An adolescent girl with syndrome of inappropriate antidiuretic hormone secretion preceding the diagnosis of olfactory neuroblastoma – a case report

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Abstract

Objectives

We present an adolescent in whom olfactory neuroblastoma (ONB) was detected on follow-up magnetic resonance imaging (MRI) 2.5 years after SIADH diagnosis. Our case contrasts prior pediatric reports in which ONB and SIADH were diagnosed concurrently.

Case presentation

A previously healthy 13-year-old girl was found to have SIADH during evaluation for restrictive eating. Work-up ruled out adrenal, thyroid and paraneoplastic causes, diuretic use, and vasopressin receptor and aquaporin channel mutations. Brain MRI was normal except for paranasal sinus (PNS) inflammatory changes to the left fronto-maxillary sinuses and frontoethmoidal recess. The sodium levels normalized with fluid restriction (800-900 ml/m ²/day). Multiple repeated attempts to liberalize fluid intake resulted in recurrent hyponatremia. Follow-up brain MRIs 4 and 11 months after the initial presentation showed persistent PNS inflammatory changes. A subsequent brain MRI 31 months after initial presentation demonstrated a lesion in the left frontoethmoidal recess extending into the left nasal cavity and biopsy showed low grade ONB. The patient underwent surgery with normalization of serum sodium on liberalized fluid intake. Seven days after surgery, she had recurrence of SIADH, and brain MRI showed remnant of the ONB at the fovea ethmoidalis. She completed adjuvant radiotherapy though her SIADH persisted.

Conclusions

Our case highlights the importance of considering ONB in the evaluation of children with SIADH. Idiopathic SIADH is rare in children and if no cause is identified, computed tomography of sinuses and nasal endoscopy should be considered earlier in the work-up of these patients, particularly in the absence of sinus symptoms.

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Author and article information

Contributors

Sabitha Sasidharan Pillai: URI : https://loop.frontiersin.org/people/2765199Role: Role: Role: Role: Role: Role: Role: Role:

Jerrold L. Boxerman: URI : https://loop.frontiersin.org/people/1525155Role: Role: Role: Role: Role: Role:

Jan C. Groblewski: Role: Role: Role: Role: Role: Role:

Bradley D. DeNardo: Role: Role: Role: Role: Role: Role:

Mohammed K. Faizan: Role: Role: Role: Role: Role: Role:

Lisa Swartz Topor: Role: Role: Role: Role: Role: Role:

Renee Robilliard: Role: Role: Role: Role: Role:

Monica Serrano-Gonzalez: URI : https://loop.frontiersin.org/people/982373Role: Role: Role: Role: Role: Role: Role:

Journal

Journal ID (nlm-ta): Front Endocrinol (Lausanne)

Journal ID (iso-abbrev): Front Endocrinol (Lausanne)

Journal ID (publisher-id): Front. Endocrinol.

Title: Frontiers in Endocrinology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2392

Publication date (Electronic): 16 October 2024

Publication date Collection: 2024

Volume: 15

Electronic Location Identifier: 1447685

Affiliations

[1] ¹ Division of Pediatric Endocrinology, Department of Pediatrics, Hasbro Children’s Hospital , Providence, RI, United States

[2] ² The Warren Alpert Medical School of Brown University , Providence, RI, United States

[3] ³ Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California , Los Angeles, CA, United States

[4] ⁴ Department of Diagnostic Imaging, Rhode Island Hospital , Providence, RI, United States

[5] ⁵ Division of Pediatric Otolaryngology, Department of Surgery, Hasbro Children's Hospital , Providence, RI, United States

[6] ⁶ Division of Pediatric Hematology-Oncology, Department of Pediatrics, Hasbro Children’s Hospital , Providence, RI, United States

[7] ⁷ Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Hasbro Children’s Hospital , Providence, RI, United States

Author notes

Edited by: Rodolfo A. Rey, Hospital de Niños Ricardo Gutiérrez, Argentina

Reviewed by: Anna Arecco, University of Genova, Italy

Sebastian Castro, CONICET Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), Argentina

*Correspondence: Monica Serrano-Gonzalez, monica_serrano@ 123456brown.edu

Article

DOI: 10.3389/fendo.2024.1447685

PMC ID: 11521841

PubMed ID: 39479268

SO-VID: ecf700df-5d2b-487b-831a-1ff8e919c84d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 12 June 2024

Date accepted : 27 September 2024

Page count

Figures: 1, Tables: 2, Equations: 0, References: 15, Pages: 6, Words: 2476

Funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Custom metadata

section-in-acceptance Pediatric Endocrinology

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: adolescents,children,olfactory neuroblastoma,esthesioneuroblastoma,siadh,hyponatremia,antidiuretic hormone,eating disorder

Data availability: