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Dang S, Zhang S, Zhao J, Li X, Li W. The syndrome of inappropriate antidiuretic hormone associated with nasal and paranasal malignant tumors. Eur Arch Otorhinolaryngol 2024; 281:1443-1448. [PMID: 38163817 PMCID: PMC10858107 DOI: 10.1007/s00405-023-08347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate the clinical characteristics of the syndrome of inappropriate antidiuretic hormone (SIADH) associated with nasal and paranasal malignant tumors. METHODS Patients with locally advanced or recurrence/metastatic malignant tumors of the nasal and paranasal sinuses were included. The SIADH was diagnosed according to the diagnostic criteria. The clinical characteristics of SIADH patients were retrospectively analyzed. RESULTS Six patients (6/188, 3.2%) met the diagnostic criteria of SIADH, including four olfactory neuroblastoma (4/26, 15.4%), one neuroendocrine carcinoma (1/9, 11.1%), and one squamous cell carcinoma (1/63, 1.6%). Five patients (83.3%) had severe hyponatremia; however, the hyponatremia could be improved by fluid restriction or tolvaptan. Three patients' SIADH were recovered during the chemotherapy and the other three were recovered after the surgery. CONCLUSION The incidence of SIADH associated with nasal and paranasal malignant tumors is relatively more common in olfactory neuroblastoma and neuroendocrine carcinoma. The hyponatremia caused by SIADH may be corrected by fluid restriction or tolvaptan, and the SIADH may be recovered through anti-tumor therapy.
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Affiliation(s)
- Shoutao Dang
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shurong Zhang
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jingyang Zhao
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xinyu Li
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Li
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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2
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Wu S, Guan W, Zhao H, Li G, Zhou Y, Shi B, Zhang X. Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer. Front Physiol 2023; 14:1277383. [PMID: 38028778 PMCID: PMC10663334 DOI: 10.3389/fphys.2023.1277383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC. Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months. Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817-15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093-8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353-11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients. Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Weizheng Guan
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Huan Zhao
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
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3
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Oda Y, Tsubouchi H, Ishii N, Kitamura A, Moriyama E, Mitsutome E, Sakai K, Shiomi K, Yanagi S, Miyazaki T. A rare case of concomitant Lambert-Eaton myasthenic syndrome and syndrome of inappropriate antidiuretic hormone secretion in a patient with small cell lung carcinoma. Respir Med Case Rep 2023; 46:101930. [PMID: 37920363 PMCID: PMC10618749 DOI: 10.1016/j.rmcr.2023.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
Small cell lung carcinoma (SCLC) is a neuroendocrine carcinoma with a poor prognosis and is a common cause of paraneoplastic syndromes. Paraneoplastic syndromes are characterized by neurological and endocrinological problems in patients with malignancy and are often associated with difficulty in induction of chemotherapy. Here we report the case of a patient with SCLC concomitant with two paraneoplastic syndromes, syndrome of inappropriate antidiuretic hormone secretion (SIADH) and Lambert-Eaton myasthenic syndrome (LEMS), who was treated with a platinum-doublet chemotherapy regimen. A 66-year-old male patient presented with a 1-month history of progressive proximal muscle weakness, ataxia gait and 5 kg of body weight loss. The laboratory tests revealed hyponatremia due to SIADH and the existence of antibodies against P/Q-type voltage-gated calcium channels. The nerve conduction study showed a low amplitude of compound muscle action potential (0.38 mv), a 34% decrement on 3-Hz stimulation, and a 1939% increment after maximum voluntary contraction in 10 seconds (7.75 mv). The endobronchial ultrasound transbronchial needle aspiration biopsy revealed the pathological findings of SCLC. A 2-cycle chemotherapy regimen of irinotecan plus cisplatin resulted in temporary tumor shrinkage that lasted 2 months, but the improvement of proximal muscle weakness and hyponatremia were maintained over the tumor re-progression period after chemotherapy. Although paraneoplastic syndromes accelerate the decrease in performance status, chemotherapy for SCLC may improve symptoms related to paraneoplastic syndromes and could be considered in similar cases.
