Sandbox:Vindhya
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Disease |
Features | Investigative findings | |
|---|---|---|---|
| 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 | Cerebral salt wasting is defined as the renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. | ||
| Adrenal insufficiency | Adrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock condition. An important distinction in these patients is the presence of mineralocorticoid deficiency. Those with secondary or tertiary adrenal insufficiency will typically have preserved mineralocorticoid function due to the separate feedback systems.
Adrenal insufficency can be primary, secondary or tertiary. Common causes of primary adrenal insufficiency:
Secondary adrenal insufficiency refers to decreased adrenocorticotropic hormone (ACTH) stimulation of the adrenal cortex and therefore does not affect aldosterone levels. Traumatic brain injury (TBI) and panhypopituitarism are common causes. Tertiary adrenal insufficiency refers to decreased hypothalamic stimulation of the pituitary to secrete ACTH. Exogenous steroid administration is the most common cause of tertiary adrenal insufficiency. | ||
| 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:
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| Hypothyroidism | |||
| Psychogenic polydipsia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Differential diagnosis
Agents and means used in the treatment of SIADH.
Indirect modalities:
- treatment of underlying pathology
- salt restriction
- Hyper-tonic saline
- Loop diuretics
- Urea
- Demecloclycline, lithium
- Hemodialysis, CVVH(continuous veno-venous hemofiltration), SLED(slow, low-efficiency daily dialysis).
Direct modalities:
"Vaptan drugs": block action of vasopressin at it's receptors,(V1A,V1B,V2)
Prognosis:Patients with SIADH have different characteristics and a different prognosis according to SIADH etiology. Serum sodium concentration at short-term follow-up is predictive of long-term survival. These findings might have diagnostic and treatment-related implications.