Syndrome of inappropriate antidiuretic hormone differential diagnosis: Difference between revisions
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*[[Fluid]] restriction and[[ behavioral]] and [[pharmacologic]] modalities. | *[[Fluid]] restriction and[[ behavioral]] and [[pharmacologic]] modalities. | ||
*The water deprivation test is the [[gold standard]] test. | *The [[water deprivation test]] is the [[gold standard]] test. | ||
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Revision as of 19:37, 14 August 2017
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Syndrome of inappropriate antidiuretic hormone Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
SIADH consists ofhyponatremia, inappropriately elevatedurine osmolality, excessive urine sodium and decreased serum osmolality in a euvolemic patient without edema. These findings should occur in the absence of diuretic treatment with normal cardiac, renal, adrenal, hepatic and thyroid function.Hyponatremia occurs in about 30% of hospitalized patients and SIADH is the most frequent cause of hyponatremia. Differentiating hyponatremia due to SIADH from other causes of hyponatremia becomes essential to evaluate the treatment plan. Syndrome of inappropriate antidiuretic hormone must be differentiated from cerebral salt wasting , adrenal insufficiency, hypopituitarism, hypothyroidism,psychogenic polydipsia
Differentiating Syndrome of inappropriate antidiuretic hormone from other Diseases
SIADH must be differentiated from cerebral salt wasting, adrenal insufficiency, hypopituitarism, hypothyroidism, psychogenic polydipsia[1][2][3]
| Disease | Causes | Symptoms | Diagnosis and treatment |
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| SIADH | SIADH is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload. |
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| Cerebral salt wasting syndrome | Cerebral salt wasting syndrome is defined as therenal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. | The patient is | Treatment is with adequate |
| Adrenal insufficiency | Adrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock like condition.
An important distinction in these patients is the presence ofmineralocorticoid deficiency. Those with secondary or tertiary adrenal insufficiency will typically have preservedmineralocorticoid function due to the separate feedback systems. Adrenal insufficiency can be Tertiary Common causes of primary adrenal insufficiency:
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Chronic disease is characterized by Acute addisonian crisis is characterized by : |
The diagnosis of Addisons disease is made through rapid ACTH administration and measurement of cortisol.
The definitive diagnosis is the cosyntropin or ACTH stimulation test. Acortisol level is obtained before and after administering ACTH. A normal person should show a brisk rise in cortisol level after ACTH administration.
Adrenal crisis:
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| Hypopituitarism | Hypopituitarism is defined as the partial or complete loss of anterior pituitary function that can result from acquired or congenital causes.
Etiology is as follows: |
Signs and symptoms ofhypopituitarism vary, depending on the deficient hormone and severity of the disorder,some of the symptoms may be as follows:
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The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitaryhormone deficiency. The clinical manifestations ofhypopituitarism result from the degree of the specific hormone deficiency.
A thorough and longitudinal history andphysical examination, including visual field testing, are important. Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary In order of frequency: growth hormone deficiency>secondary hypogonadism>secondary hypothyroidism>secondary adrenal failure). The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones
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| Hypothyroidism | Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to autoimmune causes described below:
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Diagnosis of hypothyroidism is based on blood tests:
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| Psychogenic polydipsia | Also called asprimary polydipsia is characterized bypolyuria and polydipsia. Causes are:
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Evaluation ofpsychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria,hyponatremia, and the syndrome of inappropriate secretion of antidiuretic hormone.
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References
- ↑ Heidelbaugh JJ (2016). "Endocrinology Update: Hypopituitarism". FP Essent. 451: 25–30. PMID 27936532.
- ↑ Hammer F, Arlt W (2004). "[Hypopituitarism]". Internist (Berl) (in German). 45 (7): 795–811, quiz 812–3. doi:10.1007/s00108-004-1216-5. PMID 15241506.
- ↑ de Fost M, Oussaada SM, Endert E, Linthorst GE, Serlie MJ, Soeters MR, DeVries JH, Bisschop PH, Fliers E (2015). "The water deprivation test and a potential role for the arginine vasopressin precursor copeptin to differentiate diabetes insipidus from primary polydipsia". Endocr Connect. 4 (2): 86–91. doi:10.1530/EC-14-0113. PMC 4401105. PMID 25712898.