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===Medical and Neurologic causes===
{| style="width:70%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Neurologic disorders
| style="width:75%" bgcolor="Beige" ; border="1" | Cerebral neoplasms, cerebral trauma and post concussive syndromes ,Cerebrovascular disease, [[subarachnoid hemorrhage]], [[Migraine]], [[encephalitis]],[[ cerebral syphilis]], [[Multiple sclerosis]],[[Wilsons disease]],[[Huntington disease]],[[Epilepsy]]
|-
|- bgcolor="LightSteelBlue"
| ''' Endocrine disorder'''
| bgcolor="Beige" | [[ Pituitary dysfunction]], [[Thyroid]] dysfunction, [[ parathyroid dysfunction]], [[Adrenal dysfunction]],[[ pheochromocytoma]]
|-
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Systemic conditions'''
| style="width:75%" bgcolor="Beige" ; border="1" | Hypoxia, Cardiovascular disease, pulmonary insufficiency, [[anemia]]
|-
|- bgcolor="LightSteelBlue"
| '''Inflammatory disorders'''
| bgcolor="Beige" | [[ Lupus erythematosus]], [[rheumatoid arthritis]], [[ polyarteritis nodosa]], [[temporal arteritis]]
|-
|- bgcolor="LightSteelBlue"
| '''Deficiency states'''
| bgcolor="Beige" | Vitamin B12 deficiency, [[ pellagra]]
|- bgcolor="LightSteelBlue"
| '''Miscellaneous '''
| bgcolor="Beige" | [[ hypoglycemia]], [[carcinoid syndrome]], [[ uremia]], [[premenstrual syndrome]], [[porphyria]]
|-
|- bgcolor="LightSteelBlue"
| '''Substances'''
| bgcolor="Beige" | [[Caffeine]],[[cannabis]],[[Hallucinogens]], [[theophylline]], [[amphetamines]],[[yohimbine]],[[sympathomimetics]], [[mercury]], [[Arsenic]],[[organophosphates]],[[benzene]]
|-
|- bgcolor="LightSteelBlue"
| '''Withdrawal'''
| bgcolor="Beige" | [[alcohol]],[[caffeine]], [[opiods]],[[antihypertensives]]


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


siadh classification
==Causes==
==Classification==
[[Hypogammaglobulinemia]] is caused by:


*Acute setting (<48 hours since onset) where moderate symptoms are noted, treatment options for hyponatremia include the following:
Immunodeficiency secondary to:
*3% hypertonic saline (513 mEq/L)
*[[Uremia]]
*Loop diuretics with saline
*Protein losing enteropathy
*Vasopressin-2 receptor antagonists (aquaretics, such as conivaptan or tolvaptan)
*[[Nephrotic syndrome]]
* Water restriction
*Malnutrition
*Cirrhosis
*Hemodialysis
* Intestinal lymphangiectasia


* In chronic asymptomatic setting, the treatment is as follows:
* Protein-losing gastroenteropathy
*Fluid restriction
*[[Nephrotic syndrome]]
*Vasopressin-2 receptor antagonists
*[[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>
*Other agents to be considered include loop diuretics with increased salt intake, urea, and demeclocycline
* 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>


*Raise serum sodium by 0.5-1 mEq/hr, and not more than 10-12 mEq in the first 24 hours,to avoid complications like Osmotic demyelination syndrome.
* Environmental hazards:
** Ionizing radiation
**Toxins


*In rare medical emergencies more commonly seen in cardiology in the context of hypervolemic severe hyponatremia rather than in SIADH : 
*Infections
* Continuous veno-venous hemofiltration (CVVH)  
** Viral(Herpes, Measles)
*Slow, low-efficiency daily dialysis (SLEDD  have been used to improve hyponatremia. These methods are invasive so their use is very limited.<ref name="pmid19628685">{{cite journal |vauthors=Salahudeen AK, Kumar V, Madan N, Xiao L, Lahoti A, Samuels J, Nates J, Price K |title=Sustained low efficiency dialysis in the continuous mode (C-SLED): dialysis efficacy, clinical outcomes, and survival predictors in critically ill cancer patients |journal=Clin J Am Soc Nephrol |volume=4 |issue=8 |pages=1338–46 |year=2009 |pmid=19628685 |pmc=2723965 |doi=10.2215/CJN.02130309 |url=}}</ref>
**Bacterial(Mycobacterial)
**Parasitic(Malaria, helminthic infections)

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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