An adolescent with adnexal torsion presenting with severe hyponatremia
Background: Adnexal torsion is the sixth most common pediatric surgical emergency, and one that requires high clinical suspicion and prompt surgical intervention in order to preserve adnexal function. Patients presenting with one or more additional acute medical concerns during an episode of torsion...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576623000398 |
| _version_ | 1797850423245144064 |
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| author | Carolyn Brookhart Olga Kciuk Katherine Debiec Caitlin Smith Nichole Tyson |
| author_facet | Carolyn Brookhart Olga Kciuk Katherine Debiec Caitlin Smith Nichole Tyson |
| author_sort | Carolyn Brookhart |
| collection | DOAJ |
| description | Background: Adnexal torsion is the sixth most common pediatric surgical emergency, and one that requires high clinical suspicion and prompt surgical intervention in order to preserve adnexal function. Patients presenting with one or more additional acute medical concerns during an episode of torsion must be managed carefully and effectively to ensure both safe perioperative care and expeditious surgical management. Case Presentation: We review a case of adnexal torsion in a seventeen-year-old female who was found incidentally to have severe hyponatremia, with serum sodium concentration 117 mEq/L. Further workup was initiated for this significant electrolyte derangement. This demonstrated low serum osmolality and high urine osmolality, consistent with syndrome of inappropriate antidiuretic hormone (SIADH). This case represents the first case report of SIADH in the setting of adnexal torsion. Optimizing surgical management was uniquely challenging in this case. In order to preserve fertility in this young patient, urgent detorsion was needed. This had to be balanced with aggressive but safe preoperative normalization of sodium to minimize intraoperative risk. Although serum sodium improved with medical management, it only returned to normal range after the patient underwent surgical detorsion of the adnexa, and resolution of her pain. Conclusions: Although this represents the first reported case of SIADH in the setting of adnexal torsion, the linkage between pain afferents and SIADH has been well documented, suggesting that patients with severe pain from torsion may be at risk for hyponatremia via this mechanism. As such, providers should be aware of the management of SIADH, as well as potential perioperative risks. This case, along with our review of the literature, supports surgical intervention as integral to the definitive coffection of hyponatremia in patients with adnexal masses resulting in SIADH. |
| first_indexed | 2024-04-09T19:01:04Z |
| format | Article |
| id | doaj.art-38adaa366329430aba7c6fe25150737f |
| institution | Directory Open Access Journal |
| issn | 2213-5766 |
| language | English |
| last_indexed | 2024-04-09T19:01:04Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj.art-38adaa366329430aba7c6fe25150737f2023-04-08T05:11:16ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662023-05-0192102613An adolescent with adnexal torsion presenting with severe hyponatremiaCarolyn Brookhart0Olga Kciuk1Katherine Debiec2Caitlin Smith3Nichole Tyson4Department of Obstetrics and Gynecology, Kaiser San Francisco Medical Center, San Francisco, CA, USA; Corresponding author. Kaiser San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA, 94115, USA.Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USADepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USADepartment of Pediatric Surgery, University of Washington School of Medicine, Seattle, WA, USADepartment of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USABackground: Adnexal torsion is the sixth most common pediatric surgical emergency, and one that requires high clinical suspicion and prompt surgical intervention in order to preserve adnexal function. Patients presenting with one or more additional acute medical concerns during an episode of torsion must be managed carefully and effectively to ensure both safe perioperative care and expeditious surgical management. Case Presentation: We review a case of adnexal torsion in a seventeen-year-old female who was found incidentally to have severe hyponatremia, with serum sodium concentration 117 mEq/L. Further workup was initiated for this significant electrolyte derangement. This demonstrated low serum osmolality and high urine osmolality, consistent with syndrome of inappropriate antidiuretic hormone (SIADH). This case represents the first case report of SIADH in the setting of adnexal torsion. Optimizing surgical management was uniquely challenging in this case. In order to preserve fertility in this young patient, urgent detorsion was needed. This had to be balanced with aggressive but safe preoperative normalization of sodium to minimize intraoperative risk. Although serum sodium improved with medical management, it only returned to normal range after the patient underwent surgical detorsion of the adnexa, and resolution of her pain. Conclusions: Although this represents the first reported case of SIADH in the setting of adnexal torsion, the linkage between pain afferents and SIADH has been well documented, suggesting that patients with severe pain from torsion may be at risk for hyponatremia via this mechanism. As such, providers should be aware of the management of SIADH, as well as potential perioperative risks. This case, along with our review of the literature, supports surgical intervention as integral to the definitive coffection of hyponatremia in patients with adnexal masses resulting in SIADH.http://www.sciencedirect.com/science/article/pii/S2213576623000398Adnexal torsionTubal torsionHyponatremiaSyndrome of inappropriate antidiuretic hormone |
| spellingShingle | Carolyn Brookhart Olga Kciuk Katherine Debiec Caitlin Smith Nichole Tyson An adolescent with adnexal torsion presenting with severe hyponatremia Journal of Pediatric Surgery Case Reports Adnexal torsion Tubal torsion Hyponatremia Syndrome of inappropriate antidiuretic hormone |
| title | An adolescent with adnexal torsion presenting with severe hyponatremia |
| title_full | An adolescent with adnexal torsion presenting with severe hyponatremia |
| title_fullStr | An adolescent with adnexal torsion presenting with severe hyponatremia |
| title_full_unstemmed | An adolescent with adnexal torsion presenting with severe hyponatremia |
| title_short | An adolescent with adnexal torsion presenting with severe hyponatremia |
| title_sort | adolescent with adnexal torsion presenting with severe hyponatremia |
| topic | Adnexal torsion Tubal torsion Hyponatremia Syndrome of inappropriate antidiuretic hormone |
| url | http://www.sciencedirect.com/science/article/pii/S2213576623000398 |
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