Hyponatremia and Cancer: From Bedside to Benchside

Author:

Fibbi Benedetta12,Marroncini Giada23ORCID,Naldi Laura23,Anceschi Cecilia23,Errico Alice23,Norello Dario12ORCID,Peri Alessandro123ORCID

Affiliation:

1. Endocrinology, Department of Geriatric Medicine, Careggi University Hospital, 50139 Florence, Italy

2. Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, 50139 Florence, Italy

3. Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy

Abstract

Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients. This applies also to cancer patients. Multiple causes can lead to hyponatremia, but most frequently this electrolyte disorder is due to the syndrome of inappropriate antidiuresis. In cancer patients, this syndrome is mostly secondary to ectopic secretion of arginine vasopressin by tumoral cells. In addition, several chemotherapeutic drugs induce the release of arginine vasopressin by the hypothalamus. There is evidence that hyponatremia is associated to a more negative outcome in several pathologies, including cancer. Many studies have demonstrated that in different cancer types, both progression-free survival and overall survival are negatively affected by hyponatremia, whereas the correction of serum [Na+] has a positive effect on patient outcome. In vitro studies have shown that cells grown in low [Na+] have a greater proliferation rate and motility, due to a dysregulation in intracellular signalling pathways. Noteworthy, vasopressin receptors antagonists, which were approved more than a decade ago for the treatment of euvolemic and hypervolemic hyponatremia, have shown unexpected antiproliferative effects. Because of this property, vaptans were also approved for the treatment of polycystic kidney disease. In vitro evidence indicated that this family of drugs effectively counteracts proliferation and invasivity of cancer cells, thus possibly opening a new scenario among the pharmacological strategies to treat cancer.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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