Inappropriate Antidiuretic Hormone Research Articles

Syncope and Brugada-like ECG pattern in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Syncope is a brief loss of consciousness caused by reduced blood flow to the brain, characterised by sudden onset, short duration and full recovery without intervention. Anamnesis, physical examination and other diagnostic tests such as laboratory analysis and electrocardiogram (ECG) can be conducted to identify the underlying cause of syncope. A Brugada pattern on an ECG in individuals with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who have syncope symptoms may indicate cardiac issues. A 69-year-old man with hypertension and a history of smoking presented with syncope. His vital signs were within normal limits, with no signs of a neurological deficit. The patient met the diagnostic criteria for SIADH, as evidenced by the presence of hyponatraemia (Na 118 mmol/l), a hyperosmolar condition and euvolemia. Upon arrival, a twelve-lead ECG showed ST-segment anomalies that reflected a Brugada ECG pattern. No ventricular arrhythmias were detected during the 24-hour Holter monitoring. Coronary angiography revealed no abnormalities in the coronary arteries. The ECG demonstrated the normalisation of ST elevations and the disappearance of the Brugada ECG pattern after the correction of hyponatraemia. After three months of follow-up the patient, with a normal sodium level, had no episodes of syncope.

Tumor Necrosis Factor-alpha (TNFα) receptor type 1 (TNFR1) activation during severe inflammation; Can it be a therapeutic target in hypervolemic hyponatremia?

Hyponatremia is a life-threatening situation in severe inflammatory disorders. Managing this disorder is seriously hampered because its underlying pathophysiology has remained elusive. An increase in tumor necrosis factor-alpha (TNFα) during systemic inflammation may be involved in this hyponatremic mechanism as it is known that circulating TNFα exerts potent natriuresis via its action on receptor type 1 (TNFR1). Systemic inflammation also induces non-osmotic release of Antidiuretic Hormone (ADH), commonly known as ‘Syndrome of Inappropriate ADH’ (SIADH), that would cause water retention to increase in Extracellular Fluid Volume (ECV). Thus, the inflammation-induced TNFR1 activation and sodium loss coupled with SIADH-induced increases in ECV, would lead to the serious condition of hypervolemic hyponatremia. In this brief review, some experimental evidence will be provided that indicates TNFR1 activation during the inflammatory process can be targeted therapeutically to prevent such critical conditions of hypervolemic hyponatremia. The importance of these co-morbidities also extends to several other clinical scenarios of hyponatremia observed in patients with heart failure, liver disease, and renal disease. Besides the pathophysiological insights, the recognition of the propensity for both antidiuresis and natriuresis during inflammation is critically important in selecting the appropriate intravenous fluid regimens in patients with this disorder such as in the coronavirus disease of 2019 (COVID-19).

A case of hyponatraemia cured by delivery

Hyponatraemia is the most common electrolyte abnormality in pregnancy. In severe cases, it can result in significant maternal and fetal morbidity and mortality. The prevalence of hyponatraemia in pregnancy has been estimated to be 0.27%, with the major causes being hyperemesis gravidarum in the first half and preeclampsia in the latter half of pregnancy. Pregnancy-specific causes of the syndrome of inappropriate antidiuretic hormone release include preeclampsia, prolonged labour, caesarean section, postpartum haemorrhage, cortisol deficiency and oxytocin. Excess water intake can also lead to hyponatraemia during labour, a period of excess antidiuretic hormone secretion. A case of idiopathic severe hyponatraemia with biochemistry consistent with inappropriate antidiuretic hormone secretion progressing during the third trimester with rapid spontaneous resolution post-partum is presented.

Vascular complications in craniopharyngioma-resected paediatric patients: a single-center experience.

Craniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte imbalance. Increased risk of vascular complications has been described. However, data are still poor, especially in the paediatric population. The aim of our study was to evaluate the occurrence, timing, and predisposing factors of deep venous thrombosis (DVT) and other vascular alterations in neurosurgical paediatric CP patients. In a single-centre, retrospective study, we investigated 19 CP patients (11 males, 8 females, mean age 10.5 ± 4.3 years), who underwent neurosurgery between December 2016 and August 2022, referred to Meyer Children's Hospital IRCCS in Florence. Five patients (26.3%) presented vascular events, which all occurred in connection with sodium imbalances. Three DVT (two with associated pulmonary embolism, in one case leading to death) developed in the post-operative period, most frequently at 7-10 days. Elevated D-dimers, a reduced partial activated thrombin time and a prolonged C-reactive protein increase were highly related to thrombotic vascular events. One case of posterior cerebral artery pseudoaneurysm was described soon after neurosurgery, requiring vascular stenting. Superficial vein thrombophlebitis was a late complication in one patient with other predisposing factors. CP patients undergoing neurosurgery are at risk of developing DVT and vascular alterations, thus careful follow-up is mandatory. In our study, we found that the phase of transition from central diabetes insipidus to a syndrome of inappropriate antidiuretic hormone secretion may be a period of significant risk for DVT occurrence. Careful vascular follow-up is mandatory in CP-operated patients.

