[Syndrome of inappropriate antidiuretic hormone secretion associated with meningeal infiltration of tumor cells and elevated interleukin-1 beta and interleukin-6 in cerebrospinal fluid of a patient with adult T-cell leukemia].
A 73-year-old man with acute adult T-cell leukemia (ATL) in remission was re-admitted to our hospital due to drowsiness, headache, and bilateral knee joint pain on May 17, 1998. On admission, examinations revealed decreased serum sodium concentration (112 mEq/l), low plasma osmotic pressure (259 mOsm/l), and elevated antidiuretic hormone(5.6 pg/ml). Cerebrospinal fluid examination showed an increased number of abnormal flower-like lymphocyte (951/microliter). Brain computed tomography and magnetic resonance imaging found no abnormality in the hypothalamus or pituitary gland. These findings yielded a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Though ATL patients typically exhibit a variety of clinical symptoms, SIADH is rarely one of the complications. Further investigation showed that IL-1 beta and IL-6 concentrations were increased in spinal fluid but not in serum. Recently, it has been reported that exogeneous IL-6 is an inducer of ADH secretion, and that primary ATL cells and HTLV-I infected cell lines can produce IL-6. In this case, we speculated that IL-6 produced by ATL cells that infiltrated a cerebral lesion may have played an important role in the development of SIADH.
Imaizumi
R
R
Division of Hematology/Oncology, Jiaikai Imamura Hospital.
Fujiwara
H
H
Matsumoto
T
T
Matsumoto
M
M
Matsushita
K
K
Ohtsubo
H
H
Hidaka
S
S
Arima
N
N
Tei
C
C
D000368:Aged; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000209:etiology*; D007375:Interleukin-1 / Q000134:cerebrospinal fluid*; D015850:Interleukin-6 / Q000134:cerebrospinal fluid*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000134:cerebrospinal fluid / Q000150:complications / Q000473:pathology*; D017254:Leukemic Infiltration; D008297:Male; D008578:Meninges / Q000473:pathology*
D007375:Interleukin-1; D015850:Interleukin-6