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Affiliation(s)
- Yasuharu Oda
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hironobu Tsubouchi
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Nobuyuki Ishii
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
- Chiyoda Hospital, Hyuga, Miyazaki, Japan
| | - Aya Kitamura
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Eiji Moriyama
- National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, Miyazaki, Japan
| | - Eriko Mitsutome
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
- National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, Miyazaki, Japan
| | - Katsuya Sakai
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kazutaka Shiomi
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Shigehisa Yanagi
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Taiga Miyazaki
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
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Tas F, Ozturk A, Erturk K. Neither the presence nor the severity of hyponatremia affected the outcome of the patients with small cell lung cancer. Ir J Med Sci 2023; 192:1613-1619. [PMID: 36279041 DOI: 10.1007/s11845-022-03199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte disorder in lung cancer, and it particularly occurs in small cell lung cancer (SCLC) patients. The prognostic significance of hyponatremia has been reported in several studies with controversial results. AIMS We aimed in this study to investigate hyponatremia and evaluate its prognostic value in SCLC patients. METHODS The data of 373 SCLC patients were analyzed retrospectively. Serum sodium concentrations were measured from blood samples taken from all patients before treatment. Hyponatremia was defined as a serum sodium concentration below 135 mmol/L and then assigned into two groups: mild (130 to 134 mmol/L) and severe (below ≤ 129 mmol/L) hyponatremia. RESULTS Hyponatremia was detected in 85 (22.8%) patients (mild hyponatremia in 51 (13.7%) and severe hyponatremia in 34 (9.1%) patients). Furthermore, 26% (63 of 242) of ED-SCLC patients and 16.8% (22 of 131) of LD-SCLC patients had hyponatremia. While no clinical parameter was statistically associated with serum sodium concentrations in LD-SCLC patients, hyponatremic ED-SCLC patients were more frequently associated with weight loss (p = 0.04) and liver metastasis (p = 0.04). In LD-SCLC, the overall survival (OS) rates of patients with hyponatremia were similar to those with normonatremia (p = 0.6). Likewise, hyponatremic and normonatremic ED-SCLC patients had similar life expectancies (p = 0.1). Moreover, the severity of hyponatremia did not affect OS in either LD-SCLC (p = 0.3) or ED-SCLC (p = 0.1). CONCLUSION Serum sodium concentration did not have an impact on survival in SCLC patients; thus, we concluded that neither the presence nor the severity of hyponatremia affected the outcome of these patients.
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Affiliation(s)
- Faruk Tas
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.
| | - Akin Ozturk
- Department of Medical Oncology Outpatient Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Erturk
- Department of Medical Oncology, Koc University, Istanbul, Turkey
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5
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Chowdhury AA, Rodgers K, Godbole NM, Awasthi S. Stability and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury. RSC Adv 2023; 13:18864-18877. [PMID: 37350860 PMCID: PMC10282593 DOI: 10.1039/d3ra02918b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
Lung inflammation and injuries are major health problems. The SPA4 peptide (amino acid sequence GDFRYSDGTPVNYTNWYRGE) binds to Toll-like receptor-4 and exerts anti-inflammatory activity. In this study, we have determined the stability of the structure and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury. The SPA4 peptide was maintained at different pH and temperatures, in solutions of different ionic strengths, and simulated lung fluids. The primary and secondary structure of the SPA4 peptide was determined by ultraviolet-visible (UV-VIS) and circular dichroism (CD) spectroscopy. The activity of the SPA4 peptide was determined by measurement of secreted levels of chemokine C-X-C motif ligand 1/keratinocyte-derived chemokine (CXCL1/KC) and lactate by primary mouse lung epithelial cells against lipopolysaccharide (LPS) stimuli. Our results demonstrate the stability of the structure of the SPA4 peptide at room temperature and 4 °C over 10 days. The original UV-VIS spectra of the SPA4 peptide followed a typical pattern when incubated in solutions of pH 5.7, 7.0, and 8.0 at different temperatures, simulated lung fluids, and most of the chemical components. Slight shifts in the absorbance peaks, derivative values, and vibrational fine structures were noted in the fourth-derivative spectra of the SPA4 peptide under some conditions. An increased level of lactate is the hallmark of lung injury. The SPA4 peptide on its own and in the presence of lactate exerts anti-inflammatory activity. The primary and secondary structure and the activity of the SPA4 peptide remain intact when pre-incubated in 2 mM sodium lactate solution. The results provide important insights about the stability and structure-activity relationship of the SPA4 peptide.
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Affiliation(s)
- Asif Alam Chowdhury
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
| | - Karla Rodgers
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center 940 Stanton L. Young Blvd Oklahoma City OK-73104 USA
| | - Nachiket M Godbole
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
| | - Shanjana Awasthi
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
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6
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Zhu D, Li B, Wang C, Jiang P, Tang F, Li Y. Echinocystic acid induces the apoptosis, and inhibits the migration and invasion of non-small cell lung cancer cells. Med Oncol 2023; 40:182. [PMID: 37202561 DOI: 10.1007/s12032-023-02029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 05/20/2023]
Abstract
An increasing amount of evidence has demonstrated the anticancer activity of triterpenes extracted from traditional medicines. Echinocystic acid (EA), a natural triterpene isolated from Eclipta prostrata (L.) L., has previously been shown to exhibit anticancer activity in HepG2 and HL-60 cells. The aim of the present study was to investigate the anticancer activity of EA in non-small cell lung cancer (NSCLC) cells. For this purpose, the viability and proliferation of A549 cells were determined using a Cell Counting Kit-8 and 5-ethynyl-2'-deoxyuridine staining. The migratory and invasive ability of the A549 cells were measured using wound healing and Transwell assays. Hoechst staining was also performed to detect the apoptosis of A549 cells. The proliferation of A549 cells and the distributions of different growth phases were determined using a flow cytometer. Western blot analysis was used to detect the expression levels of cyclin D, partitioning defective 3 homolog (Par3), PI3K, Akt, mTOR, Bax, Bcl-2 and caspase-3. EA inhibited the proliferation, and the migratory and invasive abilities of cultured lung carcinoma cells (A549 cells), and induced cell cycle arrest in the G1 phase of the cell cycle. Treatment with EA upregulated Par3 expression and inhibited the PI3K/Akt/mTOR pathway in vitro. In addition, EA treatment inhibited tumor growth, suppressed proliferation and induced the apoptosis of tumor cells in NSCLC tumor xenografts in mice. On the whole, these results suggest that EA may represent a potential therapeutic agent for NSCLC.
