Inappropriate secretion of ADH and central diabetes insipidus are related to antiphospholipid antibodies in SLE-case report and review of the literature

摘要

A syndrome of inappropriate secretion of antidiuretic hormone (ADH) (SIADH) and central diabetes insipidus (CDI) has been described as occurring in various central nervous system conditions. Antiphospholipid antibodies (APL) have been implicated in many neurological symptoms in patients with systemic lupus erythematosus (SLE). The presence of APL and their eventual role in the development of SIADH or CDI in SLE has never been studied.We describe two cases of SIADH occurring in the setting of SLE with APL. We retrospectively reviewed the literature on SLE associated with SIADH or CDI using a computer-assisted search from 1967 to 2005 in French, Spanish and English in the Medline Database using the keywords SIADH, CDI, APL and hyponatraemia. We found 11 cases of SIADH and five cases of CDI associated with SLE and one case of pure antiphospholipid syndrome associated with SIADH. The clinical and radiological data on all those reported patients were analysed. Laboratory data were also extracted from all the reports, and a positive status of APL was recorded if a patient had one of the following diagnostic criteria at the time SIADH (or CDI) appeared: false positive Veneral Disease Research Laboratory (VDRL), lupus anticoagulant (LA) or presence of anticardiolipin antibodies (ACA). We compared the prevalence of APL in the classic SLE population and in our collection ofreported SLE patients with ADH disorders. We found that ADH disorders (SIADH and CDI) in SLE patients were significantly associated with the presence of APL. We also found that most patients had no radiological evidence of thrombotic brain disease (evaluated by CT scan or MRI), and only one patient had focal neurological impairment. We suggest that there is a causal relationship between APL and the development of SIADH or CDI in patients with SLE, mostly not mediated by a thrombotic mechanism.