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Pneumologie 2013; 67(04): 219-222
DOI: 10.1055/s-0032-1326101
Case Report
© Georg Thieme Verlag KG Stuttgart · New York

Syndrome of Inadequate Antidiuretic Hormone Secretion in Pulmonary Tuberculosis – a Therapeutic Challenge

Case Report and Review of the LiteratureSyndrom der inadäquaten ADH-Sekretion bei Lungentuberkulose – eine therapeutische HerausforderungFallbericht und Literaturübersicht
H. Knoop
1   Department of Internal Medicine III – Respiratory and Critical Care Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
U. Knoop
1   Department of Internal Medicine III – Respiratory and Critical Care Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
J. Behr
1   Department of Internal Medicine III – Respiratory and Critical Care Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
C. M. Heyer
2   Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
S. Kuert
1   Department of Internal Medicine III – Respiratory and Critical Care Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
D. Roggenland
2   Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
M. Suermann
1   Department of Internal Medicine III – Respiratory and Critical Care Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
,
J. W. Dietrich
3   Department of Internal Medicine I – Internal Medicine, Diabetology and Endocrinology, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum
› Author Affiliations
Further Information

Publication History

received 16 December 2012

accepted after revision 28 December 2012

Publication Date:
18 February 2013 (online)

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Abstract

A forty-nine-year-old female patient with pulmonary tuberculosis developed syndrome of inadequate antidiuretic hormone secretion. Consequent restriction of fluid intake as a therapeutic measure was just as ineffective as a medication with tolvaptan which was performed later on. A probable explanation for the inefficacy of the aquaretic drug is an interaction of rifampicine and tolvaptan. This case report gives a short summary of SIADH in pulmonary TB and discusses possible reasons for the difficult antituberculotic treatment in this patient.

Zusammenfassung

Eine 49-jährige Patientin mit ansteckungsfähiger Lungentuberkulose entwickelte ein Syndrom der inadäquaten ADH-Sekretion. Eine konsequente Beschränkung der Flüssigkeitszufuhr als erster therapeutischer Schritt zeigte keinen Erfolg – ebenso wenig wie die als weiterer Ansatz durchgeführte Behandlung mit Tolvaptan. Eine mögliche Erklärung für die fehlende Wirksamkeit von Tolvaptan stellt eine Arzneimittelinteraktion zwischen dem oralen V2-Rezeptorantagonisten und Rifampicin dar. Dieser Fallbericht gibt eine kurze Übersicht über SIADH im Rahmen von Lungentuberkulosen und diskutiert mögliche Ursachen für die schwierige antituberkulotische Therapie bei dieser Patientin.

 

  • References

  • 1 World Health Organization. WHO report global tuberculosis control. Geneva/ Switzerland: World Health Organization, WHO; 2011: 10
    PubMedGoogle Scholar
  • 2 Schaberg T, Bauer T, Castell S et al. Recommendations for therapy, chemoprevention and chemoprophylaxis of tuberculosis in adults and children. [German Central Committee against Tuberculosis (DZK), German Respiratory Society (DGP)].. Pneumologie 2012; 66: 133-171
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med 2007; 356: 2064-2072
    CrossrefPubMedGoogle Scholar
  • 4 Lee P, Ho KKY. Hyponatremia in Pulmonary TB: Evidence of Ectopic Antidiuretic Hormone Production. Chest 2010; 137: 207-208
    CrossrefPubMedGoogle Scholar
  • 5 World Health Organization. Treatment of tuberculosis: guidelines. 4th. Edn.; Geneva/ Switzerland: World Health Organization, WHO; 2009: 1-160
    Google Scholar
  • 6 Willenberg HS, Kolentini C, Quinkler M et al. The serum sodium to urinary sodium to (serum potassium)2 to urinary potassium (SUSPPUP) ratio in patients with primary aldosteronism. Eur J Clin Invest 2009; 39: 43-50
    CrossrefPubMedGoogle Scholar
  • 7 Verbalis JG, Adler S, Schrier RW et al. Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion. Eur J Endocrinol 2011; 164: 725-732
    CrossrefPubMedGoogle Scholar
  • 8 Sousa M, Pozniak A, Boffito M. Pharmacokinetics and pharmacodynamics of drug interactions involving rifampicine, rifabutin and antimalarial drugs. J Antimicrob Chemother 2008; 62: 872-878
    CrossrefPubMedGoogle Scholar
  • 9 Shoaf SE, Bricmont P, Mallikaarjun S. Effects of CYP3A4 inhibition and induction on the pharmacokinetics and pharmacodynamics of tolvaptan, a non-peptide AVP antagonist in healthy subjects. Br J Clin Pharmacol 2012; 73: 579-587
    CrossrefPubMedGoogle Scholar
  • 10 Donald PR, Parkin DP, Seifart HI et al. The influence of dose and N-acetyltransferase-2 (NAT2) genotype and phenotype on the pharmacokinetics and pharmacodynamics of isoniazid. Eur J Clin Pharmacol 2007; 63: 633-639
    CrossrefPubMedGoogle Scholar