SEARCH RESULTS FOR: SIADH

Lung cancer clinical findings and paraneoplastic syndromes

Lung cancer: clinical findings and paraneoplastic syndromes Note: most presentations of lung cancer are very subtle with non-specific symptoms and signs (i.e. fever, weight loss, general malaise) Obstruction of proximal airway Inability to clear inhaled pathogens Postobstructive pneumonia Cough, fever, dyspnea Local tumor growth Spread of tumor to pleural surface Chest Pleural discomfort effusion • Obstruction or compression at local site Uncontrolled abnormal cell growth in one or both lungs 4 Lung Cancer Airway invasion Hemoptysis Lambert-Eaton syndrome (Production of auto-antibodies against Calcium channels) Muscle weakness I` effort to Compression at the Compression Superior vena ventilate the laryngeal nerve of brachial cava lungs nerve plexus compression Impaired innervation to the vocal cords Dyspnea Shortness of Arm/shoulder/ Face/arm breath Voice hoarseness neck pain edema Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Authors: Yoyo Chan Reviewers: Midas (Kening) Kang Usama Malik Leila Barss* * MD at time of publication Tumor secretes biologically active substances Paraneoplastic Syndromes 4 Associated symptoms with malignant diseases TGF131 extracellular matrix protein Fingers clubbing PTHrP T calcium release from bones Hypercalcemia Serum calcium >2.6 mmol/L ADH 1 SIADH T water reabsorption 1 Hyponatremia Serum sodium <135mEq/L Abbreviations: • ACTH: Adrenocorticotropic hormone • ADH: Anti-diuretic hormone • PTHrP: Parathyroid hormone-related protein • SIADH: Syndrome of inappropriate antidiuretic hormone production • TGFI31: Transforming growth factor beta 1 1` ACTH cortisol release and production Cushing's syndrome (symptoms and signs caused by prolonged cortisol exposure) Muscle weakness, hyperglycemia, severe hypokalemia

Hyponatremia- Physiology

Hyponatremia: Physiology Authors: Mannat Dhillon Reviewers: Andrea Kuczynski Kevin McLaughlin* * MD at time of publication Abnormal Renal H2O Handling (hypo-osmolar serum) AKI/CKD Heart failure ↓ renal blood flow ↓ glomerular filtration GFR < 25 mL/min, ↓ urine dilution ↑ H2O retention Note: • Plasma [Na+] is regulated by water intake/excretion, not by changes in [Na+]. • Artifactual hyponatremia can be differentiated by a normal or hyperosmolar serum. Appropriate ADH secretion ↓ EABV Hypovolemia: losses via GI, renal, skin, 3rd spacing, bleeding Hypervolemia: heart failure, cirrhosis ↑ Na+/H2O absorption at PCT ↓ EABV, ↑ H2O retention Urine [Na+] < 20 mmol/L Hereditary: tubular disorders (Bartter, Gitlemann syndromes). Thiazide diuretics Inappropriate: SIADH, hypothyroidism, AI Normal EABV Anti-diuresis Primary polydipsia, eating disorder ↑ H2O or ↓ solute intake ↓ Osmoles Impaired desalination Block NCC ↑ H2O retention ↑ Na+/K+ excretion Hyponatremia Serum [Na+] < 135 mmol/L Urine osmolality > 100 mmol/L Urine osmolality < 100 mmol/L Cerebral edema, ↑ intracranial pressure, vasoconstriction If hypovolemic: ↓ JVP, ↓ blood pressure Lethargy, altered mental status Abbreviations: AKI: Acute Kidney Injury CKD: Chronic Kidney Disease GFR: Glomerular Filtration Rate H2O: Water PCT: Proximal Convoluted Tubule EABV: Effective Arterial Blood Volume NCC: Na+/Cl- Co-Transporter SIADH: Syndrome of Inappropriate ADH Secretion AI: Adrenal Insufficiency Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published January 11, 2019 on www.thecalgaryguide.com