Hyponatraemia post stroke: a case study and review

This article discusses a case seen in clinical practice presenting with hyponatraemia post stroke. Strokes are a common occurrence in the UK and evidence suggests that 50% of these cases will develop some form of sodium and water imbalance, associated with increased mortality and morbidity. Hyponatraemia in acute stroke is commonly caused by either a syndrome of inappropriate antidiuretic hormone or cerebral salt wasting syndrome. This article discusses both causes which require different treatment approaches and reflects on the treatment decisions of the practitioner, who, on reading the literature around hyponatraemia, reversed their initial treatment decision.

Approach to Hyponatremia in the ICU: A review article

Hyponatremia is a common condition in clinical practice and a major cause of morbidity and mortality. Differentiating between its acute and chronic forms is challenging because of their variable symptoms. A thorough approach is necessary to diagnose hyponatremia. Proper interpretation of the numerous laboratory tests aids in the differentiation of hyponatremia types. In the ICU, management varies for acute and chronic cases to prevent neurological issues. While fluid restriction and hypertonic saline administration are two common forms of management, however, individualized strategies are essential for illnesses like cirrhosis or Syndrome of Inappropriate Anti Diuretic Hormone. To successfully treat hyponatremia, use vaptans and other protocols while monitoring the patient's condition closely. Monitoring acute and chronic cases must adhere to specific monitoring frequency and indices, and should cease only when Na+ levels are deemed safe. Balancing the diagnosis and therapy provides patient safety and avoids side effects.

Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

Abstract Background We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma. Methods This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the perioperative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression. Results Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.96–0.99, p = 0.029). DI was positively associated with female sex (OR = 2.26, 95% CI: 1.24–4.11, p = 0.008), increase in anteroposterior tumor size (OR = 1.54, 95% CI: 1.11–2.13, p = 0.010), intraoperative cerebrospinal fluid (CSF) leak (OR = 2.29, 95% CI: 1.25–4.19, p = 0.008), and every 100 mL of estimated blood loss (EBL) (OR = 1.18, 95% CI: 1.01–1.39, p = 0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR = 3.56, 95% CI: 1.24–10.21, p = 0.018) on multivariate analysis. Conclusion DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence.

70 - Severe hyponatremia in an elderly patient due to syndrome of inappropriate antidiuretic hormone secretion: can chronic opioid pump be the culprit?

70 - Severe hyponatremia in an elderly patient due to syndrome of inappropriate antidiuretic hormone secretion: can chronic opioid pump be the culprit?

Right-sided Herpes Zoster Ophthalmicus Complicated by Bilateral Third, Fourth, and Sixth Cranial Nerve Palsies and Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case Report.

Cases of herpes zoster ophthalmicus (HZO) complicated by bilateral ophthalmoplegia are rare, and no cases of bilateral third, fourth, or sixth cranial nerve palsies have been reported. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare complication of HZO. We herein report an 80-year-old Japanese woman with right-sided HZO complicated by meningoencephalitis and discuss the pathogenesis of this condition. She developed bilateral third, fourth, and sixth cranial nerve palsies and SIADH almost simultaneously during treatment for HZO. The bilateral cranial palsy spontaneously resolved within a few months.