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Affiliation(s)
- Duojie Zhu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, People's Republic of China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, People's Republic of China
| | - Cheng Wang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, People's Republic of China
| | - Peng Jiang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, People's Republic of China
| | - Futian Tang
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Yumin Li
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China.
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7
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Chung C, Allen E, Umoru G. Paraneoplastic syndromes: A focus on pathophysiology and supportive care. Am J Health Syst Pharm 2022; 79:1988-2000. [PMID: 35916756 DOI: 10.1093/ajhp/zxac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE This article aims to increase awareness of, outline pathophysiology for, and offer guidance on supportive care strategies for specific endocrine, neurological, and immunological syndromes associated with paraneoplastic syndromes (PNSs). SUMMARY PNS refers to remote effects that cannot be attributed to the direct or invasive effects of a malignancy. These syndromes are considered clinically important because they may provide early recognition, diagnosis, and management of the malignancy in a timely manner. Many of their presenting symptoms such as ectopic Cushing's syndrome, hypercalcemia of malignancy (HCM), syndrome of inappropriate secretion of antidiuretic hormone (SIADH), neurological dysfunctions, and paraneoplastic autoimmune thrombocytopenia overlap with those of nonneoplastic disorders, yet their pathogenesis and responses to treatment differ. Treatment for ectopic Cushing's syndrome due to a PNS consists of treatment of the underlying malignancy and its comorbidities. Drug therapies may include ketoconazole, mitotane, metyrapone, somatostatin analogs, and dopamine agonists. Hypercalcemia may be classified into cases with parathyroid hormone (PTH)-dependent causes or PTH-independent causes such as HCM, in which osteoclast inhibitors may be deployed. Treatments of PNS-mediated SIADH include treatment of the underlying malignancy and strategies to increase serum sodium levels. Amifampridine is now considered the first-line agent for paraneoplastic Lambert-Eaton myasthenic syndrome, whereas steroids, intravenous immune globulin, thrombopoietin receptor agonists (eg, romiplostim, eltrombopag, and avatrombopag), fostamatinib, and rituximab may find their niche in treatment of PNS-mediated autoimmune thrombocytopenia. CONCLUSION Supportive care for PNSs lends opportunities to pharmacists to add quality, value, and safety.
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Affiliation(s)
| | - Emily Allen
- Houston Methodist Hospital, Houston, TX, USA
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8
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Christ-Crain M, Refardt J, Winzeler B. Approach to the Patient: "Utility of the Copeptin Assay". J Clin Endocrinol Metab 2022; 107:1727-1738. [PMID: 35137148 PMCID: PMC9113794 DOI: 10.1210/clinem/dgac070] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Indexed: 11/19/2022]
Abstract
Copeptin derives from the same precursor peptide preprovasopressin as arginine vasopressin (AVP). The secretion of both peptides is stimulated by similar physiological processes, such as osmotic stimulation, hypovolemia, or stress. AVP is difficult to measure due to complex preanalytical requirements and due to technical difficulties. In the last years, copeptin was found to be a stable, sensitive, and simple to measure surrogate marker of AVP release. Different immunoassays exist to measure copeptin. The 2 assays which have most often be used in clinical studies are the original sandwich immunoluminometric assay and its automated immunofluorescent successor. In addition, various enzyme-linked immunosorbent assay have been developed. With the availability of the copeptin assay, the differential diagnosis of diabetes insipidus was recently revisited. The goal for this article is therefore to first review the physiology of copeptin, and second to describe its use as marker for the differential diagnosis of vasopressin-dependent fluid disorders, mainly diabetes insipidus but also hyper- and hyponatremia. Furthermore, we highlight the role of copeptin as prognostic marker in other acute and chronic diseases.
