about EFI and monitoring serum sodium should be included in the routine follow-ups of patients with PWS.
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Affiliation(s)
- Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Correspondence: ; Tel.: +33-(0)-142175771
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
| | - Anthony P. Goldstone
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London; Department of Endocrinology, Imperial College Healthcare NHS Trust; Hammersmith Hospital, London W12 0NN, UK
| | - Antonino Crinò
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Hospital, Research Institute, 00050 Palidoro, Italy
| | - Graziano Grugni
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Divison of Auxology, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy
| | - Tania P. Markovic
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Charlotte Høybye
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Department of Molecular Medicine and Surgery, and Department of Endocrinology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Assumpta Caixàs
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Helena Mosbah
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
| | - Laura C. G. De Graaff
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
| | - Maithé Tauber
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Department of Endocrinology, Bone Diseases, Genetics, and Gynecology, Children’s Hospital, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291—CNRS UMR5051—Université Toulouse III, F-31000 Toulouse, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics), Research Unit, Sorbonne University, F-75013 Paris, France
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Landau D, Hirsch HJ, Gross-Tsur V. Case report: severe asymptomatic hyponatremia in Prader-Willi Syndrome. BMC Pediatr 2016; 16:28. [PMID: 26888082 PMCID: PMC4758139 DOI: 10.1186/s12887-016-0563-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome is a complex neurogenetic, multisystem disorder. Despite the variable endocrine abnormalities and hypothalamic-pituitary axis dysfunction, hyponatremia has been reported in only a few PWS patients. In previously reported PWS individuals, hyponatremia was associated with abnormal fluid intake or during desmopressin treatment. CASE PRESENTATION We describe an infant with Prader-Willi syndrome who had severe, prolonged asymptomatic hyponatremia without a history of excessive fluid intake or desmopressin treatment. We compare the findings with those of the few other reported cases and describe, for the first time, results of a hypertonic saline infusion test and studies of adrenal cortical function. CONCLUSION Hyponatremia should be suspected in children with Prader-Willi syndrome, especially in infants with severe failure to thrive. Further studies are needed to determine the pathophysiology of hyponatremia in this syndrome.
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Affiliation(s)
- Daniel Landau
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel and Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Harry J Hirsch
- Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, P.O.B 3235, Jerusalem, 91031, Israel.
| | - Varda Gross-Tsur
- Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, P.O.B 3235, Jerusalem, 91031, Israel.,The Faculty of Medicine, the Hebrew University, Jerusalem, Israel
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Lucchini B, Simonetti GD, Ceschi A, Lava SAG, Faré PB, Bianchetti MG. Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: a systematic review. J Pediatr Urol 2013; 9:1049-53. [PMID: 23619353 DOI: 10.1016/j.jpurol.2013.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/20/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Dilutional hyponatremia is a serious adverse effect of desmopressin, a vasopressin analog that is widely prescribed to manage monosymptomatic enuresis. The presentation of hyponatremia, largely related to cerebral dysfunction, can include severe signs like altered mental status and seizures. METHODS We reviewed the literature dealing with altered mental status or seizures in enuretic subjects on desmopressin. The retained publications included patients who were described individually, revealing data on mode of administration, further identifiable factors predisposing to hyponatremia, presentation and clinical course. RESULTS We found 54 cases of hyponatremia secondary to desmopressin treatment presenting with altered mental status or seizures. In most cases the complication developed 14 days or less after starting desmopressin. An intranasal formulation had been used in 47 patients. Excess fluid intake was documented as a contributing factor in at least 22 cases. In 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses. CONCLUSION Altered mental status or seizures are very rare but recognized complications of desmopressin in enuresis. This complication mostly develops in subjects managed with the intranasal formulation 14 days or less after starting the medication, following excess fluid intake and during intercurrent illnesses.