Hyponatremia in the Elderly Induced by Risperidone: A Case Report

Hyponatremia due to risperidone is a rare complication that can be associated with drowsiness, confusion to coma and seizures. We report a case of a 92-year-old female with delirium combined with pulmonary infection who developed severe hyponatremia after 30 days of risperidone treatment, and the patient’s blood sodium gradually increased to normal after administration of concentrated sodium chloride, tolvaptan and gradual reduction of risperidone dosage until discontinuation. Through clinical observation, the mechanism of hyponatremia caused by risperidone is related to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

Traumatic brain injury inducing swift transition from syndrome of inappropriate antidiuretic hormone secretion to central diabetes insipidus: a case report

Traumatic brain injury inducing swift transition from syndrome of inappropriate antidiuretic hormone secretion to central diabetes insipidus: a case report

Pramipexole induced syndrome of inappropriate antidiuretic hormone secretion in a patient with young onset Parkinson’s disease

Abstract Pramipexole, a dopaminergic agonist, has rarely been implicated as a cause of hyponatremia in patients with Parkinson’s disease (PD). Pramipexole-induced stimulation of anti-diuretic hormone results in euvolemic hyponatremia. This is often neglected, and hyponatremia may lead to worsening of the motor symptoms with PD and an unnecessary increase in dopaminergic medications, causing disabling dyskinesias. This case report describes a patient with young-onset PD who developed new-onset hyponatremia due to pramipexole-induced syndrome of inappropriate anti-diuretic hormone within 3 months of starting the drug.

Primary central nervous system lymphoma with initial presentation of cerebral salt-wasting syndrome shifting to syndrome of inappropriate antidiuretic hormone secretion: A case report

Background. Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma which may affect brain parenchyma. Hyponatremia can be present as one of the complications, either due to neuronal injury arising from in-situ tumor and/or surgical resection (resulting in cerebral salt wasting syndrome/CSWS) or indolent, slowly progressing and often asymptomatic one as a consequence of ongoing chronic illness (so-called syndrome of inappropriate antidiuretic hormone/SIADH). Differentiating between the two is critical, since each diagnosis has a starkly different treatment approach which may exacerbate one another. Case presentation. Herein, we reported a case of a 48-year-old immunocompetent male who presented with diplopia, hallucination, imbalance, and dizziness, later to be diagnosed with PCNSL on multiple brain regions. He suffered from symptomatic hyponatremia post-surgically as a result of CSWS which in turn responding well to intensive dose of desmopressin acetate and fluid replenishment. However, as the disease progressed, hyponatremia also relapsed but was refractory to the same treatment approach. After subsequent investigations, patient was known to have SIADH. Treatments tailored to SIADH including fluid restriction and administration of hypertonic saline as well as tolvaptan lead to stabilization of sodium levels and significant clinical improvements. Conclusion. Post-operative hyponatremia in the setting of a PCNSL continues to be a complex issue. It underscores the importance of careful clinical assessment, monitoring, and the need for flexibility in diagnosis and management strategies. Furthermore, it highlights the challenges of distinguishing between CSWS and SIADH, two conditions with similar laboratory findings but divergent management approaches. Recognizing the subtleties in clinical presentation and responding appropriately can greatly influence patient outcomes. The rising incidence of PCNSL in immunocompetent individuals also needs a heightened awareness and understanding of its presentations and potential post-operative complications among clinicians.

Uncommon presentation of small cell lung carcinoma with ectopic adrenocorticotropic hormone secretion and resistant hypokalemia: A case report

Paraneoplastic syndromes can serve as initial indicators of malignancy, with small cell lung cancer accounting for 13% of new lung cancer diagnoses. The most prevalent paraneoplastic syndrome associated with small cell lung cancer is inappropriate antidiuretic hormone syndrome, followed by ectopic adrenocorticotropic hormone-mediated Cushing’s syndrome. Cushing’s syndrome manifests as hypercortisolemia and presents with diverse symptoms, including central obesity, plethora, menstrual irregularities, hypertension/diabetes mellitus, ecchymoses, osteoporosis, muscle weakness, virilization/hirsutism, skin atrophy, decreased libido, and infertility. This case report details the uncommon presentation of small cell lung carcinoma manifesting with ectopic adrenocorticotropic hormone secretion (EAS), leading to resistant hypokalemia and rhabdomyolysis. This case emphasizes the importance of considering EAS in severe cases of Cushing's syndrome and highlights the diagnostic and therapeutic challenges associated with this condition.

Acid base homeostasis and serum bicarbonate concentration in syndrome of inappropriate anti-diuretic hormone secretion (SIADH) with hyponatremia.

The Syndrome of Inappropriate ADH secretion (SIADH) presents with excess ADH release caused by a range of conditions; including pneumonia, brain tumors, certain lung cancers, and diseases of the hypothalamus. It presents with significant reduction in both sodium and chloride concentrations in the blood. However, reports examining the acid base status indicate a normal serum bicarbonate concentration and systemic acid base homeostasis. The mechanisms for the absence of abnormalities in acid base homeostasis remain speculative. This mini review is highlighting the recent advances in renal molecular physiology to provide answers for the maintenance of acid base status and serum bicarbonate in a physiological range.

