Inappropriate ADH Secretion Research Articles

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.

Challenges in post-operative management of Cushing disease

Patients with Cushing disease (CD) undergo transsphenoidal resection of the pituitary tumor as the primary management option. Post operative period is considered as one of the most challenging aspects in the CD management due to the related high morbidity and mortality. Assessing remission following surgery is done commonly by assessing nadir serum cortisol level, a level < 2 to 5 µ,g/ dL (55-138 nmol/L) during 24 to 7 4 hours postoperatively is accepted as remission. Values more than 5-10 µ,g/dL (138-276 nmol/L) considered as non-remission. If remission is achieved, it is important to treat the adrenal insufficiency (AI) with steroids until the Hypothalamic-Pituitary-Adrenal axis (HPA axis) recovery happens. Other anterior pituitary hormone dysfunctions should be assessed and treated appropriately. If the remission is not achieved by the surgery, secondary management options such as repeat surgery, radiotherapy and medical therapy can be used. Prevention and management of hypercortisolemia associated complications such as infections, thromboembolic events, cardiovascular and metabolic diseases are also important aspect in the post operative management of CD. It is also challenging to manage surgery related complications such as Syndrome of Inappropriate ADH Secretion (SIADH) and Diabetes Insipidus (DI). Prevention or successful treatment of cortisol withdrawal syndrome is another challenging aspect that a physician needs to focus on.

Presentation of severe brucellosis in 5-year-old boy - challenges and results

Brucellosis is highly contagious zoonotic bacterial disease caused by gram-negative genus. It has a wide spectrum of clinical manifestations and due to variety and nonspecificity of clinical signs the diagnostics can be very complicated. We present a clinical case of severe chronic brucellosis in a 5-years old boy with long-term course of disease and multiorgan involvement. A different complication of brucellosis including severe syndrome of inappropriate ADH secretion (SIADH) are discussed. Despite severe course of disease patient achieved significant clinical improvement due to multidisciplinary approach and optimal etiotropic and pathogenetic treatment.

Incidence of Diabetes Insipidus and SiADH in Postoperative of Transsphenoidal Resection of Pituitary Adenoma

Diabetes Insipidus (DI) and Syndrome of inappropriate ADH secretion (SiADH) are well-known complications of transsphenoidal resection of pituitary adenoma. The incidence of these complications had not been evaluated in Canada. Furthermore, there is no expert recommendations regarding the follow-up of natremia after transsphenoidal surgery. The objective of this study was to determine the incidence of transitory DI, permanent DI and SiADH.

SIADH (Syndrome of Inappropriate ADH Secretion): Perplexing Look of Dengue Fever

Dengue is a mosquito-borne disease (female mosquitoes of the Aedes genus, principally Aedes aegypti) caused by any one of four closely related dengue viruses. It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifests as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever (with or without shock). Isolated organopathy or expanded dengue syndrome (EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystemic and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system. Dengue virus has long been considered as a non-neurotropic virus, as animal studies have shown that virus does not cross blood brain barrier. Hyponatremia may be found in association with dengue fever and is thought to be caused by peripheral fluid extravasation and resulting intravascular hypovolaemia. But hyponatremia due to syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) in Dengue fever is rare. We report a 40 years old male who was diagnosed as Dengue fever (Dengue Ns1Ag positive) with thrombocytopenia and hyponatremia. He was admitted and further investigations revealed SIADH. He responded well to cautious sodium replacement and addition of tolvaptan. He recovered completely and was discharged after one week. Thus, all clinicians should keep in mind the possibility of SIADH as a part of expanded dengue syndrome.

Acute and Chronic Posterior Pituitary Insufficiency Among Traumatic Brain Injury Patients at a Tertiary Care Center

