Syndrome of inappropriate antidiuretic hormone classification: Difference between revisions

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Revision as of 16:17, 14 August 2017

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 may be classified into several sub-types based on the pattern of AVP( arginine vasopressin) secretions across a range of plasma osmolalities: Type A, type B, type C, type D.

Classification

SIADH may be classified in to several sub-types based on the pattern of AVP secretion across a range of plasma osmolalities:

Differentiating Gynecomastia from other Diseases

Gynecomastia can be differentiated from other pathologies by detailed history taking and physical examination.^[1]^[2]^[3]


Differential Diagnosis	Differentiating Features

Gynecomastia	Round discrete mass felt under areola and usually bilateral.
Pseudogynecomastia	Increased adipose rather than glandular tissue on examination.
Lipoma	Asymmetric breast enlargement.
Breast cancer	Nipple discharge, Axillary lymphadenopathy, usually nonpainful mass.
Sebaceous cyst	Asymmetric enlargement and swelling feels closer tothe skinn.
Mastitis	Systemic s/s of infection.

References

↑ Dickson G (2012). "Gynecomastia". Am Fam Physician. 85 (7): 716–22. PMID 22534349.
↑ Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V; et al. (2009). "Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure". Int J Hyg Environ Health. 212 (6): 612–25. doi:10.1016/j.ijheh.2009.05.002. PMID 19546029.
↑ Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL (2010). "Treatment of adolescent gynecomastia". J Pediatr Surg. 45 (3): 650–4. doi:10.1016/j.jpedsurg.2009.11.016. PMID 20223338.

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[pmid22534349-1] Dickson G (2012). "Gynecomastia". Am Fam Physician. 85 (7): 716–22. PMID 22534349.

[pmid19546029-2] Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V; et al. (2009). "Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure". Int J Hyg Environ Health. 212 (6): 612–25. doi:10.1016/j.ijheh.2009.05.002. PMID 19546029.

[pmid20223338-3] Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL (2010). "Treatment of adolescent gynecomastia". J Pediatr Surg. 45 (3): 650–4. doi:10.1016/j.jpedsurg.2009.11.016. PMID 20223338.

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@@ Line 10: / Line 10: @@
 [[SIADH]] may be classified in to several sub-types based on the pattern of AVP secretion across a range of plasma osmolalities:
-*Type A : is the commonest form of [[SIADH]] responsible for a much higher proportion of SIADH, at around 60–70%. Characteristically, type A patients exhibit excessive, random secretion of AVP, with loss of the close linear relationship between plasma osmolality and plasma[[ AVP]]. Type A is common in [[lung cancer]]; in[[ vitro studie]]s have demonstrated that some lung tumours synthesize AVP, and that tumour tissue stains positive for AVP[[ mRNA]].Plasma AVP concentrations in type A SIADH are not suppressed [[physiologically]] by drinking , which makes patients vulnerable to the development of severe [[hyponatremia]]. Studies have also demonstrated a lower[[ osmotic]] threshold for [[thirst]] appreciation in this type of SIADH. This type of SIADH is also characteristic of [[nasopharyngeal tumours]], which also stain positive for AVP mRNA.
+==Differentiating Gynecomastia from other Diseases==
+* Gynecomastia can be differentiated from other pathologies by detailed history taking and physical examination.<ref name="pmid22534349">{{cite journal |vauthors=Dickson G |title=Gynecomastia |journal=Am Fam Physician |volume=85 |issue=7 |pages=716–22 |year=2012 |pmid=22534349 |doi= |url=}}</ref><ref name="pmid19546029">{{cite journal| author=Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V et al.| title=Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure. | journal=Int J Hyg Environ Health | year= 2009 | volume= 212 | issue= 6 | pages= 612-25 | pmid=19546029 | doi=10.1016/j.ijheh.2009.05.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19546029  }} </ref><ref name="pmid20223338">{{cite journal| author=Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL| title=Treatment of adolescent gynecomastia. | journal=J Pediatr Surg | year= 2010 | volume= 45 | issue= 3 | pages= 650-4 | pmid=20223338 | doi=10.1016/j.jpedsurg.2009.11.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20223338  }} </ref>
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
+| valign="top" |
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Gynecomastia]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Round discrete mass felt under [[areola]] and usually bilateral.
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pseudogynecomastia
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Increased [[adipose]] rather than glandular tissue on examination.
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Lipoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Asymmetric breast enlargement.
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Breast cancer]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Nipple discharge, [[Axillary|Axillary lymphadenopathy]], usually nonpainful mass.
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Sebaceous cyst]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Asymmetric enlargement and swelling feels closer tothe skinn.
+|-
+|-
-*Type B: is also common (20–40%). The osmotic[[ threshold ]]for AVP release is lowered – a [[reset osmostat]] – such that secretion of AVP occurs at lower plasma [[osmolalities]] than normal. Because [[AVP]] is suppressed at plasma osmolalities below the lower, reset threshold, further over-hydration leads to suppression of AVP release, which protects against the progression to severe[[ hyponatraemia]]. Although most [[tumours]] manifest type A[[ SIADH]], some also present with type B SIADH, so the[[ pattern]] of [[abnormal]] AVP secretion cannot be utilized to predict the [[causation]] of SIADH.
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Mastitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Systemic s/s of infection.
-*Type C :is a rare condition characterized by failure to suppress AVP secretion at plasma osmolalities below the osmotic threshold. Plasma AVP concentrations are thus inappropriately high at low plasma osmolalities, but there is a normal relationship between plasma osmolality and plasma AVP at physiological plasma osmolalities. This variant may be due to dysfunction of inhibitory neurons in the hypothalamus, leading to persistent low-grade basal AVP secretion.
+|}
-*Type D: is a rare clinical picture of SIADH with low or undetectable AVP levels and no detectable abnormality in circulating AVP response . It is thought that a nephrogenic SIADH (NSIAD) may be responsible for this picture . Gain-of-function mutations in the V2 receptor leading to a clinical picture of SIADH, with undetectable AVP levels, have been described. The identified mutations had different nucleotide substitutions causing different levels of V2 receptor activation. This syndrome appears to be inherited in an X-linked manner,although heterozygous females may have varying degrees of inappropriate antidiuresis. Owing to variable expressivity of the gene involved, NSIAD may be clinically undetectable for years, until other contributing factors in later life lead to clinically significant hyponatraemia . <ref name="pmid20164214">{{cite journal |vauthors=Hannon MJ, Thompson CJ |title=The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences |journal=Eur. J. Endocrinol. |volume=162 Suppl 1 |issue= |pages=S5–12 |year=2010 |pmid=20164214 |doi=10.1530/EJE-09-1063 |url=}}</ref>
 ==References==