Ibuprofen use for the treatment of pediatric patients with polyuria and dysnatremia. A case series report.

Children with sellar and/or suprasellar lesions may develop central diabetes insipidus with subsequent inappropriate antidiuretic hormone secretion. An increased incidence of polyuria, natriuresis, and hyponatremia has been reported in some cases, which make up the diagnostic triad of cerebral salt wasting syndrome. Here we report the clinical course of 7 patients with a history of acute central nervous system injury and central diabetes insipidus followed by cerebral salt wasting syndrome. Treatment included the sequential use of parenteral saline solution, oral sodium chloride, desmopressin, mineralocorticoids, and even thiazides. Due to persistent polyuria and hyponatremia, ibuprofen was added. As a result of this sequential therapeutic regimen, daily urine output reduced significantly from 10 mL/kg/h to 2 mL/kg/h over an average period of 5 days, together with a normalization of natremia (from 161 mEq/L to 143 mEq/L) over an average period of 9 days. No treatment-related adverse effects were observed in any case.

Chemical meningitis and syndrome of inappropriate antidiuretic hormone release (SIADH): a rare presentation of pituitary adenoma apoplexy

Pituitary apoplexy is an uncommon condition typically resulting from a sudden haemorrhage within a pituitary adenoma. This bleed can present clinically with a wide array of signs and symptoms. This report documents the case of a 62-year-old male who presented to the Lebanese Hospital Geitaoui University Medical Center with signs and symptoms of meningeal irritation. He was initially thought to have meningitis, and was started on antibiotics; he was then found to have pituitary adenoma apoplexy that was complicated by syndrome of inappropriate antidiuretic hormone release (SIADH). The patient was successfully treated with antibiotics, and fluid restriction and hypertonic saline after ruling out other more common causes for his hyponatraemia, before undergoing a transsphenoidal resection of the pituitary adenoma. A three-month follow-up evaluation of the patient demonstrated the absence of hormonal imbalances and the absence of residual tumours on imaging.

Intoxicación por vancomicina en un paciente con síndrome de secreción inadecuada de hormona antidiurética y diarrea

Vancomycin is an antibiotic used for infections by gram-positive bacteria with a two-compartment pharmacokinetic model. Its monitoring has an established therapeutic range (10-20 mg/L) to prevent nephrotoxicity and ototoxicity due to supra-therapeutic levels, and inefficiency and development of resistance by subtherapeutic levels.Nephrotoxicity for vancomycin monotherapy at standard doses according to pathogen and typical regimens (usual dose: 15-20 mg/kg/12 h) is rare and usually reversible. Moreover, monitoring plasma concentrations allows to achieve concentrations within therapeutic range to allow safe and effective drug use. The renal hypoperfusion can cause pre-renal damage, resulting in elevated levels of serum creatinine, resulting in decreased antibiotic elimination and nephrotoxicity.We report a case of unexpected vancomycin nephrotoxicity in a patient with syndrome Inappropriate antidiuretic hormone secretion associated paraneoplastic.

Syndrome of Inappropriate Antidiuretic Hormone (Siadh) in Lung Cancer

Lung cancer is one of the deadliest cancers in both men and women. Lung cancer is generally divided into 2, categories: small-cell lung carcinoma and non-small-cell lung carcinoma. Small cell lung carcinoma (SCLC) represents approximately 15% of all lung cancers. Paraneoplastic syndromes occur in 10% of lung cancer cases and constitute a group of disorders associated with the secretion of functional polypeptides or hormones from tumor cells. The syndrome of inappropriate antidiuretic hormone is a paraneoplastic syndrome that is closely related to SCLC and is associated with worse survival. The key to understanding SIADH is that the hyponatremia that occurs in this syndrome is not caused by Na+ deficiency but rather by excess fluid. The syndrome of inappropriate antidiuretic hormone that occurs is a secondary event caused by the release of antidiuretic hormone due to tumor lysis or because the tumor releases ectopic ADH. Hyponatremia in SCLC is a negative prognostic factor in hospitalized patients and patients with advanced disease

Syndrome of inappropriate antidiuretic hormone secretion approach in lung tuberculosis patient

Syndrome of inappropriate antidiuretic hormone secretion approach in lung tuberculosis patient