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Khan et al. J Cancer Metastasis Treat 2019;5:71 I http://dx.doi.org/10.20517/2394-4722.2019.017 Page 5 of 12

Table 1. Causes of syndrome of inappropriate antidiuresis
Tumors Infections Drugs Other
Chemotherapy agents
Extrapulmonary small cell AIDS Cisplatin Postoperative state (major
carcinoma Encephalitis Cyclophosphamide abdominal or thoracic surgery;
Lymphoma Hydrocephalus Ifosfamide pituitary surgery or other
Meningeal carcinomatosis Idiopathic, Vinristine neurosurgery)
Metastatic brain and spine particulary in the Vinblastine Hydrocephalus
tumors elderly Melphalan Cavernous sinus Thrombosis
Olfactory neuroblastoma Meningitis Methotrexate Multiple sclerosis
Ovarian teratoma Pneumonia (bacterial Targeted Therapies: Guillain-Barre Syndrome
Endometrial carcinoma and viral) Afatinib Delirium Tremens
Pancreatic carcinoma Pulmonary abscess Brivanib Acute intermittent porphyria
Primary brain tumors Aspergillosis Cetuximab Acute respiratory failure
Prostate carcinoma Tuberculosis Geftinib Acute Psychosis
Bladder carcinoma Brain abscess Linifanib Stroke
Small cell lung carcinoma and Rocky mountain Pazopanib Subarachnoid hemorrhage and
other pulmonary tumors spotted fever Sorafenib other intracranial hemorrhages
Thymic tumors Malaria Vorinostat Traumatic brain injury
Sarcomas General anesthesia
Non-chemotherapy agents Nausea
Desmopressin/Vasopressin Pain
Methylenedioxymethamphetamine Stress
NSAIDs
Opiates
Oxytocin
Phenothiazines
Prostaglandin-synthesis inhibitors
Rosiglitazone
Selective serotonin reuptake inhibitors (SSRIs)
Selective norepinephrine reuptake inhibitors (SNRIs)
Thiazide diuretics
Ciprofloxacin
Tricyclic antidepressants
Chlorpropamide

e.g., thiazides, loop diuretics and spironolactone, may also contribute to hyponatremia. Reduced oncotic
pressure in nephrotic syndrome has a similar effect due to baroreceptor-mediated neurohormonal
activation. Chemotherapy induced tubulopathy decreases the ability of the kidney to excrete free water.
[10]
Increased free water intake in the presence of kidney disease causes hypervolemic hyponatremia .
HYPOVOLEMIC HYPONATREMIA
Reduced effective circulatory volume (as seen in pancreatitis, bowel obstruction, sepsis, diarrhea, and
sweating) increases vasopressin release leading to increase water retention and hyponatremia that worsens
[10]
with hypotonic volume repletion .
CEREBRAL SALT WASTING SYNDROME
Cerebral salt wasting (CSW) syndrome is a clinical entity primarily but not exclusively associated with
[24]
intracranial disease that leads to hyponatremia and decreased extracellular fluid volume . Although
most commonly described in neurosurgical patients with subarachnoid hemorrhage, CSW is also seen in
[8]
cerebral neoplastic dissemination in brain metastasis . However, CSW syndrome remains controversial
and incompletely understood.

CSW is associated with primary overproduction of atrial natriuretic peptide and brain natriuretic peptide
resulting in a decrease in sodium and water reabsorption in the kidney while reduced sympathetic outflow
in intracranial disease reduces activity of renin-angiotensin system and increases natriuresis [25-27] . CSW
[28]
syndrome may lead to a clinical picture similar to SIAD . Laboratory findings common to SIAD and
CSW syndrome include hypotonic hyponatremia, increased fractional excretion of urate (FEurate > 11%),
high urine osmolality (> 100 mOsm/kg), and urine sodium (> 30 mE/L) in the presence of normal thyroid,