Fettah EREN, Ayşegül DOĞAN DEMİR, Güllü EREN

PRAMIPEKSOL İLIŞKILI UYGUNSUZ ANTIDIÜRETIK HORMON SALINIMI SENDROMU

Hiponatreminin en sık sebeplerinden birisi uygunsuz antidiüretik hormon salınımı (UADHS) sendromudur. Serotonin geri alım inhibitörleri, trisiklik antidepresanlar, karbamazepin, amantadin ve sitotoksik ilaçlar UADHS sonucunda hiponatremiye sebep olabilir. Pramipeksol, non-ergot dopamin agonistidir. Parkinson hastalığı ve huzursuz bacaklar sendromu tedavisinde sıklıkla kullanılmaktadır. Parkinson hastalığında pramipeksol ilişkili UADHS sendromu nadirdir. Bununla birlikte patogenetik mekanizmalar belirsizliğini korumaktadır. Olgumuzda Parkinson hastalığında, pramipeksol ile ilişkili UADHS sendromu takdim edilmiştir. Klinik semptomlar ve hiponatremi ilaç doz artışından 12 gün sonra ortaya çıkmıştır. İlaç dozu azaltılması ile serum sodyum seviyesi ve klinik yakınmalar normale dönmüştür. UADHS sendromuna bağlı hiponatremi özellikle pramipeksol tedavisinden sonra ilk 2-3 hafta içerisinde gelişir. Bundan dolayı pramipeksol ile tedavi edilen hastalar ilk haftalarda ve doz artışında hiponatremi açısından daha sık izlenmelidir.

Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Pramipexole

One of the most common causes of hyponatremia is inappropriate antidiuretic hormone release syndrome (SIADH). Serotonin reuptake inhibitors, tricyclic antidepressants, carbamazepine, amantadine and cytotoxic drugs can cause of hyponatremia as a result of SIADH. Pramipexole is a non-ergot dopamine agonist. It is frequently used for treatment of Parkinson disease and restless legs syndrome. Pramipexole-associated SIADH are rare in Parkinson disease. Also, pathogenetic mechanisms are uncertain. In our case, SIADH associated with pramipexole was presented in Parkinson disease. Clinical symptoms and hyponatremia occurred 12 days after the drug dose increase. Serum sodium level and clinical complaints returned to normal with drug dose reduction. SIADH-related hyponatremia occurs especially within the first 2-3 weeks after pramipexole treatment. Therefore, patients treated with pramipexole should be monitored more frequently for hyponatremia in the first weeks and dose increase.

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