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{| class="wikitable"
!Disease
!Features
|-
|SIADH
|SIADH is a disease categorized as hypo-osmolar hyponatremia; small amount of volume expansion is caused by excess of renal water reabsorption through inappropriate antidiuretic hormone (ADH) secretion. In patients with SIADH there is too much water in the blood,this leads to low sodium in the body. Hyponatremia is the most common manifestation. The symptoms are based on level of sodium.(hyponatremia: sodium level below 135meq/l). When symptoms do occur, they may include any of the following: Headache, altered mental status, frequent falls, neurologic manifestations such as lethargy and confusion. In severe cases , seizures and coma may result.
Diagnostic criteria of SIADH include:
* Na<135mmol/litre
* decreased effective serum osmolality<275mosm/kg
* urine osmolality>100mosm/kg
* presence of underlying disorders;CNS,pulmonary,malignancies,medications
* normal adrenal and thyroid function
* urine Na concentration>40mmol/l,unless taking diuretics,(or) on a severe salt restriction.
* absence of edematous diseases(such as heart failure,nephrotic syndrome, liver cirrhosis)
|-
|Cerebral salt wasting
| Cerebral salt wasting is defined as the renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume.
|
|-
|Adrenal insufficiency


|Adrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock condition. An important distinction in these patients is the presence of mineralocorticoid deficiency. Those with secondary or tertiary adrenal insufficiency will typically have preserved mineralocorticoid function due to the separate feedback systems.
Adrenal insufficency can be primary, secondary or tertiary.
Common causes of primary adrenal insufficiency:
* Autoimmune
*Iatrogenic
*Drugs
*Others- adrenal hemorrhage, cancer, infection.
*congenital.
Secondary adrenal insufficiency refers to decreased adrenocorticotropic hormone (ACTH) stimulation of the adrenal cortex and therefore does not affect aldosterone levels. Traumatic brain injury (TBI) and panhypopituitarism are common causes.
Tertiary adrenal insufficiency refers to decreased hypothalamic stimulation of the pituitary to secrete ACTH. Exogenous steroid administration is the most common cause of tertiary adrenal insufficiency. <ref name="pmid28722862">{{cite journal |vauthors=Huecker M, Dominique E |title= |journal= |volume= |issue= |pages= |year= |pmid=28722862 |doi= |url=}}</ref>
|-
|Hypopituitarism
|
|-
|Hypothyroidism
|
|-
|Psychogenic polydipsia
|
|}
__NOTOC__


{{CMG}}; {{AE}} {{Vbe}}
_NOTOC _
{{CMG}};{{AE}}{{Vbe}}


==Differential diagnosis==
==Causes==
[[Hypogammaglobulinemia]] is caused by:


Immunodeficiency secondary to:
*[[Uremia]]
*Protein losing enteropathy
*[[Nephrotic syndrome]]
*Malnutrition
*Cirrhosis
*Hemodialysis
* Intestinal lymphangiectasia


* Protein-losing gastroenteropathy
*[[Nephrotic syndrome]]
*[[Thymoma]] <ref name="pmid29881497">{{cite journal |vauthors=Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD |title=[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome] |language=French |journal=Pan Afr Med J |volume=28 |issue= |pages=253 |date=2017 |pmid=29881497 |pmc=5989270 |doi=10.11604/pamj.2017.28.253.11352 |url=}}</ref>
* Medications :
** Gold
**D-Penicillamine
**Sulfasalazin
**Anticonvulsants
**Glucocorticoids
**Methotrexate
**Calcineurin inhibitors
** Rituximab<ref name="pmid29755528">{{cite journal |vauthors=Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M |title=Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura |journal=Case Rep Med |volume=2018 |issue= |pages=2096186 |date=2018 |pmid=29755528 |pmc=5884289 |doi=10.1155/2018/2096186 |url=}}</ref><ref name="pmid29752554">{{cite journal |vauthors=Farhat L, Dara J, Duberstein S, De A |title=Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report |journal=Drug Saf Case Rep |volume=5 |issue=1 |pages=22 |date=May 2018 |pmid=29752554 |pmc=5948191 |doi=10.1007/s40800-018-0087-y |url=}}</ref><ref name="pmid29627491">{{cite journal |vauthors=Thorlacius H, Jerkeman A, Marginean FE, Toth E |title=Colorectal malakoplakia in a patient with hypogammaglobulinemia |journal=Gastrointest. Endosc. |volume= |issue= |pages= |date=April 2018 |pmid=29627491 |doi=10.1016/j.gie.2018.04.001 |url=}}</ref>


* Environmental hazards:
** Ionizing radiation
**Toxins


 
*Infections
 
** Viral(Herpes, Measles)
Agents and means used in the treatment of SIADH.
**Bacterial(Mycobacterial)
 
**Parasitic(Malaria, helminthic infections)
Indirect modalities:
*treatment of underlying pathology
*salt restriction
*Hyper-tonic saline
*Loop diuretics
*Urea
*Demecloclycline, lithium
*Hemodialysis, CVVH(continuous veno-venous hemofiltration), SLED(slow, low-efficiency daily dialysis).
 
Direct modalities:
 
"Vaptan drugs": block  action of vasopressin at it's receptors,(V1A,V1B,V2)
 
Prognosis:Patients with SIADH have different characteristics and a different prognosis according to SIADH etiology. Serum sodium concentration at short-term follow-up is predictive of long-term survival. These findings might have diagnostic and treatment-related implications.
<references />

Latest revision as of 14:23, 3 August 2018


_NOTOC _ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Causes

Hypogammaglobulinemia is caused by:

Immunodeficiency secondary to:

  • Protein-losing gastroenteropathy
  • Nephrotic syndrome
  • Thymoma [1]
  • Medications :
    • Gold
    • D-Penicillamine
    • Sulfasalazin
    • Anticonvulsants
    • Glucocorticoids
    • Methotrexate
    • Calcineurin inhibitors
    • Rituximab[2][3][4]
  • Environmental hazards:
    • Ionizing radiation
    • Toxins
  • Infections
    • Viral(Herpes, Measles)
    • Bacterial(Mycobacterial)
    • Parasitic(Malaria, helminthic infections)
  1. ↑ Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD (2017). "[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome]". Pan Afr Med J (in French). 28: 253. doi:10.11604/pamj.2017.28.253.11352. PMC 5989270. PMID 29881497.
  2. ↑ Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M (2018). "Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura". Case Rep Med. 2018: 2096186. doi:10.1155/2018/2096186. PMC 5884289. PMID 29755528.
  3. ↑ Farhat L, Dara J, Duberstein S, De A (May 2018). "Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report". Drug Saf Case Rep. 5 (1): 22. doi:10.1007/s40800-018-0087-y. PMC 5948191. PMID 29752554.
  4. ↑ Thorlacius H, Jerkeman A, Marginean FE, Toth E (April 2018). "Colorectal malakoplakia in a patient with hypogammaglobulinemia". Gastrointest. Endosc. doi:10.1016/j.gie.2018.04.001. PMID 29627491.
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