Journal List > J Korean Endocr Soc > v.22(3) > 1003362

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Oh, Yun, Lee, Lee, Jung, Kim, Hong, Park, and Cho: A Case of Inappropriate Antidiuretic Hormone Syndrome Complicated with Tuberculous Meningitis Refractory to Antituberculosis Drugs
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(3): 210-214.

Published online: 20 June 2007

DOI: https://doi.org/10.3803/jkes.2007.22.3.210

A Case of Inappropriate Antidiuretic Hormone Syndrome Complicated with Tuberculous Meningitis Refractory to Antituberculosis Drugs

Ju Hee Oh, Sang Pil Yun, So Young Lee, Yeo Kyung Lee, Young Sun Jung1, Soo Kyung Kim, Sung Kwan Hong, Seok Won Park, Yong Wook Cho

Department of Internal Medicine, College of Medicine, Pochon CHA University, Korea.

1Department of Neurosurgery, College of Medicine, Pochon CHA University, Korea.

Received 26 December 2006       Accepted 19 January 2007

Copyright © 2007 Korean Endocrine Society

Abstract

Syndrome of inappropriate antidiuretic hormone is the most common cause of hyponatremia in hospitalized patients. It is defined as retention of water, loss of sodium and inappropriately concentrated urine in euvolemic patients with normal renal and adrenal function. A 26-year old male was admitted due to weight loss and fever that he had experienced for the previous 1 month. The chest X-ray and CT scan of lung showed about 2.5×1.2 cm lymph node enlargement at the left hilum and multiple lymph node enlargements. Thoracoscopic biopsy revealed tuberculosis. During treatment with antituberculosis drugs, the serum sodium was 125 mEq/L, the serum osmolality was 263 mOsm/kg, the urine osmolality was 577 mOsm/kg, and the urine sodium concentration was 177 mEq/L. He was treated by fluid restriction and hypertonic saline infusion, but he did not improve. Brain CT scan showed tuberculous meningitis with hydrocephalus. He fully recovered after undergoing ventriculoperitoneal shunt. We report here on a case of inappropriate antidiuretic hormone syndrome complicated by tuberculous meningitis that was refractory to antituberculosis drugs.

Keywords: Syndrome of inappropriate antidiuretic hormone, Tuberculous meningitis, Hyponatremia

Figures and Tables

Fig. 1
Chest x-ray shows ovoid opacity at left suprahilar portion (white arrow).
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Fig. 2
Chest CT shows multiple lymph node enlargement at anterior mediastinum and paraaortic portion (Fig. 2A, white arrows), left main bronchus was compressed by lymph node enlargement at left hilum and left lower paratracheal portion extrinsically (Fig. 2B, white arrow).
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Fig. 3
Non-contrast brain CT scan shows communicating hydrocephalus. This CT axial image demonstrates dilatation of the lateral ventricles.
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Fig. 4
Plasma sodium concentration according to hospital days. Sodium concentration recovered after the ventriculoperitoneal (V-P) shunt operation.
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