Progesterone Receptor Antagonists – A Novel Treatment for Severe Hyponatremia from the Endocrine Paraneoplastic Syndrome

Updata:01-01-1970

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By:JEROME H. CHECK

DOI: https://doi.org/10.30564/jer.v3i2.3611

Abstract:
Hyponatremia related to ectopic secretion of cancer cells of arginine
vasopressin (AVP) or atrial natriuretic peptide (ANP) is most commonly
caused by small cell lung cancer. The ideal treatment would be one that
not only corrects the hyponatremia, especially if it is life threatening, but
at the same time causes regression of the cancer, and thus improves both
quality and length of life. As one is waiting for chemotherapy, surgery,
or radiotherapy to decrease the cancer burden, tolvaptan has been used
to correct the hyponatremia to improve symptoms or prevent death.
Mifepristone, a progesterone receptor modulator/antagonist has been used
to treat various cancers. The oral 200mg tablet was given to an 80-year-old
woman who developed sudden extensive lung cancer with a serum sodium
of 118 mmol/L. She refused chemotherapy but agreed to take mifepristone.
The hyponatremia was completely corrected (145 mmol/L) within one
month of treatment. She was in complete remission for 5 years and died
not from lung cancer, but an acute myocardial infarction. Mifepristone
may serve the purpose to not only quickly correct hyponatremia when it
is related to an endocrine paraneoplastic syndrome, but also to provide
improved quality and length of life.
References:

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