Ann Pediatr Endocrinol Metab.  2015 Dec;20(4):220-225. 10.6065/apem.2015.20.4.220.

Cerebral salt-wasting syndrome after hematopoietic stem cell transplantation in adolescents: 3 case reports

• Jeon YJ
• Lee HY
• Jung IA
• Cho WK
• Cho B
• Suh BK

• KMID: 2354699
• DOI: http://doi.org/10.6065/apem.2015.20.4.220

Abstract

Cerebral salt-wasting syndrome (CSWS) is a rare disease characterized by a extracellular volume depletion and hyponatremia induced by marked natriuresis. It is mainly reported in patients who experience a central nervous system insult, such as cerebral hemorrhage or encephalitis. The syndrome of inappropriate antidiuretic hormone secretion is a main cause of severe hyponatremia after hematopoietic stem cell transplantation, whereas CSWS is rarely reported. We report 3 patients with childhood acute leukemia who developed CSWS with central nervous system complication after hematopoietic stem cell transplantation. The diagnosis of CSW was made on the basis of severe hyponatremia accompanied by increased urine output with clinical signs of dehydration. All patients showed elevated natriuretic peptide and normal antidiuretic hormone. Aggressive water and sodium replacement treatment was instituted in all 3 patients and 2 of them were effectively recovered, the other one was required to add fludrocortisone administration.

Keyword

Hyponatremia; Sodium; Polyuria; Hematopoietic stem cell transplantation

MeSH Terms

Central Nervous System
Cerebral Hemorrhage
Dehydration
Diagnosis
Encephalitis
Fludrocortisone
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Hyponatremia
Leukemia
Natriuresis
Polyuria
Rare Diseases
Sodium
Water
Fludrocortisone
Sodium
Water

Figure

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  Fig. 1 (A) Diffuse fluid-attenuated inversion recovery image high SI lesions in both periventicular white matter, probably chemotherapy-induced leukoencephalopathy on posttransplant day 64 in case 2. (B) Diffusion magnetic resonance imaging show prominent pachymeningeal enhancement on posttransplant day 21 in case 3.

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