Syndrome of inappropriate antidiuretic hormone causes
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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]
SIADH
Definition :The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by the excessive release of serum antidiuretic hormone (ADH) relative to serum osmolality. It typically results in excessive water reabsorption in the collecting ducts and hyponatremia
Historical perspective: Described by researchers from Boston, Massachusetts and Bethesda, Maryland (including Dr Frederic Bartter) in two patients with lung cancer.[1] Criteria were developed by Schwartz and Bartter in 1967,[2].
Pathogenesis: Pathophysiology: Normal amounts of ADH are produced by the anterior pituitary gland. In SIADH ,ADH level rises above the normal value.
- Aquaporins are localized on storage vesicles in the cytoplasm of the epithelial cells which make up the collecting ducts of the kidneys.
- High ADH level stimulates mass fusion of aquaprin-carrying storage vesicles with the plasma membrane.
- High aquaporin density facilitates high diffusion of water across the plasma membrane.
- Excess water is reabsorbed from the nephrons and is returned to the blood.
Genetics: clinical picture of SIADH may result from genetic disorders that result in antidiuresis. A mutation affecting the gene for the renal V2 receptor, which some investigators have named nephrogenic syndrome of inappropriate antidiuresis, has been found to cause clinically significant hyponatremia. congenital nephrogenic diabetes insipidus is characterized by a resistance of the renal collecting duct to the action of the arginine vasopressin hormone responsible for the inability of the kidney to concentrate urine.He X-linked form is due to inactivating mutations of the vasopressin 2 receptor gene leading to a loss of function of the mutated receptors.conversely, the nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is linked to a constitutive activation of the V(2)-receptor due to activating mutations with clinical and biological features of inappropriate antidiuresis but with low or undetectable plasma arginine vasopressin hormone levels.[1]
Associated conditions:
- malignancies
- drugs
- CNS disorders
- pulmonary disease
- Surgery
- hereditary syndrome of inappropriate antidiuretic hormone
- HIV
- idiopathic
Pillai BP, Unnikrishnan AG, Pavithran PV (2011). "Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder". Indian J Endocrinol Metab. 15 Suppl 3: S208–15. doi:10.4103/2230-8210.84870. PMC 3183532. PMID 22029026.
Causes: Intracranial:
- Tumor
- meningitis
- encephalitis
- abscess
- vasculitis
- subarachnoid hemorrhage
- subdural hemorrhage
- traumatic brain injury
Drugs :
- amiodarone
- tricyclic antidepressants
- bromocriptine
- quinolones
- chlorpropamide
- carbamazapine
- cyclophosphamide
- cisplatin
- SSRI
- vincristine
- vinblastine
- thioridazine
- thiothixene
- haloperidol
- MAOI
- melphalan
- methotrexate
- opiates
- NSAID
- IFN-alpha
- IFN-gamma
- clofibrate
- oxytocin
- hydrochlorthiazide
- desmopressin
- neuroleptic agents
- prostaglandins
- phenothiazines
- 3,4-methylenedioxymethamphetamines
- leveteiracetam
- Pulmonary disease: particularly pneumonia (leigonella ,mycoplasma, tuberculosis),abscess,vasculitis.
- Malignancy:
- small cell lung cancer
- pancreatic
- genitourinary
- gastrointestinal
- mesothelioma
- lymphoma
- sarcoma
- Miscellaneous:
- Multiple sclerosis
- Guillian barre syndrome
- Acute intermittent porphyria
- HIV
- Idiopathic
- surgery
- hormone deficiency: hypopituitirarism,hypothyroidism
Overview
The most common cause of ectopic ADH secretion is cancer. Certain lung cancers, as well as some head and neck tumors, are the most common cancers that cause this problem. In rare cases, many other tumors may cause ectopic ADH secretion.
Causes
Common Causes
- Head injury
- Cancers
- Lung cancer (especially small cell lung cancer, as well as other small-cell malignancies of other organs)
- Infections
- Drugs
- Chlorpropamide
- Cyclophosphamide
- Carbamazepine
- Selective serotonin reuptake inhibitors (SSRIs, a class of antidepressants)
- Methylenedioxymethamphetamine (MDMA, commonly called Ecstasy. SIADH due to taking ecstasy was cited as a factor in the death of Leah Betts)
Causes by Organ System
Causes in Alphabetical Order
- Agenesis corpus collosum
- AIDS
- Amyotropic lateral sclerosis
- Asthma
- Bacterial pneumonia
- Brain abscess
- Bronchial adenoma
- Carbamazepine
- Carcinoid
- Cavernous sinus thrombosis
- Chlorpropamide
- Cyclophosphamide
- Delirium tremens
- Desmopressin
- Duodenal carcinoma
- Encephalitis
- Ewing's sarcoma
- Hydrocephalus
- Lung abscess
- Lung carcinoma
- Lung cavitation
- Meningitis
- Mesothelioma
- Midline defects
- Mono Amine Oxidase Inhibitors
- Multiple sclerosis
- Nicotine
- Ovarian cancer
- Oxytocine
- Pancreatic cancer
- Pergolide
- Peripheral neuropathy
- Phenothiazines
- Pneumothorax
- Polyradiculitis
- Positive pressure restoration
- Psychosis
- SSRI
- Stroke
- Thymoma
- Tricyclic antidepressants
- Tuberculosis
- Vasopressin
- Vinblastine
- Vincristine
References
- ↑ Morin D (2014). "[Vasopressin V2 receptor-related pathologies: congenital nephrogenic diabetes insipidus and nephrogenic syndrome of inappropiate antidiuresis]". Nephrol Ther. 10 (7): 538–46. doi:10.1016/j.nephro.2014.09.002. PMID 25449762.