Clinical presentation
A 56 year old man diagnosed with oat cell carcinoma of the lung develops progressivelethargy and confusion.
Laboratory findings
Laboratory investigation produced the following results.
ELEMENTMEASUREDRESULT OBTAINEDNORMAL RANGE
Sodium119 mmol/l135-145 mmol/lPotassium4.6 mmol/l3.6-5.0 mmol/lUrea5.0 mmol/l3.3-6.7 mmol/lChloride77 mmol/l98-107 mmol/lBicarbonate26 mmol/l22-30 mmol/lGlucose6.2 mmol/l2.0-6.7 mmol/lUr osmolality857 mOsm/kg300-900 mOsm/kg
Comment on laboratory findings
Plasma sodium levels are low and urine osmolality is close to upper limit.This is suggestive of hyponatremia.
Possible causes of the abnormality
In health sodium concentration in the body is controlled by Antideuretic Hormonesecreted by the pituitary gland in the hypothalamus. Increase in plasma osmolality whichis mainly due to sodium concentration in the blood is sensed by osmo-receptors in thehypothalamus. This induces secretion of Antideuretic hormone (ADH) by the pituitarygland. The hormone act on the distal convoluted tubule of the kidney. This makes thekidney to retain water in the blood thus diluting the ECF and bringing plasma osmolalityto normal.In oatcell carcinoma the cancer cells contain neurosecretory bodies which secreteAntideuretic Hormone and other hormones like Adenocorticotrophic Hormone (ACTH)and calcitonin.
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