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Intracranial pineal tumor as a cause of a cerebral salt-wasting syndrome
Tumor intracraneal pineal como causa de un síndrome pierde sal cerebral
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Martínez-Cuéllar, R. Gil-Montesdeoca, M.P. Arocha-Saavedra, L. Santana-Cabrera" "autores" => array:4 [ 0 => array:3 [ "nombre" => "S." "apellidos" => "Martínez-Cuéllar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Gil-Montesdeoca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.P." "apellidos" => "Arocha-Saavedra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "L." "apellidos" => "Santana-Cabrera" "email" => array:1 [ 0 => "lsancabx@gobiernodecanarias.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor intracraneal pineal como causa de un síndrome pierde sal cerebral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1979 "Ancho" => 1508 "Tamanyo" => 203112 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan of the head in which tumors in the pineal gland area can be observed.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT: computed tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hyponatremia, defined as a serum sodium concentration <135 mEq/L, is one of the most frequently encountered hydroelectrolytic disorders in clinical practice. It tends to appear as a complication associated with pathologies that affect the central nervous system (CNS).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In these patients, the differential diagnosis between syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) is fundamental, given that these sodium disorders require opposing therapeutic measures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 70-year-old male patient who was admitted to the intensive care unit (ICU) for symptoms that had been ongoing for several days consisting of peripheral vertigo, mutism, and a progressive decline in level of consciousness. A CT (computed tomography) scan of the head was performed, which showed a mass in the pineal gland compatible with pineocytoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">During his hospitalization, he developed hyponatremia (130 mEq/L) with plasma hyposmolality (268 mOsm/kg), natriuresis (135 mEq/L), and a urine osmolality of 461 mOsm/kg. In this context, the patient was polyuric (diuresis >1 mL/kg/h) with clinical signs of volume depletion (hypotension, dry skin and mucosa, and tachycardia) and a negative fluid balance (−3 L in 24 h). Plasma levels of urea, creatinine, uric acid, thyroid stimulating hormone (TSH), and free thyroxine (T<span class="elsevierStyleInf">4</span>) were normal. Given these findings, a diagnosis of CSWS was established and replacement fluid therapy was started, with a slow, progressive correction of the natremia, in addition to the administration of mineralocorticoids.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathogenesis of CSWS has classically been linked to two hypotheses: one that points to the sympathetic nervous system as the cause of a reduction in proximal tubule sodium reabsorption and another that associates it with the action of natriuretic agents (atrial natriuretic peptide and brain natriuretic peptide).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Four main criteria have been described for its diagnosis: (1) clinical signs of hypovolemia; (2) analytical evidence of dehydration with elevation of hematocrit, hemoglobin, serum albumin, or blood urea nitrogen; (3) a negative fluid balance, and (4) central venous pressure <6 cm of water.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Dehydration or hypovolemia are the main differentiating factor between a diagnosis of CSWS and SIADH.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In regard to the etiology of CSWS, this syndrome has been related to numerous pathologies that affect the CNS (cerebrovascular accidents, subarachnoid hemorrhage, etc.). Its relation to CNS tumors has not been widely studied, and after ruling out other causes that could explain the onset of this syndrome, we propose that in our patient, it is associated with a pineal gland tumor found on the CT scan of the head, just like some cases reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Pineocytoma is a benign primary tumor of the pineal gland. Its frequency is less than 1% and it can appear at any age, though it is more recurrent in childhood.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The symptoms it produces can be varied, from Parinaud syndrome to headaches, deterioration in balance, urinary incontinence, or mood swings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, in the diagnosis of CSWS, unidentified intracranial pathology must be considered as a cause and its treatment will depend both on the underlying pathology and the time since onset, both of which must be drawn on in order to provide the correct treatment.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Cuéllar S, Gil-Montesdeoca R, Arocha-Saavedra MP, Santana-Cabrera L. Tumor intracraneal pineal como causa de un síndrome pierde sal cerebral. Rev Clin Esp. 2022;222:59–60.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1979 "Ancho" => 1508 "Tamanyo" => 203112 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan of the head in which tumors in the pineal gland area can be observed.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT: computed tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inappropriate antidiuretic hormone secretion and cerebral salt-wasting syndromes in neurological patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. 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Wass" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2020" "volumen" => "183" "paginaInicial" => "9" "paginaFinal" => "15" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022200000001/v1_202201050658/S2254887421000874/v1_202201050658/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022200000001/v1_202201050658/S2254887421000874/v1_202201050658/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000874?idApp=WRCEE" ]
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