title: Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor administration.
abstract: Angiotensin-converting enzyme inhibitors (ACEI's) are an important medication in the treatment of congestive heart failure. However, ACEIs may cause harmful side effects, such as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which is a rare but important side effect. We describe here a case of SIADH associated with ACEI administration in a 6-year-old boy with restrictive cardiomyopathy. After recovery from acute exacerbation of congestive heart failure by tolvaptan administration, an ACEI (cilazapril) was started to decrease the production of angiotensin II, which upregulates serum antidiuretic hormone secretion. The patient's heart failure symptoms worsened, including accumulation of right pleural effusion and ascites, after the initiation of ACEI administration. Cessation of ACEI administration dramatically improved his symptoms. Because it is difficult to distinguish SIADH associated with ACEI from worsening congestive heart failure, the possibility of fluid retention due to ACEI administration should always be considered when this agent is administered to patients with heart failure.
authors.affiliation: Department of Adult Congenital Heart Disease and Pediatric Cardiology, Chiba Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba 290-0512, Japan. murat@seagreen.ocn.ne.jp
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Yoko
authors.initials: Y
authors.lastname: Horibata
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tateno
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kawasoe
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D002648:Child; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000139:chemically induced*; D008297:Male
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors