{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:11:08Z","timestamp":1778217068407,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and central fever are rare and underrecognized manifestations of multiple system atrophy (MSA). Here, we report a 66-year-old woman who presented with a progressively evolving combination of parkinsonian features and pronounced autonomic dysfunction, fulfilling the diagnostic criteria for clinically probable MSA. Notably, she also developed two uncommon comorbidities: euvolemic hypotonic hyponatremia fulfilling the diagnostic criteria for SIADH, alongside episodic fever refractory to antipyretics in the absence of infection, but responsive to environmental cooling, consistent with central fever. These uncommon comorbidities underscore the involvement of hypothalamic and neuroendocrine regulatory pathways in MSA. This case broadens the well-recognized non-motor clinical spectrum of MSA and emphasizes the importance of considering central mechanisms when evaluating unexplained hyponatremia or fever in MSA. Awareness of these atypical manifestations may facilitate early recognition, guide targeted homeostatic management, and ultimately improve the quality of clinical care in MSA.<\/jats:p>","DOI":"10.3389\/fendo.2026.1792679","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:46:32Z","timestamp":1778215592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A case report of syndrome of inappropriate antidiuretic hormone secretion unveiling hypothalamic involvement in multiple system atrophy"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhe","family":"Long","sequence":"first","affiliation":[{"name":"Department of Neurology, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]},{"name":"Clinical Medical Research Center for Stroke Prevention and Treatment of Hunan Province, Department of Neurology, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(24)00396-x","article-title":"Multiple system atrophy: advances in pathophysiology, diagnosis, and treatment","volume":"23","author":"Krismer","year":"2024","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.29005","article-title":"The movement disorder society criteria for the diagnosis of multiple system atrophy","volume":"37","author":"Wenning","year":"2022","journal-title":"Mov Disord"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz189","article-title":"Improving diagnostic accuracy of multiple system atrophy: a clinicopathological study","volume":"142","author":"Miki","year":"2019","journal-title":"Brain"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000200861","article-title":"Diagnosing premotor multiple system atrophy: natural history and autonomic testing in an autopsy-confirmed cohort","volume":"99","author":"Vichayanrat","year":"2022","journal-title":"Neurology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awae033","article-title":"Phenoconversion in pure autonomic failure: a multicentre prospective longitudinal cohort study","volume":"147","author":"Millar Vernetti","year":"2024","journal-title":"Brain"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.nbd.2020.104813","article-title":"Disease progression and prognostic factors in multiple system atrophy: a prospective cohort study","volume":"139","author":"Foubert-Samier","year":"2020","journal-title":"Neurobiol Dis"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.13822","article-title":"Development and validation of a prognostic model to predict overall survival in multiple system atrophy","volume":"10","author":"Eschlboeck","year":"2023","journal-title":"Mov Disord Clin Pract"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00382-6","article-title":"Can autonomic testing and imaging contribute to the early diagnosis of multiple system atrophy? 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