Complains of vomiting since 1 day
C/o hiccups since 1 day
Known case of Hypertension (TAB TELMISARTAN 20MG 1-0-0)
K/c/o Type 2 Diabetes
Mellitus (Insulin Inj. Human Mixtard 30/70 20-0-16 U S/C)
K/c/o Cerebrovascular accident (CVA)
K/c/o Benign prostatic hyperplasia (BPH)
K/c/o Coronary artery disease (CAD)- Triple vessel disease (Ecospirin Gold 0-0-1)
BP: 140/80 mmHg
No added sounds
S1 S2 heard.
Soft, Non-tender, No organomegaly. Bowel sounds heard.
No focal neurological deficits
Blood routine, LFT, RFT, CXR, MRI brain were normal
no ketone bodies
Urine osmolality:364mOsm/kg water
USG abdomen: s/o BPH
ECHO and Coronary angiogram: s/o CAD
CT abdomen: Mild wall thickening involving pylorus and D1 segment of duodenum, Gall bladder sludge, small right renal calculi
Upper GI endoscopy: Hiatus hernia, duodenal nodule(D1)-biopsy was taken-S/o neuroendocrine tumour
Serum gastrin: 171pg/ml
1.Duodenal Neuroendocrine tumor with Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
2.Hypertensive diabetic nephropathy
Tolvaptan was started and patient was followed for one month.
Sodium correction was done.
This is a case of SIADH with no identifiable cause. Nevertheless, we incidentally found this patient to have functional Neuroendocrine tumour (NET) of the GIT. They can arise from any part of GIT. In relation to their pluripotent neuroendocrine cellular origin, NET can produce several resultant paraneoplastic syndromes. One of these syndromes is SIADH. We associate this SIADH with NET.
However, literature does not mention NET as one of the causes of SIADH. Persistent hiccups were an unusual presenting manifestation of hyponatremia.Tolvaptan selectively inhibits the binding of ADH to the V2 receptor . Binding to the V2 receptor induces excretion of electrolyte-free water without altering the electrolyte excretion.
1. J Emerg Med 1987 Jul-Aug;5(4):283-7
2. Ecancermedicalscience. 2014 Jul 31;8:450. doi: 10.3332/ecancer.2014.450.eCollection 2014.