Prompt Efficacy of Tolvaptan in Treating Hyponatremia of Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) Closely Associated with Rupture of a Gastric Artery Aneurysm

Takeshi Yamashita; Masashi Yoshida; Hodaka Yamada; Tomoko Asano; Atsushi Aoki; Aki Ikoma; Ikuyo Kusaka; Masafumi Kakei; San-e Ishikawa

doi:10.2169/internalmedicine.53.1440

CASE REPORTS

Prompt Efficacy of Tolvaptan in Treating Hyponatremia of Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) Closely Associated with Rupture of a Gastric Artery Aneurysm

Takeshi Yamashita, Masashi Yoshida, Hodaka Yamada, Tomoko Asano, Atsushi Aoki, Aki Ikoma, Ikuyo Kusaka, Masafumi Kakei, San-e Ishikawa

Author information

Takeshi Yamashita
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Masashi Yoshida
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Hodaka Yamada
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Tomoko Asano
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Atsushi Aoki
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Aki Ikoma
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Ikuyo Kusaka
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
Masafumi Kakei
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan
San-e Ishikawa
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan

Keywords: arginine vasopressin (AVP), gastric artery aneurysm, AVP V2 receptor antagonist, hyponatremia, cerebral artery vasoconstriction

JOURNAL OPEN ACCESS

2014 Volume 53 Issue 8 Pages 845-849

DOI https://doi.org/10.2169/internalmedicine.53.1440

Details

Abstract

A 78-year-old man with abdominal pain was diagnosed with a rupture of a gastric artery aneurysm. The serum Na level promptly decreased from 135 to 110 mmol/L within several days. Brain magnetic resonance angiography revealed severe vasoconstriction of the cerebral basilar artery and anterior cerebral artery. There was neither dehydration nor edema. The plasma arginine vasopressin level was 3.3 pg/mL, despite hypoosmolality. These findings indicated a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) derived from severe vasoconstriction of the cerebral arteries. The administration of 7.5 mg of tolvaptan rapidly increased the serum Na level from 123 to 138 mmol/L within the first 24 hours, thereafter continuously maintaining a normal level. Treatment with tolvaptan corrected the patient's dilutional hyponatremia.

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