Syndrome of inappropriate antidiuretic hormone classification: Difference between revisions

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Revision as of 16:32, 29 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) secretion across a range of plasma osmolalities into type A, type B, type C and type D.

Classification

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


Classification	Features

TypeA	Accounts for about 60-70% of SIADH Excessive secretion of ADH is noted Associated with lung cancer and nasopharyngeal tumors Patients are more susceptible to development of severe hyponatremia
Type B	Accounts for (20–40%) of the cases Secretion of AVP occurs at lower plasma osmolalities than normal
TypeC	style="padding: 5px 5px; background: #F5F5F5;" Failure to suppress AVP secretion at plasma osmolalities below the osmotic threshold Occurs due to dysfunction of inhibitory neurons in thehypothalamus, leading to persistent low-grade basal AVP secretion
Type D	style="padding: 5px 5px; background: #F5F5F5;" Low or undetectableAVP levels and circulating AVP response is not defective Nephrogenic SIADH (NSIAD) may be attributed to this condition Associated with Gain-of-functionmutations in the V2 receptor leading to a clinical picture of SIADH, with undetectable AVP levels The condition is inherited in an X-linked manner,although heterozygous females may have inappropriate antidiuresis of varying degrees. ^[1]

References

↑ Hannon MJ, Thompson CJ (2010). "The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences". Eur. J. Endocrinol. 162 Suppl 1: S5–12. doi:10.1530/EJE-09-1063. PMID 20164214.

Template:WS Template:WH

[pmid20164214-1] Hannon MJ, Thompson CJ (2010). "The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences". Eur. J. Endocrinol. 162 Suppl 1: S5–12. doi:10.1530/EJE-09-1063. PMID 20164214.

[1]

@@ Line 22: / Line 22: @@
 *Associated with [[lung cancer]] and nasopharyngeal tumors
 * Patients are more susceptible to development of severe [[hyponatremia]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Type B
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Accounts for (20–40%) of the cases
-*The[[ osmotic]][[ threshold ]]for AVP release is lowered – a reset osmostat – such that secretion of AVP occurs at lower plasma [[osmolalities]] than normal
+*Secretion of AVP occurs at lower plasma [[osmolalities]] than normal
-*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 tumors manifest type A[[ SIADH]], some also present with type B SIADH, so the[[ pattern]] of [[abnormal]][[ AVP]] (arginine vasopressin) secretion cannot be utilized to predict the [[causation]] of [[SIADH]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[TypeC]]
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;"
-*  A rare condition characterized by failure to suppress AVP secretion at plasma osmolalities below the [[osmotic]] threshold
+* 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
+* Occurs due to dysfunction of inhibitory neurons in the[[ hypothalamus]], leading to persistent low-grade basal AVP secretion
-*This variant may be due to dysfunction of inhibitory neurons in the[[ hypothalamus]], leading to persistent low-grade basal AVP secretion
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Type D]]
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;"
-* Is a rare clinical picture of [[SIADH]] with low or undetectable[[ AVP]] levels and no detectable abnormality in circulating AVP response
+* Low or undetectable[[ AVP]] levels and circulating AVP response is not defective
-*It is thought that a nephrogenic SIADH (NSIAD) may be responsible for this picture
+*Nephrogenic SIADH (NSIAD) may be attributed to this condition
-*Gain-of-function[[ mutations]] in the V2 receptor leading to a clinical picture of SIADH, with undetectable AVP levels, have been described
+* Associated with Gain-of-function[[ mutations]] in the V2 receptor leading to a clinical picture of SIADH, with undetectable AVP levels
-*The identified mutations had different [[nucleotide]] substitutions causing different levels of V2 receptor activation
+*The condition is inherited in an X-linked manner,although heterozygous females may have inappropriate antidiuresis of varying degrees. <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>
-*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>
 |}

Syndrome of inappropriate antidiuretic hormone classification: Difference between revisions

Revision as of 16:32, 29 August 2017

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