scholarly journals A Case Of Panhypopituitarism, Resembling The Picture Of Syndrome Of Inappropriate Antidiuretic Hormone Secretion

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A561-A561
Author(s):  
Andrew Jung ◽  
Novera Shahid ◽  
Noreen Shaaban ◽  
Eugenio Angueira-Serrano
Keyword(s):  
Antidiuretic Hormone ◽  
Sodium Level ◽  
Treatment Guidelines ◽  
Medical Condition ◽  
Correct Diagnosis ◽  
Hormone Secretion ◽  
Serum Triglyceride ◽  
The Elderly ◽  
Fluid Restriction ◽  
Secondary Hypothyroidism

Abstract Background: Hyponatremia is a common medical condition in the elderly. When encountering hyponatremia in the clinical setting, it is important to start with a broad differential list, and then work through all the different possibilities before arriving at the correct diagnosis. Treatment guidelines recommend starting with broad differentials in order to avoid premature conclusions, reach the correct diagnosis, and avoid suboptimal treatment or inappropriate workup. Clinical Case: 86-year old female presented with one week of general weakness, decreased appetite, sleep, and polyuria. Initial serum sodium was 128 mmol/L (136-146), and plasma and urine osmolarities were 271mOsmol/kg (285-305) and 592 mOsmol/kg (50-1400), respectively. Her urine sodium was elevated at 126 mmol/L (n<20), suggestive of a clinical picture of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The patient did not respond to <1L/day fluid restriction alone. The initial dose of furosemide did not improve the sodium level; thus, the dosage was raised and salt tablets were added, which improved sodium level steadily. Meanwhile, her thyroid profile showed TSH 0.07uU/mL (0.3-4.2), free T4 0.9 ng/dL (0.8-1.8), demonstrating central hypothyroidism while taking levothyroxine as a home medication. Further pituitary workup revealed an abnormally low level of FSH 4.95mIU/mL (16.7-113.5) and LH 2.33mIU/mL (10.8-58.6), considering the post-menopausal state. Prolactin was elevated at 39ng/mL (3.3-26.7). The rest of the hormone labs including cortisol, ACTH, and GH were normal. Blood sugar and serum triglyceride levels were within the normal range. Per history and physical, the patient neither exhibited hypervolemic nor hypovolemic features. No home medications would have likely caused SIADH. Her MRI of the brain in 2016 reported a sellar mass uplifting the optic chiasm and its extension of the right cavernous sinus. Latest outpatient record from October 2020 documented pituitary macroadenoma with secondary hypothyroidism, secondary hypogonadism, and hyperprolactinemia due to the stalk effect. Finally, ADH returned as <0.8 pg/mL (0-4.7), ruling out SIADH as the most likely etiology. Conclusion: Treating hyponatremia in the elderly is a challenge. Starting with a broad differential list and effectively ruling out each diagnosis is critical to find the most likely etiology and prevent a premature diagnosis. Instances of such diagnoses and subsequent inappropriate treatments invariably lead to poor patient outcomes. It is, therefore, crucial to keep an open mind and consider all possibilities when approaching a hyponatremic elderly patient. References: Paul Grant, John Ayuk, Pierre-Marc Bouloux. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Invest 2015;45(8):888-894.

scholarly journals SIADH in COVID 19 infection, an association or cause : A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 126-128
Author(s):  
Karishma Shamarukh ◽  
Sharmin Rahman ◽  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Case Report ◽  
Antidiuretic Hormone ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Laboratory Parameters ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Low Sodium

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved. Bangladesh Crit Care J September 2020; 8(2): 126-128

scholarly journals Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options

2019 ◽  
Vol 82 (1-3) ◽  
pp. 32-40 ◽  
Author(s):  
George Liamis ◽  
Fotios Barkas ◽  
Efstathia Megapanou ◽  
Eliza Christopoulou ◽  
Andromachi Makri ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Hypertonic Solution ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Management Options ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion

Background: Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. Summary: Nonstroke-related causes of hyponatremia include patients’ comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, “inappropriate” administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.

scholarly journals Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion

2011 ◽  
Vol 164 (5) ◽  
pp. 725-732 ◽  
Author(s):  
Joseph G Verbalis ◽  
Suzanne Adler ◽  
Robert W Schrier ◽  
Tomas Berl ◽  
Qiong Zhao ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Health Survey ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Efficacy And Safety ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Days Of Therapy ◽  
Positive Treatment Effect ◽  
Positive Treatment

