Mesothelioma associated with the syndrome of inappropriate secretion of antidiuretic hormone

Our plain-English summary of Mesothelioma associated with the syndrome of inappropriate secretion of antidiuretic hormone, by W.H. Perks, J.C. Crow, M. Green (The American Review of Respiratory Disease, 1978).

The study

• Authors: W.H. Perks, J.C. Crow, M. Green
• Journal: The American Review of Respiratory Disease
• Published: 1978;117(4):789-94
• Type of article: Case report
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A patient with a malignant mesothelioma developed the syndrome of inappropriate secretion of antidiuretic hormone. The electrolyte abnormalities were corrected by treatment with demethylchlortetracycline. Arginine vasopressin concentrations were increased in serum and urine. It is suggested that the syndrome might have been mediated by secretion of antidiuretic hormone from the posterior pituitary, because arginine vasopressin was not detected in the patient's tumor using a sensitive radioimmunoassay.

In plain English

This article was a case report about one patient. A 56-year-old man had worked for 12 years at a tin mine in South Africa, where he said there was a high concentration of asbestos dust. The article does not name a fiber type. He had a left-sided pleural effusion, and a pleural biopsy specimen showed sarcomatous (sarcomatoid) mesothelioma. He became confused, and his serum sodium fell to 119 mEq per liter. Arginine vasopressin (antidiuretic hormone) was raised in his urine and plasma, which fitted the syndrome of inappropriate secretion of antidiuretic hormone. He was treated with fluid restriction and 1,200 mg of demeclocycline daily. His confusion lessened and his sodium returned to normal, but he died 100 days after his first symptoms. At autopsy, no asbestos bodies were found in either lung. The hormone was not detected in tumor, uninvolved lung or liver. The authors concluded that the posterior pituitary, not the tumor, was more likely the hormone's source. They noted that tumor production was not completely excluded, given the delay before autopsy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 56-year-old man, an accountant who smoked 20 cigarettes daily, admitted to hospital (authors at The Brompton Hospital, London, and Northwick Park Hospital, England)
• Exposure: 12 years working at a tin mine in South Africa (ending five years before admission), where the patient alleged a high concentration of asbestos dust in the air; no fiber type stated
• Main results:
  • On readmission the patient's serum sodium fell to 119 mEq per liter, with serum osmolality 252 and urine osmolality 418 mOsm per kg
  • Arginine vasopressin was 212 fmole per ml in urine (normal range 20 to 40 fmole per ml) and 12 pg per ml in plasma (normal range 4 to 8 pg per ml)
  • The tumor was diagnosed as the sarcomatoid variety of pleural mesothelioma
  • With fluid restriction plus demeclocycline 1,200 mg daily, then demeclocycline alone, the patient became less confused and his serum osmolality and sodium returned to normal
  • The patient continued to lose weight and died 100 days after his first symptoms
  • At autopsy, no asbestos bodies were identified in either lung
  • Arginine vasopressin was not detected in extracts of tumor, right middle lobe of lung, or liver, using an assay sensitive to 5 pg per mg of tissue
• The authors' conclusion: The authors concluded that it seemed more likely that the posterior pituitary, not the tumor, was the source of the hormone. They also concluded that treatment with demeclocycline is safe and effective and may improve quality of life even in a fatal illness.
• Limitations the authors state:
  • The negative tumor assay does not completely exclude hormone production by the tumor, especially given the delay between death and autopsy (75 hours) when tissue was removed
  • For their hypothesis that tumor stimulation of vagal nerves triggered hormone release, the authors noted there was no evidence of disturbance of other vagal reflexes

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Pleural mesothelioma and the syndrome of inappropriate secretion of antidiuretic hormone — N.M. Siafakas, K. Tsirogiannis, et al. (1984)
• Solitary fibrous tumor of the pleura. An immunohistochemical, electron microscopic and tissue culture study of a tumor producing insulin-like growth factor I in a patient with hypoglycemia — E.H. Strøm, F. Skjørten, et al. (1991)
• Platinum-bisphosphonate complexes have proven to be inactive chemotherapeutics targeted for malignant mesothelioma because of inappropriate hydrolysis — N. Margiotta, R. Ostuni, et al. (2011)
• Steroid hormone receptor in pleural solitary fibrous tumours and CD34+ progenitor stromal cells — M. Bongiovanni, L. Viberti, et al. (2002)
• Antagonists of growth hormone-releasing hormone (GHRH) inhibit the growth of human malignant pleural mesothelioma — T. Villanova, I. Gesmundo, et al. (2019)
• Antagonist of Growth Hormone-Releasing Hormone Potentiates the Antitumor Effect of Pemetrexed and Cisplatin in Pleural Mesothelioma — I. Gesmundo, F. Pedrolli, et al. (2022)

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