肺癌：临床发现和副癌综合征

肺癌：临床发现和副癌综合征 作者: Yoyo Chan 审稿人: Midas (Kening) Kang Usama Malik, Leila Barss* 译者: Huiting Wang (王慧婷), Yang xiang (向阳) 翻译审稿人: Ran Zhong (钟然), Yonglin Mai (麦泳琳), Zesheng Ye (叶泽生) * 发表时担任临床医生 肿瘤分泌生物活性物质 副癌综合征à 与恶性疾病相关的症状 注意: 肺癌的大多数表现隐匿，具有非特异性的 症状和体征(即发烧、体重减轻、全身不适) 单侧或双侧肺部发生的不受控 异常细胞增生à肺癌 近端气道梗阻 无法清除吸入的 病原体 局部肿瘤生长 肿瘤向胸膜 气道侵袭 表面扩散 胸部不适 胸腔积液 咯血 肺癌梗阻性肺炎 局部阻塞 或 压迫 咳嗽、发热、呼 吸困难 肺通气做功↑ 喉神经压迫 ↑ ADH 合征 水重吸收↑ 低钠血症 血钠 <135mEq/L Lambert-Eaton 综合征 (肌无力样综合征) (产生针对钙通道的自身 抗体) 肌肉无力 上腔静脉 压迫 ↑ TGFβ1 细胞外基 质蛋白↑ 杵状指 ↑ PTHrP 骨骼钙 ↑释放 高钙血症 血钙 >2.6 mmol/L ↑ ACTH 皮质醇的产生 分泌异常综 和释放↑ 抗利尿激素 臂丛神经 压迫 库欣综合征 (长期皮质醇增 多所引起的症状 和体征) 肌肉无力、高血 糖、严重低钾血 症 呼吸困难 呼吸急促 支配声带的神经受损 声音嘶哑 手臂/肩膀/颈 面部/手臂 部疼痛 水肿 缩写: • ACTH:促肾上腺皮质激素 • ADH: 抗利尿激素 • PTHrP: 甲状旁腺激素相关肽 • SIADH:抗利尿激素分泌异常综合征 • TGFβ1: 转化生长因子β1 图注: 病理生理 机制 体征/症状/实验室检查 并发症 2018年2月6日发布于 www.thecalgaryguide.com

SIADH

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH): Pathogenesis and clinical Malignancy (e.g. Small cell lung cancer, head and neck cancer) Tumor originates from neuroendocrine cells Tumor acts as an ectopic site of ADH production ADH binds receptors on basolateral side (facing peritubular capillary) of principal cells in nephron ADH ↑ principal cells’ production of Aquaporin type II channels on their apical surface (side facing tubule lumen) ↑ Reabsorption of water from the collecting ducts back into circulation ↑ Blood Volume (↑ extracellular fluid volume) Blood Na+ levels diluted Hyponatremia (blood Na+ <135 mEq/L) Brain injury (e.g. Stroke, encephalitis hemorrhage, trauma) ↑ hypothalamic ADH production, storage in posterior pituitary, & pituitary secretion of ADH ↑ Uncontrolled ADH secretion SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone) Drugs (e.g. Cyclophosphamide, SSRIs, vincristine) Break down into active metabolites Metabolites mimic ADH activity findings Authors: Krusang Patel Yan Yu* Reviewers: Davis Maclean Brooke Fallis Juliya Hemmett* * MD at time of publication Atria and Ventricles of the heart stretch Heart secretes ↑ atrial natriuretic and B-type natriuretic peptides (ANP/BNP) Peptides promotes natriuresis (excretion of Na+ into urine) Loss of Na+ in serumàalters charge balance across neuron membranesàImproper action potential firing: ↓ Renin secretion ↓ Release of Angiotensin II & Aldosterone ↓Reabsorption of Na+ into circulation in area postrema of medulla in hypothalamus in motor neurons Extracellular fluid volume becomes hypotonic relative to intracellular fluid volume Water moves from circulation into cells Extracellular fluid volume normalizes Euvolemia Nausea Headaches Muscle Cramps ↓ Urine volume Cells, particularly neurons, swell up Cerebral edema Neurons burst and die Severe Neurocognitive Effects (confusion, mood swings, hallucinations, seizure, coma) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Dec 30, 2021 on www.thecalgaryguide.com

Sindrome da Inappropriata Secrezione di Ormone Antidiuretico