QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liapis, K. Articles by Nikiforakis, E. Search for Related Content PubMed PubMed Citation Articles by Liapis, K. Articles by Nikiforakis, E.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Imatinib

Resident in Hematology, Department of Hematology and Lymphoma, Evangelismos Hospital, Athens, Greece

John Apostolidis, MD

Hematologist, Department of Hematology and Lymphoma, Evangelismos Hospital

Evangelia Charitaki, MD

Resident in Nephrology, Department of Nephrology, Evangelismos Hospital

Fotios Panitsas, MD

Resident in Hematology, Department of Hematology and Lymphoma, Evangelismos Hospital

Nikolaos Harhalakis, MD

Hematologist, Department of Hematology and Lymphoma, Evangelismos Hospital

Emmanuel Nikiforakis, MD

Hematologist, Department of Hematology and Lymphoma, Evangelismos Hospital

Reprints: Dr. Liapis, Department of Hematology and Lymphoma, Evangelismos Hospital, 45-47 Ipsilandou St., Athens, 10676, Greece, fax 30-210-720-1131, kosliapis{at}hotmail.com

OBJECTIVE: To describe a patient with Bcr-abl⁺ acute lymphoblastic leukemia who developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) while being treated with high-dose imatinib.

CASE SUMMARY: A 29-year-old woman was diagnosed with Bcr-abl⁺ acute lymphoblastic leukemia, and treatment was initiated with chemotherapy and imatinib 800 mg daily. Following imatinib initiation, a gradual decrease in serum sodium level was noticed. Prolonged aplasia and neutropenic fever prompted discontinuation of therapy for 4 weeks. Following the patient's recovery, complete remission was achieved and monotherapy with imatinib 800 mg daily was restarted; however, hyponatremia recurred a few days later. The clinical findings and laboratory workup were compatible with the diagnosis of SIADH, which was attributed to high-dose imatinib. Fluid restriction and imatinib dosage reduction (to 600 mg/day) restored sodium levels. According to the Naranjo probability scale, this adverse reaction was probably associated with imatinib.

DISCUSSION: Imatinib emerged as the first tyrosine kinase inhibitor to enter everyday clinical practice for the treatment of Ph⁺ leukemias. Due to its molecular specificity, imatinib lacks the broad cytotoxicity of conventional chemotherapy. Inhibition of kinases in normal tissues accounts for many of imatinib's adverse reactions. To our knowledge, this is the first reported case of imatinib-induced SIADH.

CONCLUSIONS: We recommend monitoring for SIADH if a patient receiving high-dose imatinib develops hyponatremia.

Key Words: imatinib, osmoregulation, syndrome of inappropriate secretion of antidiuretic hormone

Published Online, November 18, 2008. www.theannals.com, DOI 10.1345/aph.1L410

This article has been cited by other articles:

				N. van der Lubbe, C. J. Thompson, R. Zietse, and E. J. Hoorn The clinical challenge of SIADH--three cases NDT Plus, November 1, 2009; 2(suppl_3): iii20 - iii24. [Abstract] [Full Text] [PDF]