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Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence: Mirjam Christ-Crain, MD, PhD, Department of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Julie Refardt
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
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9
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Donald DM, Sherlock M, Thompson CJ. Hyponatraemia and the syndrome of inappropriate antidiuresis (SIAD) in cancer. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R78-R89. [PMID: 37435459 PMCID: PMC10259335 DOI: 10.1530/eo-22-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 07/13/2023]
Abstract
Hyponatraemia is a common electrolyte abnormality seen in a wide range of oncological and haematological malignancies and confers poor performance status, prolonged hospital admission and reduced overall survival, in patients with cancer. Syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatraemia in malignancy and is characterised by clinical euvolaemia, low plasma osmolality and concentrated urine, with normal renal, adrenal and thyroid function. Causes of SIAD include ectopic production of vasopressin (AVP) from an underlying tumour, cancer treatments, nausea and pain. Cortisol deficiency is an important differential in the assessment of hyponatraemia, as it has an identical biochemical pattern to SIAD and is easily treatable. This is particularly relevant with the increasing use of immune checkpoint inhibitors, which can cause hypophysitis and adrenalitis, leading to cortisol deficiency. Guidelines on the management of acute, symptomatic hyponatraemia recommend 100 mL bolus of 3% saline with careful monitoring of the serum sodium to prevent overcorrection. In cases of chronic hyponatraemia, fluid restriction is recommended as first-line treatment; however, this is frequently not feasible in patients with cancer and has been shown to have limited efficacy. Vasopressin-2 receptor antagonists (vaptans) may be preferable, as they effectively increase sodium levels in SIAD and do not require fluid restriction. Active management of hyponatraemia is increasingly recognised as an important component of oncological management; correction of hyponatraemia is associated with shorter hospital stay and prolonged survival. The awareness of the impact of hyponatraemia and the positive benefits of active restoration of normonatraemia remain challenging in oncology.
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Affiliation(s)
- D Mc Donald
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - M Sherlock
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - C J Thompson
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
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10
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Bartalis E, Gergics M, Tinusz B, Földi M, Kiss S, Németh D, Solymár M, Szakács Z, Hegyi P, Mezösi E, Bajnok L. Prevalence and Prognostic Significance of Hyponatremia in Patients With Lung Cancer: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:671951. [PMID: 34950676 PMCID: PMC8688712 DOI: 10.3389/fmed.2021.671951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/29/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The prevalence of hyponatremia is highly variable among patients with lung cancer. However, its prevalence and prognostic significance in subgroups of patients with lung cancer have not yet been evaluated in a meta-analysis. Methods: We have registered our meta-analysis and review protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library. Results: We identified a total of 8,962 potentially eligible studies, and we included 31 articles in our evaluation. The prevalence of hyponatremia in patients with lung cancer varied between 3 and 94.8% with an average of 25% without any significant differences between the following subgroups: histotype, gender, age, Eastern Cooperative Oncology Group (ECOG) state, and the extent of disease. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months [RR.59 (95% CI.47-0.74), p < 0.001] and at 20 months [RR.44 (95% CI.33-0.59), p < 0.001], with worse survival rates in non-small cell lung cancer (NSCLC) [RR.27 (95% CI.12-0.44), p < 0.001] than in small cell lung cancer (SCLC) [RR.42 (95% CI.27-0.57), p < 0.001]. If hyponatremia was corrected, OS at 10 months was significantly higher than in the uncorrected hyponatremia group [RR 1.83 (95% CI 1.37-2.44), p < 0.001], but, at 20 months, no statistically significant difference could be found between these subgroups [RR 2.65 (95% CI.94-7.50), p = 0.067]. Conclusions: Patients with lung cancer diagnosed with hyponatremia, especially patients with NSCLC, seem to have significantly lower survival rates than normonatremic patients. If hyponatremia remains uncorrected, the mortality rates might be even higher.
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Affiliation(s)
- Eszter Bartalis
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Marin Gergics
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Benedek Tinusz
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Mária Földi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Kiss
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Dávid Németh
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Emese Mezösi
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Bajnok
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
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11
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Abstract
Lung cancer continues to be the leading cause of cancer death globally. Delayed diagnosis is a major contributing factor to poor outcomes and remains a key challenge to overcome. While debate around the implementation of lung cancer screening for asymptomatic high-risk individuals continues, rapid access to relevant diagnostic tests is essential. The new National Optimal Lung Cancer Pathway describes 'diagnostic standards of care' in an effort to implement best practice, reduce variation and improve delays in diagnosis, staging and treatment of lung cancer. Lung cancer treatment continues to develop with new surgical techniques, radiotherapy options and more drugs being licensed as part of standard treatment. We provide an overview of the core lung cancer diagnostic steps, recognition and management of acute presentations as well as the latest treatment options.
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Affiliation(s)
| | | | - Haval Balata
- Manchester Thoracic Oncology Centre, Manchester, UK and University of Manchester, Manchester, UK
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12
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Yin G, Man C, Cheng W, Gao X, Wang J, Tian T, Xu J, Duan L, Qiu H. The prevalence and prognosis of hyponatraemia in non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis. Leuk Lymphoma 2021; 63:362-369. [PMID: 34661498 DOI: 10.1080/10428194.2021.1992623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Non-Hodgkin lymphoma associated hemophagocytic lymphohistiocytosis (NHL-HLH) in adult secondary HLH is a common and universally highly lethal critical disorder. Hyponatraemia is the most common electrolyte disorder in the critical illness setting and acts as a negative prognostic factor. The aim of our study was to evaluate the prognostic role of hyponatraemia among patients with NHL-HLH. The results showed that 81 (52.9%) patients had hyponatraemia. After a median follow up 47 (range 14-180) days, there were 72 (88.9%) cumulative deaths in hyponatraemia group while 50 (69.4%) in normonatremia group. After adjustment for confounders, multivariate analysis revealed that hyponatraemia was an independent prognostic factor for OS (HR:1.51, 95% CI: 1.03-2.20; p = 0.033). Restricted cubic spline confirmed a linear and positive association between serum sodium and the risk of mortality. Hyponatraemia is relatively frequent in NHL-HLH. As a readily available biomarker in clinical routine, it was a promising prognostic predictor for NHL-HLH.