ObjectiveTolvaptan, an oral antagonist of the vasopressin V2 receptor, has been found to improve hyponatremia in patients with mixed etiologies. This study analyzed a subgroup of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to evaluate the efficacy and safety of tolvaptan in this group.Design and patientsHyponatremic patients in the SALT-1 and SALT-2 studies with a diagnosis of SIADH were identified based on clinical diagnosis by individual study investigators. Subjects were randomized to receive oral placebo (n=52) or tolvaptan 15 mg daily, with further titration to 30 and 60 mg daily, if necessary, based on the response of serum [Na+] (n=58).ResultsIn patients with SIADH, improvement in serum [Na+] was significantly greater (P<0.0001) with tolvaptan than placebo over the first 4 days of therapy as well as the entire 30-day study, with minimal side effects of increased thirst, dry mouth, and urination. Only 5.9% of tolvaptan-treated patients had overly rapid correction of hyponatremia as defined by current guidelines. After discontinuation of tolvaptan, serum [Na+] declined to values similar to placebo. A significant positive treatment effect favoring tolvaptan on the physical component, and a near-significant trend on the mental component, was found using the SF-12 Health Survey. Tolvaptan was associated with a significantly reduced incidence of fluid restriction.ConclusionsResults for the SIADH subgroup were analogous to those of the combined SALT population regarding efficacy and safety but demonstrated a greater improvement in the physical component of the SF-12 Health Survey than in the full mixed etiology SALT patient group.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Secondary to Fluoxetine

1993 ◽  
Vol 27 (6) ◽  
pp. 723-724 ◽  
Author(s):  
Joleen V. Blacksten ◽  
Julie A. Birt
Keyword(s):  
Antidiuretic Hormone ◽  
Case Reports ◽  
Hormone Secretion ◽  
Term Therapy ◽  
Fluid Restriction ◽  
Short Term ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Potassium Supplementation ◽  
Days Of Therapy ◽  
Severe Weakness

OBJECTIVE: To report a case of possible fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE SUMMARY: A 92-year-old patient was prescribed oral fluoxetine 20 mg daily for depression. After 13 days of therapy, she developed severe weakness and was found to have hyponatremia. Fluoxetine was discontinued. Treatment included fluid restriction and sodium chloride and potassium supplementation. Eight days after admission, the hyponatremia resolved and the patient was discharged without any pharmacologic treatment for depression. DISCUSSION: Case reports on fluoxetine-induced SIADH were reviewed. Fluoxetine-associated SIADH appears to occur most commonly after short-term therapy in elderly patients. Resolution of hyponatremia occurs six days to two weeks after discontinuation of fluoxetine. CONCLUSIONS: Geriatric patients receiving fluoxetine should be monitored regularly to detect abnormal electrolyte values.

scholarly journals Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Masanori Hasebe ◽  
Jun Shirakawa ◽  
Daisuke Miyashita ◽  
Rieko Kunishita ◽  
Mayu Kyohara ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Antidiuretic Hormone ◽  
Arginine Vasopressin ◽  
Hormone Secretion ◽  
Emission Tomography ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Positron Emission

Abstract Background Syndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases. Case presentation A 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography–computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration. Conclusions This case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

Routine postoperative fluid restriction to prevent syndrome of inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary adenoma

2021 ◽  
pp. 1-8
Author(s):  
M. Harrison Snyder ◽  
David T. Asuzu ◽  
Dawn E. Shaver ◽  
Mary Lee Vance ◽  
John A. Jane
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Pituitary Surgery ◽  
Fluid Restriction ◽  
Readmission Rates ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
History Of ◽  
Transsphenoidal Resection

OBJECTIVE Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma. METHODS In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons. RESULTS In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0–0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9–1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1–9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0–5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3–26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1–0.9], p = 0.04). CONCLUSIONS Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

Syndrome of Inappropriate Antidiuretic Hormone with Imipramine

1986 ◽  
Vol 20 (10) ◽  
pp. 787-789 ◽  
Author(s):  
Rita A. Mitsch ◽  
Albert K. Lee
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Alternative Therapy ◽  
Antidepressant Drug ◽  
Normal Serum ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Initiation Of Therapy ◽  
Normal Serum Sodium

Among the various medications that have been associated with the development of syndrome of inappropriate antidiuretic hormone secretion (SIADH) are the tricyclic antidepressants. A 69-year-old man admitted for treatment of a depressive disorder that had not responded to trazodone was prescribed imipramine. Twenty-two days after initiation of therapy, the patient developed hyponatremia. The patient also had depressed serum osmolality and elevated urine sodium concentrations consistent with SIADH. With the discontinuation of imipramine, fluid restriction, and several doses of furosemide, normal serum sodium concentrations were attained. As antidepressant therapy was indicated, doxepin was selected. The patient maintained normal electrolyte values and water balance over the next two months of follow-up. No reports of doxepin-related SIADH were found in the literature; therefore, this agent may be considered as an alternative therapy in patients developing SIADH during antidepressant drug therapy.

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