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Affiliation(s)
- Barbara Lucchini
- Integrated Department of Pediatrics, Ente Ospedaliero Cantonale Ticinese, and University of Bern, Switzerland
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Del Gado R, Del Gaizo D, Cennamo M, Auriemma R, Del Gado G, Vernì M. Desmopressin is a safe drug for the treatment of enuresis. ACTA ACUST UNITED AC 2009; 39:308-12. [PMID: 16118106 DOI: 10.1080/00365590410018729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To verify the safety of desmopressin treatment and its associated side-effects in a large number of patients. MATERIAL AND METHODS The study was conducted in accordance with the guidelines of the Italian Club for Nocturnal Enuresis, whose criteria are: age >5 years; absence of malformations and infections of the urinary tract; absence of psychological disorders or neurological alterations; number of "wet nights" >5-7; control of liquid intake during the afternoon and evening; monitoring of serum electrolytes before beginning treatment; control of body weight before the beginning of treatment and during the first 4-5 days of therapy; and the informed consent of the parents. The therapeutic regimen provided for a maximum dose of desmopressin of 40 microg/day (four puffs/nostril or two tablets), starting from an initial dosage of 20 microg/day (two puffs/nostril or one tablet) 1 h before going to bed. The study involved two groups of patients with monosymptomatic enuresis: some of them had been administered desmopressin in the form of a spray and others in the form of tablets. RESULTS A small percentage of patients presented mild, transient side-effects; in no case were severe side-effects verified. CONCLUSION Desmopressin is a safe drug with a low incidence of side-effects.
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Affiliation(s)
- Roberto Del Gado
- Department of Pediatrics, Second University of Naples, Naples, Italy.
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Akefeldt A. Water intake and risk of hyponatraemia in Prader-Willi syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:521-528. [PMID: 19302470 DOI: 10.1111/j.1365-2788.2009.01169.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND METHODS Unusual water intake and drinking behaviour has occasionally been observed in individuals with Prader-Willi syndrome (PWS). The aim of this study is to explore whether this observation is a part of the PWS phenotype and what the consequences may be. The parents of 51 individuals with PWS (age range 2-40 years) were asked by questionnaire to answer on past and present water intake, drinking behaviour, fluid preferences and medical treatment in their PWS-affected and unaffected children. Questionnaires with information on 47 PWS individuals and 17 without PWS were returned for analysis. The questionnaire information was complemented with information from the individual's medical records. Siblings to PWS individuals made up the control group. The study was approved by the regional medical research ethics committee. RESULTS During infancy, 36 (76%) individuals with PWS disliked water without any flavouring and had an extremely small daily intake of water. Seven individuals (15%) increased the daily water intake to unusually high amounts. In 45 the clinical PWS diagnosis was confirmed by molecular (genetic) testing: nine of them with a confirmed PWS diagnosis had a deletion of chromosome 15q11-13, in nine individuals no deletion was identified. The majority of individuals who increased their water consumption to extreme values belonged to the non-deletion group. Two in the non-deletion group developed hyponatraemia while receiving psychiatric medication. CONCLUSIONS Infants with PWS seem to be predisposed to unusual drinking behaviour. They dislike and have an unusually small intake of pure water without flavouring, and most of them continue this even after infancy. Some individuals, especially those without deletion, increase their fluid intake and also accept pure water. They have an increased risk of developing water retention and severe hyponatraemia if exposed to medication known to cause side effects like the syndrome of inappropriate antidiuretic hormone secretion. Perhaps this behaviour is just secondary to overeating; perhaps it is a result of a dysfunction of the hypothalamic nuclei engaged in antidiuretic hormone production.
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Affiliation(s)
- A Akefeldt
- Child and Adolescent Psychiatry Department, Göteborg University, Sweden.
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Robson WLM, Leung AKC, Norgaard JP. The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol 2007; 178:24-30. [PMID: 17574054 DOI: 10.1016/j.juro.2007.03.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. We assessed the safety of desmopressin in children 18 years or younger with nocturnal enuresis with a focus on the relative safety of the oral compared with the intranasal formulation. MATERIALS AND METHODS Published data (MEDLINE) from December 1972 to August 2006 and post-marketing safety data from December 1972 to June 2005 were analyzed. RESULTS A total of 21 clinical trials on desmopressin use in children with nocturnal enuresis were identified. There were no reports of hyponatremia. A total of 21 publications were identified that included 48 case reports of hyponatremia in children with nocturnal enuresis. In all case reports patients were treated with intranasal desmopressin. Post-marketing safety data included 151 cases of hyponatremia in children with nocturnal enuresis, of whom 145 were treated with intranasal desmopressin and 6 were treated with the tablet formulation. Prodromal symptoms of hyponatremia were identified as headache, nausea and vomiting. CONCLUSIONS Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops.
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Affiliation(s)
- W L M Robson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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