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Affiliation(s)
- Guangli Yin
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Changfeng Man
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wanying Cheng
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Xin Gao
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jujuan Wang
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Tian Tian
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ji Xu
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Limin Duan
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Hongxia Qiu
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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13
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Suh SH, Kim SW. A novel role of copeptin as a biomarker for the prediction of treatment response in hyponatremia. Kidney Res Clin Pract 2021; 40:329-331. [PMID: 34510853 PMCID: PMC8476310 DOI: 10.23876/j.krcp.21.000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
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14
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Kudo T, Murai Y, Kojima Y, Uehara K, Satoh T. Efficacy and safety of tolvaptan in patients with malignant ascites: a phase 2, multicenter, open-label, dose-escalation study. Jpn J Clin Oncol 2021; 51:354-362. [PMID: 33173939 PMCID: PMC7937426 DOI: 10.1093/jjco/hyaa196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This phase 2 study examined the efficacy and safety of tolvaptan, an aquaretic drug, in the treatment of ascites associated with cancer. METHODS In the dose-escalation phase, oral tolvaptan was initiated at a dose of 3.75 mg/day, and the dose was increased daily to 7.5, 15 and 30 mg/day. Dose escalation was terminated once the increase from baseline in the daily urine volume reached 500 ml, at which point the patient proceeded to the maintenance phase of 5-7 days. Improvement of ascites was determined primarily by reduction in body weight and ascitic fluid volume. RESULTS The mean change from baseline in body weight was maintained below 0 kg throughout the study. The mean change (±standard deviation) from baseline in ascitic fluid volume at the end of treatment (EOT) was 237.45 ± 868.14 ml in 33 evaluable patients. Although an increase from baseline in ascitic fluid volume at the EOT was observed in 23 of 33 patients (maximum: 1589.3 ml, minimum: 3.83 ml), a reduction in ascitic fluid volume was observed in the remaining 10 patients (maximum: -2304.3 ml, minimum: -27.5 ml). The common treatment-emergent adverse events included vomiting (5 of 43 patients, 11.6%), abdominal distension, constipation, thirst, blood osmolarity increased and renal impairment (3 of 43 patients, 7.0% each). CONCLUSIONS Tolvaptan seemed to have no definitive effect on reducing ascites; however, it might be effective in at least some cancer patients. No new safety concerns were identified at doses of 3.75-30 mg/day.
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Affiliation(s)
- Toshihiro Kudo
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Medical Oncology, Osaka International Cancer Institute, Osaka Prefectural Hospital Organization, Osaka, Japan
| | - Yoshiyuki Murai
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yoshitsugu Kojima
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Kenji Uehara
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokushima, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka, Japan
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15
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Hun M, Xie M, She Z, Abdirahman AS, Li C, Wu F, Luo S, Han P, Phorn R, Wu P, Luo H, Chen K, Tian J, Wan W, Wen C. Management and Clinical Outcome of Posterior Reversible Encephalopathy Syndrome in Pediatric Oncologic/Hematologic Diseases: A PRES Subgroup Analysis With a Large Sample Size. Front Pediatr 2021; 9:678890. [PMID: 34277519 PMCID: PMC8280768 DOI: 10.3389/fped.2021.678890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022] Open
Abstract
This study investigated the management and clinical outcomes along with associated factors of posterior reversible encephalopathy syndrome (PRES) in childhood hematologic/oncologic diseases. We present data from children with hematologic/oncologic diseases who developed PRES after treatment of the primary disease with chemotherapy and hematopoietic stem cell transplantation (HSCT) at 3 medical centers in Changsha, China from 2015 to 2020, and review all previously reported cases with the aim of determining whether this neurologic manifestation affects the disease prognosis. In the clinical cohort of 58 PRES patients, hypertension [pooled odds ratio (OR) = 4.941, 95% confidence interval (CI): 1.390, 17.570; P = 0.001] and blood transfusion (OR = 14.259, 95% CI: 3.273, 62.131; P = 0.001) were significantly associated with PRES. Elevated platelet (OR = 0.988, 95% CI: 0.982, 0.995; P < 0.001), hemoglobin (OR = 0.924, 95% CI: 0.890, 0.995; P < 0.001), and blood sodium (OR = 0.905, 95% CI: 0.860, 0.953; P < 0.001), potassium (OR = 0.599, 95% CI: 0.360, 0.995; P = 0.048), and magnesium (OR = 0.093, 95% CI: 0.016, 0.539; P = 0.008) were protective factors against PRES. Data for 440 pediatric PRES patients with hematologic/oncologic diseases in 21 articles retrieved from PubMed, Web of Science, and Embase databases and the 20 PRES patients from our study were analyzed. The median age at presentation was 7.9 years. The most common primary diagnosis was leukemia (62.3%), followed by solid tumor (7.7%) and lymphoma (7.5%). Most patients (65.0%) received chemotherapy, including non-induction (55.2%) and induction (44.8%) regimens; and 86.5% used corticosteroids before the onset of PRES. Although 21.0% of patients died during follow-up, in most cases (93.2%) this was not attributable to PRES but to severe infection (27.3%), underlying disease (26.1%), graft-vs.-host disease (14.8%), multiple organ dysfunction syndrome (8.0%), and respiratory failure (3.4%). PRES was more common with HSCT compared to chemotherapy and had a nearly 2 times higher mortality rate in patients with oncologic/hematologic diseases than in those with other types of disease. Monitoring neurologic signs and symptoms in the former group is therefore critical for ensuring good clinical outcomes following treatment of the primary malignancy.
