August 1969

Adrenal Insufficiency and Inappropriate Secretion of Antidiuretic HormoneOccurrence in a Patient With Carcinoma of the Lung

Author Affiliations

San Francisco

From the Medical Services, San Francisco General Hospital, University of California School of Medicine, San Francisco.

Arch Intern Med. 1969;124(2):197-201. doi:10.1001/archinte.1969.00300180069013

In recent years a syndrome has been described 1,2 in which hyponatremia and renal loss of sodium have been attributed to the overexpansion of body fluids resulting from the inappropriate secretion of antidiuretic hormone (ADH). The majority of cases occur in patients with carcinoma of the lung,3 but the syndrome is also associated with other diseases including porphyria,4 myxedema,5 and a variety of disorders of the central nervous system.6 The characteristic features of this syndrome are hyponatremia and hypotonicity of body fluids, continued renal excretion of sodium, urine osmolality greater than that appropriate for concomitant tonicity of plasma, normal renal and adrenal function, and correction of both hyponatremia and urinary sodium loss by fluid restriction.7,8 Recognition of this syndrome is rarely difficult, although patients with adrenal insufficiency may have similar clinical manifestations. While careful evaluation of adrenal function usually differentiates between these disorders, Bartter and

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