Four cases of refractory hyponatremia caused by secondary adrenal cortical insufficiency after chemotherapy in children with tumors of lymphoid hematopoietic system
10.3760/cma.j.cn101070-20240308-00141
- VernacularTitle:儿童淋巴造血系统肿瘤化疗后继发性肾上腺皮质功能不全致顽固性低钠血症4例
- Author:
Ying LIU
1
;
Bai LI
;
Huixia WEI
;
Yufeng LIU
Author Information
1. 郑州大学第一附属医院儿童医院血液肿瘤科，郑州 450052
- Keywords:
Child;
Secondary adrenal cortical insufficiency;
Refractory hyponatremia;
Tumor of lymphatic hematopoiesis system
- From:
Chinese Journal of Applied Clinical Pediatrics
2024;39(8):605-608
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical features, treatment and prognosis of refractory hyponatremia caused by secondary adrenal cortical insufficiency (SACI) after chemotherapy in children with tumors of the lymphoid hematopoietic system.Methods:Clinical data including age, sex, serum sodium level, time of onset of hyponatremia, duration of hyponatremia, cortisol level, 24 h urinary sodium level, plasma/urine osmotic pressure, treatment and prognosis of 3 acute lymphoblastic leukemia (ALL) children and 1 lymphoblastic lymphoma (LBL) child with SACI-caused refractory hyponatremia treated at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2023 were analyzed retrospectively.Results:The 4 patients were all boys, and they received Dexamethasone chemotherapy.The primary clinical manifestations were fatigue, moderate hyponatremia in 3 cases, and mild hyponatremia in 1 case.Hyponatremia occurred after 1 week of glucocorticoid therapy and persisted for 10-20 days (mean 14.25 days).The 24 h urinary sodium level increased, plasma osmotic pressure slightly decreased or was at the low limit of the normal range, and urine osmotic pressure was greater than plasma osmotic pressure.The serum cortisol level at 8∶00 AM.decreased in 1 LBL case, increased in 1 ALL case, and remained normal in 2 ALL cases.After treatment with Hydrocortisone [10 mg/(m 2·d), taken orally in 2 doses], hyponatremia was quickly corrected within 3-5 days. Conclusions:When receiving glucocorticoid therapy, children with tumors of the lymphoid hematopoietic system may have SACI, and the hyponatremia caused by it generally appears 1 week after glucocorticoid therapy and persists for a long time.Laboratory tests are similar to the syndrome of inappropriate antidiuretic hormone secretion, but the response to intravenous/oral supplementation of concentrated sodium and water restriction treatment is poor.The addition of Hydrocortisone can quickly correct hyponatremia, and the prognosis is excellent.