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Affiliation(s)
- Marady Hun
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Xie
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhou She
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Amin S Abdirahman
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cuifang Li
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feifeng Wu
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Senlin Luo
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Phanna Han
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Rithea Phorn
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Pan Wu
- Department of Hematology, Hunan Children's Hospital, University of South China, Changsha, China
| | - Haiyan Luo
- Department of Hematology, Hunan Children's Hospital, University of South China, Changsha, China
| | - Keke Chen
- Department of Hematology, Children's Medical Center, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, China
| | - Jidong Tian
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wuqing Wan
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chuan Wen
- Division of Hematology and Tumor, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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16
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Watanabe M, Yasuda J, Ashida K, Matsuo Y, Nagayama A, Goto Y, Iwata S, Watanabe M, Sasaki J, Hoshino T, Nomura M. Masked Diabetes Insipidus Hidden by Severe Hyponatremia: A Case of Pituitary Metastasis of Lung Adenocarcinoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928113. [PMID: 33335085 PMCID: PMC7755591 DOI: 10.12659/ajcr.928113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 70-year-old Final Diagnosis: Adrenal insufficiency • diabetes insipidus • lung adenocarcinoma Symptoms: Anorexia • fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Neurosurgery • Oncology
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Affiliation(s)
- Miki Watanabe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Junichi Yasuda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuko Matsuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuka Goto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayuki Watanabe
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jun Sasaki
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume, Fukuoka, Japan
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17
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Wu R, Li C, Wang Z, Fan H, Song Y, Liu H. A narrative review of progress in diagnosis and treatment of small cell lung cancer patients with hyponatremia. Transl Lung Cancer Res 2020; 9:2469-2478. [PMID: 33489807 PMCID: PMC7815354 DOI: 10.21037/tlcr-20-1147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small cell lung cancer (SCLC) is one of the malignant cancers of lung tumors, and hyponatremia, defined as serum sodium concentration (Na+) lower than 135 mmol/L, is the most common complication of solid tumors, with an incidence of up to 18.9% and a negative impact on quality of life in SCLC. As a prognostic index of SCLC, timely monitoring and correcting of hyponatremia is of great clinical significance for prolonging the survival period of patients. In the explore of new drugs for small cell lung cancer, it is necessary to include hyponatremia as an evaluation index in clinical studies. As the occurrence of hyponatremia is sometimes unavoidable owing to SCLC specific neurological characteristics, early monitoring to detect the presence of hyponatremia and timely correction are helpful to improve the prognosis of patients. There are many predisposing factors for hyponatremia, including heterotopia of antidiuretic hormone (ADH), use of platinum-based chemotherapy drugs, and intracranial metastasis, among others. Patients with small cell lung cancer are usually asymptomatic in the early stage, while it is of great significance to find a suitable clinical index to judge whether it is a malignant inducement or not. In the clinical setting, due to different electrolyte levels and therapeutic scheduling for the primary disease, an individualized plan is often made, mainly comprising water restriction, infusion, and medications. This review includes related clinical studies and describes the common symptoms and predisposing factors of hyponatremia in patients with SCLC, and their impact on quality of life and prognosis.
