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A rare case of combined syndrome of inappropriate antidiuretic hormone secretion and Fanconi syndrome in an elderly woman.

Abstract
An 83-year-old Japanese woman was admitted to our hospital with severe hyponatremia (sodium, 108 mEq/L [108 mmol/L]), hypokalemia, hypochloridemia, hypocalcemia, hypophosphatemia, and hypouricemia. Despite low plasma osmolarity (232 mOsm/kg [232 mmol/kg]), urine osmolarity (320 mOsm/kg) was greater than that of plasma, and she had increased urinary sodium excretion (88 mEq/L [88 mmol/L]) and an unsuppressed high plasma level of antidiuretic hormone (ADH; 5.5 pg/mL [5.1 pmol/L]). These findings indicated that she had syndrome of inappropriate ADH secretion (SIADH). In addition, she had a generalized reabsorption defect of the proximal tubules, including decreased tubular reabsorption of phosphate, increased fractional excretion of uric acid, glycosuria despite a normal blood glucose level, and panaminoaciduria. Thus, combined SIADH and Fanconi syndrome was diagnosed. The cause was thought to be the antidepressant paroxetine, which is a selective serotonin reuptake inhibitor (SSRI). Several of the abnormal values resolved within 1 week after discontinuation of this drug. Although the precise mechanism responsible was not elucidated, we report an extremely rare case of combined SIADH and Fanconi syndrome, probably caused by short-term SSRI therapy.
AuthorsTomoko Ishii, Takayasu Ohtake, Takeo Yasu, Yasuhiro Kadotani, Shuji Hayashi, Machiko Oka, Kyoko Maesato, Tsutomu Mano, Ryota Ikee, Hidekazu Moriya, Shuzo Kobayashi
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 48 Issue 1 Pg. 155-8 (Jul 2006) ISSN: 1523-6838 [Electronic] United States
PMID16797399 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Serotonin Uptake Inhibitors
  • Paroxetine
Topics
  • Aged
  • Aged, 80 and over
  • Fanconi Syndrome (etiology, pathology)
  • Female
  • Humans
  • Inappropriate ADH Syndrome (etiology, pathology)
  • Paroxetine (adverse effects, therapeutic use)
  • Selective Serotonin Reuptake Inhibitors (adverse effects, therapeutic use)

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