Syndrome of inappropriate antidiuretic hormone differential diagnosis: Difference between revisions
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*In adrenal crisis,measure cortisol level,then rapidly administer | *In adrenal crisis,measure cortisol level,then rapidly administer | ||
* Fluids | * Fluids | ||
* Hydrocortisone | and | ||
* Hydrocortisone. | |||
|- | |- | ||
|Hypopituitarism: | |Hypopituitarism: | ||
|Hypopituitarism is defined as the partial or complete loss of | |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: | Etiology is as follows: | ||
* | *Pituitary tumors | ||
* | *Sellar tumors | ||
* | *Head trauma | ||
* | *Infection | ||
* | *Empty sella | ||
* | *Infiltration | ||
*Idiopathic | *Idiopathic | ||
* | *Congenital | ||
| | | | ||
Signs and symptoms of | Signs and symptoms of hypopituitarism vary, depending on the deficient | ||
[[hormone ]] and severity of the disorder,some of the | [[hormone ]] and severity of the disorder,some of the symptoms may be as follows: | ||
* | * Fatigue | ||
* | * Weight loss | ||
* Decreased | * Decreased libido | ||
* Decreased | * Decreased appetite | ||
* Facial | * Facial puffiness | ||
* | * Anemia | ||
* | * Infertility | ||
* | * Cold insensitivity. | ||
* | * Amenorrha | ||
* | *Inability to lactate in breast feeding women | ||
* Decreased | * Decreased facial or body hair in men | ||
* | * Short stature in children | ||
|The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitary | |The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitary hormone deficiency. The clinical manifestations of[[ hypopituitarism]] result from the degree of the specific hormone deficiency. | ||
A thorough and longitudinal | A thorough and longitudinal history and physical examination, including visual field testing, are important. | ||
Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary | 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]]). | In order of frequency: [[growth hormone]] deficiency>[[secondary hypogonadism]]>[[secondary hypothyroidism]]>[[secondary adrenal failure]]). | ||
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*[[Surgery]] and/or | *[[Surgery]] and/or | ||
*[[ Radiotherapy]] to restore normal [[endocrine]] function and quality of life. | *[[ Radiotherapy]] to restore normal [[endocrine]] function and quality of life. | ||
Patients with hypopituitarism require lifelong monitoring of serum hormone levels and symptoms of hormone deficiency or excess. Long-term care and monitoring of patients with hypopituitarism requires a experienced [[endocrinologist]]. | |||
|- | |- | ||
|Hypothyroidism | |Hypothyroidism | ||
|Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to [[autoimmune]] causes described below: | |Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to [[autoimmune]] causes described below: | ||
* | *Congenital | ||
* | *Autoimmune | ||
* | *Drugs | ||
* | *Post surgery | ||
* | *Post radiation | ||
* | *Infiltrative e.g., amyloid | ||
| | | | ||
* | * Fatigue | ||
* | * Constipation | ||
* | * Dry skin | ||
* | * Weight gain | ||
* | * Cold intolerance | ||
* | * Puffy face | ||
* | * Hoarseness | ||
* | * Muscle weakness | ||
* Elevated blood | * Elevated blood cholesterol level | ||
* | * Bradycardia | ||
* | * Myopathy | ||
* | * Depression | ||
* Impaired | * Impaired memory | ||
| Diagnosis of [[hypothyroidism]] is based on [[blood]] tests: | | Diagnosis of [[hypothyroidism]] is based on [[blood]] tests: | ||
*T3(triiodothyronine) | *T3(triiodothyronine) | ||
*T4(Thyroxine) and | *T4(Thyroxine) and | ||
*TSH (thyroid stimulating hormone). | *TSH (thyroid stimulating hormone). | ||
Signs and symptoms are neither sensitive nor specific for the diagnosis. TSH is the most sensitive tool for screening,diagnosis and treatment follow up, when pituitary is normal. | |||
*The drug of choice for treatment is [[Levothyroxine]]. | *The drug of choice for treatment is [[Levothyroxine]]. | ||
|- | |- | ||
|[[Psychogenic polydipsia]] | |[[Psychogenic polydipsia]] | ||
| Also called as[[ primary polydipsia]] is characterized by[[ polyuria]] and [[polydipsia]]. Causes | | Also called as[[ primary polydipsia]] is characterized by[[ polyuria]] and [[polydipsia]]. Causes could be: | ||
* Defect in the [[hypothalamus]] | * Defect in the [[hypothalamus]] | ||
*Adverse effect of a [[medication]] | *Adverse effect of a [[medication]] | ||
*Traumatic | *Traumatic brain injury | ||
* | *Psychiatric disorders such as [[schizophrenia]] | ||
| | | | ||
*[[Polyuria]] | *[[Polyuria]] | ||
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*[[Seizures]] and | *[[Seizures]] and | ||
*Sometimes, even [[Death]]. | *Sometimes, even [[Death]]. | ||
|Evaluation of[[ psychiatric]] patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria,[[ hyponatremia]], and the syndrome of inappropriate secretion of antidiuretic hormone. | |Evaluation of[[ psychiatric]] patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria,[[ hyponatremia]], and the syndrome of inappropriate secretion of antidiuretic hormone. The management strategy in[[ psychiatric]] patients should include: | ||
*[[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 to differentiate central or [[nephrogenic diabetes insipidus]] (DI) from [[primary polydipsia]] (PP) in patients with polyuria and polydipsia. In healthy subjects, water deprivation causes the plasma [[osmolality]] to rise above 280–290 mOsmol/kg, which leads to the release of [[AVP]] into the circulation. In the [[collecting ducts]] of the [[kidney]], AVP binds to the vasopressin type 2 receptor and this is followed by expression of aquaporin 2 channels. This results in increased [[water retention]] with a rise in urine[[ osmolality]] to a maximum of 1000–1200 mOsmol/kg and restoration of plasma osmolality toward the [[reference]] range. | ||
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Revision as of 19:32, 14 August 2017
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 |
---|---|---|---|
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. |
| |
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:
|
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:
and
|
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 of hypopituitarism vary, depending on the deficient hormone and severity of the disorder,some of the symptoms may be as follows:
|
The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitary hormone deficiency. The clinical manifestations ofhypopituitarism result from the degree of the specific hormone deficiency.
A thorough and longitudinal history and physical 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
Patients with hypopituitarism require lifelong monitoring of serum hormone levels and symptoms of hormone deficiency or excess. Long-term care and monitoring of patients with hypopituitarism requires a experienced endocrinologist. |
Hypothyroidism | Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to autoimmune causes described below:
|
|
Diagnosis of hypothyroidism is based on blood tests:
Signs and symptoms are neither sensitive nor specific for the diagnosis. TSH is the most sensitive tool for screening,diagnosis and treatment follow up, when pituitary is normal.
|
Psychogenic polydipsia | Also called asprimary polydipsia is characterized bypolyuria and polydipsia. Causes could be:
|
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. The management strategy inpsychiatric patients should include:
|
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.