Abstract Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Disorders of salt and water balance are the most commonly recognized medical complications in the immediate post-TBI period and contribute to early morbidity and mortality. Objective: We aimed to evaluate the prevalence of acute (during hospital stay) and chronic posterior pituitary dysfunction in patients of head injury admitted at our tertiary care hospital. Study Design: Prospective, Observational study. Participants: 136 patients, attending tertiary care in North India with TBI with radiological evidence of head injury. Methodology: The severity of brain injury was assessed by the Glasgow Coma Scale (GCS), and Modified Rankin Scale (MRS) score at the time of admission. Lab measurements, apart from routine CBC and biochemical tests, included tests of serum and urinary osmolality, serum sodium, cortisol, and thyroid function test during the hospital stay. All patients were monitored closely during the hospital stay. Surviving patients were evaluated at 3, 6, and 12 months of follow-up. Urinary output and water deprivation tests were done to determine chronic posterior pituitary dysfunction. The results were compared against normative data obtained from 25 matched, healthy controls. Serum & urinary osmolality was measure by the freezing point method. Diabetes insipidus (DI) and Syndrome of inappropriate ADH secretion (SIADH) were diagnosed according to standard criteria. Results: Of 136 patients admitted, 61 (44.85%) had a mild head injury (GCS, ≤8), 47 (35.55%) had a moderate injury (GCS, 9-12), and 27 (19.85%) had a severe injury (GCS, 13-15). DI occurred in 10 patients (7.4%), while SIADH was observed in 4 patients in the immediate TBI period. Risk factors for diabetes insipidus were GCS of ≤ 8 at admission, midline shift, and surgical intervention. DI was an independent risk factor for death. There was a negative correlation between the presence of DI and GCS score (r, -0.367). Most of the patients with DI (8 out of 10) died during the hospital stay. One patient persisted to have partial diabetes insipidus and another one SIADH at three months post-TBI; both patients had recovered at six months of follow-up. No new case of DI or SIADH occurred on the follow up to 12 months. Conclusion: The incidence of acute DI in severe head injury (GCS ≤ 8) could be an indicator of the severity of TBI, and associated with increased mortality as most of our patients died during the hospital stay.

Severe Hyponatremia With Partial Hypoadrenalism in Acute Porphyria

Background: Hyponatremia is the most common electrolyte-abnormality in hospitalized-patients, it increases likelihood of hospital death up-to 50% when serum Na<120mEq/L. Syndrome of inappropriate ADH secretion (SIADH) is the most common cause of hyponatremia in hospital inpatients. Clinical Case: 29 years-old woman, hospitalized several times due to severe hyponatremia of 103mEq/L; Admissions were accompanied by severe abdominal-pain and vomiting. She complained of severe premenstrual syndrome with severe abdominal pain and was hospitalized twice after intrauterine insemination. She was euvolemic and due to high urinary-sodium was diagnosed with SIADH. Brain MRI, chest x-ray, thyroid-function test, and 1-mcg ACTH-test were normal. Insulin Tolerance Test for hypoadrenalism was abnormal with cortisol levels of 14.2mcg/dl and 40mg/dl glucose. She was instructed to take strong analgesics and prednisone during attacks, this did not prevent hyponatremia. Finally, due to recurrent abdominal pain, porphyria workup was done and was positive. There are 30 case-reports of porphyria and SIADH. Porphyrias are a group of 8 inherited metabolic-disorders of heme biosynthesis, often classified as hepatic or erythropoietic according to the organ in which heme precursors accumulate. Acute intermitted porphyria is estimated in ~1/75000 people of European descend, yet clinical disease is seen in ~10% of carriers. Attacks present with severe abdominal-pain, nausea, vomiting, constipation, occasionally excretion of red colored urine and signs of increased sympathetic activity. Hyponatremia due to SIADH develops in 40% of patients and can lead to convulsions. Porphyria can exacerbate by several drugs, infectious processes, alcohol, and menstruation-induced hormonal-changes. Diagnosis is made by excess of urine porphobilinogen and 5-aminolaevulinic-acid. Treatment should include avoidance of precipitating factors and hemein infusions. Conclusions: SIADH is considered responsible for the hyponatremia seen in porphyria patients. Our patient showed an abnormal cortisol response to Insulin induced hypoglycemia, in accordance to (1) that demonstrated decreased output of cortisol and metabolites in porphyria patients secondary to decreased hemoproteins, as p450 cytochromes. Importantly, levels of endogenous hormones, particularly progesterone, can trigger an attack especially in luteal phase and in clomiphene citrate administration.1. Pozo et al Orphanet Journal of Rare Diseases 2014

Aquaporins and diseases pathogenesis: From trivial to undeniable involvements, a disease-based point of view.

Aquaporins(AQPs), as transmembrane proteins, were primarily identified as water channels with the ability ofregulating the transmission of water, glycerol, urea, and other small-sized molecules. The classic view of AQPs involvement in therapeutic plan restricted them and their regulators into managing only a narrow spectrum of the diseases such as diabetes insipidus and the syndrome of inappropriate ADH secretion. However, further investigations performed, especially in the third millennium, has found that their cooperation in water transmission control can be manipulated to handle other burden-imposing diseases such as cirrhosis, heart failure, Meniere's disease, cancer, bullous pemphigoid, eczema, and Sjögren's syndrome.

A Case of Abscess Formation from Sphenoid Sinusitis to Pituitary Gland Associated with Syndrome of Inappropriate ADH Secretion

A Case of Abscess Formation from Sphenoid Sinusitis to Pituitary Gland Associated with Syndrome of Inappropriate ADH Secretion

An unusual case report of COVID-19 presenting with syndrome of inappropriate ADH secretion

Coronavirus disease-2019 (COVID-19) caused by novel coronavirus continues to produce enormous health effects and deaths since it started in 2019. Research till now has shown that COVID-19 manifests with unusual presentations causing various challenges in its management. Hyponatremia is a common condition found in critical care units and syndrome of inappropriate ADH (SIADH) accounts for one-third of those cases. Several infections associated with COVID-19 have been reported, but there are only few case reports of association with SIADH. We report the case of a 30-year-old male admitted with seizure due to acute symptomatic hyponatremia and SIADH attributed to COVID-19.