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Affiliation(s)
- Ranpu Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China
| | - Chuling Li
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Zimu Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hang Fan
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
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18
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Qayyum MA, Farooq Z, Yaseen M, Mahmood MH, Irfan A, Zafar MN, Khawaja M, Naeem K, Kisa D. Statistical Assessment of Toxic and Essential Metals in the Serum of Female Patients with Lung Carcinoma from Pakistan. Biol Trace Elem Res 2020; 197:367-383. [PMID: 31848922 DOI: 10.1007/s12011-019-01998-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 01/09/2023]
Abstract
Lung cancer (LC) is the number one cancer killer of women both in the USA and around the world. Besides cigarette smoking, an important feature in the etiology of LC is its strong association with exposure of toxic metals. The primary objective of the present investigation was to assess the concentrations of toxic/essential elements (Ni, Ca, Se, Zn, Co, K, Cr, As, Cu, Na, Fe, Hg, Cd, Mg, Mn, and Pb) in the serum samples of LC female patients with female controls by atomic absorption spectrometry after wet-acid digestion procedure. Carcinoembryonic antigen (CEA) was also measured in the serum of the patients using immunoradiometric method. Comparative appraisal of the data revealed that concentrations of Cr, Mg, Cd, Pb, Hg, As, and Ni were noted to be high significantly in serum of LC female patients, while the average Fe, Co, Mn, Na, K, Zn, Ca, and Se were observed at higher levels in female controls (p < 0.05). The correlation study revealed significantly different mutual associations among the elements in the both donor groups. Markedly, variations in the elemental levels were also noted for different types (non-small cell lung cancer and small cell lung cancer) and stages (I, II, III, & IV) of LC patients. Multivariate analyses showed substantially diverse apportionment of the metals in the female patients and female controls. Hence, present findings suggest that the toxic and essential metals accumulated in the body may pose a high risk for LC progression in Pakistani females.
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Affiliation(s)
- Muhammad Abdul Qayyum
- Department of Chemistry, Division of Science & Technology, University of Education, Lahore, Pakistan.
| | - Zahid Farooq
- Department of Physics, Division of Science & Technology, University of Education, Lahore, Pakistan
| | - Muhammad Yaseen
- Department of Chemistry, Division of Science & Technology, University of Education, Lahore, Pakistan
| | - Mian Hr Mahmood
- Department of Chemistry, Division of Science & Technology, University of Education, Lahore, Pakistan
| | - Ahmad Irfan
- Department of Chemistry, Faculty of Science, King Khalid University, P.O. Box 9004, Abha, 61413, Saudi Arabia
- Research Center for Advanced Materials Science, King Khalid University, P.O. Box 9004, Abha, 61413, Saudi Arabia
| | | | - Muddassir Khawaja
- Division of Pulmonary Critical Care and Sleep Medicine, University of Tennessee Health Science Center , Memphis, TN, 38163, USA
| | - Kashif Naeem
- Central Analytical Facility Division, Pakistan Institute of Nuclear Science and Technology (PINSTECH), P.O Nilore, Islamabad, 45650, Pakistan
| | - Dursun Kisa
- Department of Molecular Biology and Genetics, Bartin University Kutlubey Campus Yazcilar, Merkez , Bartin 74110, Turkey
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19
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Chan VWQ, Henry MT, Kennedy MP. Hyponatremia and hypercalcemia: a study of a large cohort of patients with lung cancer. Transl Cancer Res 2020; 9:222-230. [PMID: 35117176 PMCID: PMC8798502 DOI: 10.21037/tcr.2019.12.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hyponatremia and hypercalcemia are reported to be associated with poorer prognosis in lung cancer. Our study assessed the incidence of hyponatremia and hypercalcemia in a recent large cohort of patients diagnosed with lung cancer in an academic institution and correlated incidence with patient and tumour parameters. METHODS All patients presented at our regional lung cancer multidisciplinary team meeting between January 2011 and December 2016 were included. The incidence of hyponatremia (serum sodium ≤135 mEq/L) and hypercalcemia (serum calcium >2.62 mmol/L), including severity (mild, moderate or severe) was evaluated and stratified by tumour subtype and stage, and correlated with patient parameters. RESULTS A total of 624 patients (mean age, 67.4 years; 59.3% male) diagnosed with tissue-proven lung cancer were included. Hyponatremia and hypercalcemia were present in 31.6% (n=197) and 7.1% (n=44) at time of diagnosis. Hyponatremia occurred most commonly in patients with small cell lung carcinoma (SCLC) (n=42; 41.2%; P=0.001). Hypercalcemia occurred most commonly in patients with non-small cell lung carcinoma (NSCLC) squamous subtype (n=27; 12.2%; P=0.003). The incidence of hyponatremia and hypercalcemia were significantly higher in the advanced stages (P<0.041), except in SCLC where no difference in hypercalcemia incidence across the stages was observed (P=0.573). The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score was positively correlated with severity of hyponatremia at the early stage of NSCLC (Spearman correlation coefficient =0.325; P=0.003). CONCLUSIONS Hyponatremia is a common association in lung cancer, especially in SCLC. Hypercalcemia is an uncommon but significant association in the NSCLC squamous subtype. Hyponatremia might contribute to poorer ECOG-PS scores at the early stage of NSCLC.