SIADH: A RARE ENTITY IN HEAD AND NECK CANCER- A CASE REPORT WITH REVIEW OF LITERATURE

Hyponatremia secondary to malignancy is a rare finding. Syndrome of inappropriate ADH secretion in head and neck cancer patient can be a serious comorbidity leading to decline in the survival rate. However, most of the time it goes undetected at the outset. And the pathophysiology of this link is not clarified. This article highlights a case of SIADH developed in 40-yr-old man with oral cancer. Also, focusses on the importance of diagnosing it and rendering treatment at the earliest.

Low-solute intake in chronic asymptomatic hyponatraemia related to syndrome of inappropriate secretion of ADH (SIADH): think about food beyond water intake!

Low-solute intake in chronic asymptomatic hyponatraemia related to syndrome of inappropriate secretion of ADH (SIADH): think about food beyond water intake!

Extended Endoscopic Endonasal Surgery to Ventral Skull Base Lesions

Abstract Introduction In the last two decades, Endoscopic endonasal approaches (EEAs) have undergone a significant evolution with a major shift from a transsellar approach to a variety of approaches that can directly access the midline and paramedian ventral skull base. Once the technical feasibility of any surgical approach is established; its safety (assessed through complications), and treatment outcomes (assessed through long-term follow-up) should be addressed. Aim of the Study To assess the feasibility, safety, and efficacy of EEA as a minimally invasive approach to ventral skull base lesions. Methodology and Materials this is a prospective observational study of group of 30 patients with ventral skull base lesions that were managed via endoscopic endonasal approaches. All patients’ clinical data, radiographic evaluations, procedural detail, complications, and follow-up data were recorded and analyzed. Results The mean age of patients was 50.8 years (range: 18-74 years), with a male:female ration of 1:1.72. The most commonly encountered pathological entities in the cohort was meningiomas (43.3%), pituitary adenomas (23.3%). and craniopharyngiomas (13.3%). Postoperative CSF leak was observed in 6.6% of cases and was managed successfully. There were no cases with postoperative infection in the cohort. Other procedure-related complications include transient diabetes insipidus (10%), pneumocephaly (3.3%), Syndrome of inappropriate ADH secretion (3.3%). Gross total resection was achieved in 93.3% of cases. Improvement of preoperative symptoms was recorded in 89.2% of cases. The mean follow-up duration was 17.8 ± 2.7 months. Conclusion EEAs provide direct access and better visualization to the ventral skull base without brain retraction and with minimal neurovascular manipulation, leading to less morbidity and mortality. EEA can be considered a feasible, safe, and effective tool on the armamentarium of skull base surgery. EEAs should not be considered as a replacement to the traditional transcranial approaches; rather. EEAs are deemed as a complementary route and a potential alternative to conventional skull base surgery in select cases.

An audit on the management of patients with SIADH (Syndrome of inappropriate ADH secretion) in a District General hospital in the UK

Syndrome of inappropriate ADH (SIADH) secretion is a condition where there is an increase in the secretion of ADH resulting in retention of excess water in the body. ADH or Antidiuretic hormone (also called Vasopressin) is produced in the hypothalamus of the brain and released by the pituitary gland. The main biochemical abnormality is low plasma sodium or hyponatraemia. However hyponatraemia can occur for multiple reasons and it is important to diagnose the specific cause as the management can vary. SIADH is a cause for euvolaemic hyponatraemia and the management includes stopping the drug responsible for causing it, fluid restriction and using medications like Tolvaptan and Demeclocycline. The audit below is an attempt to find out if the prevailing Guidelines were considered during the management of SIADH in our hospital.

An audit on the management of patients with SIADH (Syndrome of inappropriate ADH secretion) in a District General hospital in the UK

An audit on the management of patients with SIADH (Syndrome of inappropriate ADH secretion) in a District General hospital in the UK

Sex-specific risks of death in patients hospitalized for hyponatremia: a population-based study

PurposeSeveral studies have reported an association between hyponatremia and lethality. However, it remains elusive whether hyponatremia independently contributes to lethality. The aim of the study was to investigate associations between hyponatremia and lethality and differences in lethality between men and women hospitalized due to hyponatremia.MethodsFour registries were utilized in this population-based retrospective study: The National Patient Registry, the Cause of Death Register, the Swedish Prescribed Drug Register and the Total Population Register (NPR) from which the controls were sampled. All hospitalized patients with a first-ever principal ICD10 diagnosis of hyponatremia or syndrome of inappropriate ADH secretion in the NPR between 1 October 2005 and 31 December 2014 were defined as cases. Cox regression with adjustment for potential confounders was used.Results14,359 individuals with a principal diagnosis of hyponatremia, and 57,382 matched controls were identified. Median age was 76 years and the majority were women (72%). Median age for women and men was 79 and 68 years, respectively. Adjusted hazard ratios (and 95% CI) for lethality in those with hyponatremia compared with controls were for the entire population 5.5 (4.4–7.0) and in the subgroup free from previously known underlying disease 6.7 (3.3–13.3). Lethality in women with hyponatremia was lower compared with men: HR: 0.56 (0.49–0.64). In the healthier group the lethality remained lower for women: HR: 0.49 (0.34–0.71).ConclusionsPatients hospitalized due to hyponatremia faced an increased subsequent lethality that was independent of concomitant disease. This increase was nearly twice as large among men compared with women.

Hiccups and Inappropriate ADH Secretion Syndrome as Presentations of Tick-Borne Disease.

Tick-borne diseases (Lyme disease and tick-borne encephalitis) are becoming a major public health concern. Rapid and correct diagnosis is crucial for complicated cases but is often delayed because of low suspicion or unusual clinical presentation. In this paper the authors describe two atypical presentations of Lyme disease and tick-borne encephalitis in order to help clinicians resolve diagnostic challenges.LEARNING POINTSTick -borne diseases canould have atypical presentations.In endemic areas, patients with unexplained and refractory hyponatremiaaemia, should be screened for Lyme disease even in the absence of elevatedion of inflammatory markers or other specific symptoms.Persistent hiccups could be an atypical clinical presentation of tick-borne encephalitis (TBE).

362 A Case of Syndrome of Inappropriate ADH Secretion in Guillain-Barre Syndrome

362 A Case of Syndrome of Inappropriate ADH Secretion in Guillain-Barre Syndrome

MON-340 Concomitant TIO and SIADH in a Patient with Neuroendocrine Tumor

83 year old male patient with remote history of bladder cancer post TURBT, who presented with generalized weakness, poor appetite, and decreased PO intake of one week duration. He was found to have hyponatremia with Na level of 120mmol/L. IV hydration failed to correct his sodium levels. Persistent hyponatremia in the setting of euvolemia and inappropriately elevated urine sodium was suggestive of SIADH (serum Na 126 mmol/l, urine Na 79mmol/l). Lab work was also significant for hypocalcemia (7.4 mg/dl corrected for albumin) and hypophosphatemia (0.9-1.3 mg/dl). PTH was 48.3pg/ml which was inappropriately normal in the setting of hypocalcemia. 25(OH) vitamin D and 1,25(OH)2 Vitamin D levels were measured and were 41 ng/ml and 19.5 pg/ml (19.9-79.3 pg/ml) respectively. Patient was started on calcium and vitamin D replacement. Hypophosphatemia was treated with potassium phosphate supplementation (up to 2 grams a day) with persistently low levels (1.4 mg/dl). 24 hour urine collection was performed and showed urine calcium excretion of 200 mg/24 hrs with a concomitant serum calcium level of 8.2 mg/dl and urine Phosphorus excretion of 684 mg/24hrs with a concomitant serum phosphorus of 1.3 mg/dl (Patient excreted 0.72 g creatinine in 24 hrs which was slightly low). These results were consistent with renal phosphate wasting. The combination of hypocalcemia, hypophosphatemia, renal phosphate wasting along with normal PTH levels is consistent with Oncogenic Osteomalacia. CT scan of the chest abdomen pelvis showed a large mediastinal mass suggestive of primary malignancy in addition to multiple lesions in the liver and adrenal and axillary lymphadenopathy. Liver biopsy was positive for poorly differentiated Neuroendocrine Carcinoma with small cell features. FGF23 level was elevated to 242 RU/ml (Ref range < or = 180 RU/ml) consistent with TIO. Phosphorus level corrected after initiating chemotherapy, as well as 1,25(OH)2 VitD which increased to 51.7 pg/ml. Serum sodium and calcium also normalized. FGF23 was checked again after completing 2 sessions of therapy and was down to 89 RU/ml. Discussion: We report a case of combined TIO and SIADH in the setting of neuroendocrine mediastinal tumor with small cell features. The patient demonstrated hypophosphatemia, hypocalcemia, and hyponatremia due to elevated FGF-23, decreased hydroxylation of 25 OH vitamin D, and inappropriate ADH secretion. All these findings corrected with chemotherapy.

A case of the syndrome of inappropriate ADH secretion in the setting of pre eclampsia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)