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Affiliation(s)
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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20
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Refardt J, Winzeler B, Christ-Crain M. Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clin Endocrinol (Oxf) 2019; 91:22-32. [PMID: 31004513 PMCID: PMC6850413 DOI: 10.1111/cen.13991] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 01/14/2023]
Abstract
Copeptin is secreted in an equimolar amount to arginine vasopressin (AVP) but can easily be measured in plasma or serum with a sandwich immunoassay. The main stimuli for copeptin are similar to AVP, that is an increase in osmolality and a decrease in arterial blood volume and pressure. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation. Copeptin has, therefore, been evaluated as diagnostic biomarker in vasopressin-dependent disorders of body fluid homeostasis. Disorders of body fluid homeostasis are common and can be divided into hyper- and hypoosmolar circumstances: the classical hyperosmolar disorder is diabetes insipidus, while the most common hypoosmolar disorder is the syndrome of inappropriate antidiuresis (SIAD). Copeptin measurement has led to a "revival" of the direct test in the differential diagnosis of diabetes insipidus. Baseline copeptin levels, without prior thirsting, unequivocally identify patients with nephrogenic diabetes insipidus. In contrast, for the difficult differentiation between central diabetes insipidus and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is clearly superior to the classical water deprivation test. On the contrary, in the SIAD, copeptin measurement is of only little diagnostic value. Copeptin levels widely overlap in patients with hyponatraemia and emphasize the heterogeneity of the disease. Additionally, a variety of factors lead to unspecific copeptin elevations in the acute setting further complicating its interpretation. The broad use of copeptin as diagnostic marker in hyponatraemia and specifically to detect cancer-related disease in SIADH patients can, therefore, not be recommended.
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Affiliation(s)
- Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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21
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Guo JY, Gong TT, Yang Z, Liu Y, Wang L, Wang YN, Wu QJ. Prognostic value of preoperative hyponatremia in patients with epithelial ovarian cancer. J Cancer 2019; 10:836-842. [PMID: 30854089 PMCID: PMC6400813 DOI: 10.7150/jca.28118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/21/2018] [Indexed: 12/23/2022] Open
Abstract
Hyponatremia is an emerging issue in cancer patients. However, few studies have explored the prognostic value of preoperative hyponatremia in epithelial ovarian cancer (EOC) patients. We conducted a retrospective study of women diagnosed with EOC at Shengjing Hospital from 2011 to 2015. Preoperative serum sodium levels were measured and classified as normal (136-145 mmol/L) or hyponatremic (≤135 mmol/L) according to the average/most recent measurements of this biomarker. Multivariable Cox proportional hazard regression models were applied to determine the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of preoperative hyponatremia with progression-free survival (PFS) and overall survival (OS). We identified 607 EOC patients meeting the inclusion criteria with a median age of 51 years (inter-quartile range: 47-59 years). The median follow-up duration was 3.1 years (inter-quartile range: 2.2-4.2). The recurrence and mortality rates were 56.8% (345/607) and 38.4% (233/607), respectively. Among the patients, 81 (13.3%) were observed as hyponatremic. Preoperative hyponatremia was associated with poorer PFS (HR=1.51; 95%CI=1.07-2.15) as well as OS (HR=1.47; 95%CI=1.03-2.11) after adjusting for potential confounders. Notably, results were in line with the main findings only when using the most recent serum sodium levels before treatment, with corresponding HRs of 1.58 (95%CI=1.12-2.23) for PFS and 1.45 (95%CI=1.02-2.07) for OS. Preoperative hyponatremia is an independent prognostic factor of EOC. Further studies are warranted to confirm our findings as well as to determine whether correction of preoperative hyponatremia may alter clinical outcomes in these patients.
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Affiliation(s)
- Jing-Yi Guo
- Department of postgraduate, Shengjing Hospital of China Medical University, Shenyang, China (J-YG, LW, and Y-NW)
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China (T-TG, ZY, and YL)
| | - Zhuo Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China (T-TG, ZY, and YL)
| | - Yi Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China (T-TG, ZY, and YL)
| | - Ling Wang
- Department of postgraduate, Shengjing Hospital of China Medical University, Shenyang, China (J-YG, LW, and Y-NW)
| | - Ya-Nan Wang
- Department of postgraduate, Shengjing Hospital of China Medical University, Shenyang, China (J-YG, LW, and Y-NW)
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China (Q-JW)
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The prognostic effects of hyponatremia and hyperchloremia on postoperative NSCLC patients. Curr Probl Cancer 2019; 43:402-410. [PMID: 30685068 DOI: 10.1016/j.currproblcancer.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/21/2018] [Indexed: 01/12/2023]
Abstract
Electrolytic disorders are common in lung cancer patients. But the association between serum electrolytes levels and survival in patients undergoing lung cancer resections for non-small-cell lung cancer (NSCLC) has been poorly investigated. A retrospective study was conducted on consecutive postoperative NSCLC patients. Pearson's test was used to determine the association between serum sodium and chlorine levels and clinical characteristics, and cox regression and Kaplan-Meier model were applied to analyze risk factors on overall survival. We found that hyponatremia was an independent prognostic factor associated with poor prognosis in NSCLC patients undergoing complete resection (log-rank test, P = 0.004). In addition, we found that hyperchloremia predicted a poor clinical outcome in patients with non-anion-gap (log-rank test, P = 0.011), whereas it predicted a favorable clinical outcome in patients with high-anion-gap (log-rank test, P = 0.002). The serum electrolytes levels may reflect the prognosis of NSCLC patients who receive complete resection. Early detection, monitoring, and management of hyperchloremia and hyponatremia might improve patients' prognosis.
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