1. [Current considerations in syndrome of inappropriate secretion of antidiuretic hormone/syndrome of inappropriate antidiuresis].
- Author
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Velasco Cano MV and Runkle de la Vega I
- Subjects
- Aging physiology, Aquaporin 2 genetics, Arginine Vasopressin physiology, Blood Volume, Brain Edema etiology, Brain Edema prevention & control, Combined Modality Therapy, Diagnosis, Differential, Digestive System Diseases complications, Digestive System Diseases physiopathology, Furosemide therapeutic use, Hospitalization, Humans, Hyponatremia drug therapy, Hyponatremia therapy, Iatrogenic Disease, Mutation, Natriuresis, Neoplasms complications, Neoplasms physiopathology, Osmolar Concentration, Postoperative Complications physiopathology, Receptors, Vasopressin genetics, Saline Solution, Hypertonic adverse effects, Saline Solution, Hypertonic therapeutic use, Hyponatremia etiology, Inappropriate ADH Syndrome classification, Inappropriate ADH Syndrome diagnosis, Inappropriate ADH Syndrome drug therapy, Inappropriate ADH Syndrome epidemiology, Inappropriate ADH Syndrome etiology, Inappropriate ADH Syndrome physiopathology, Inappropriate ADH Syndrome therapy
- Abstract
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH)/syndrome of inappropriate antidiuresis is characterized by a hypotonic hyponatremia, with an insufficiently diluted urine given the plasmatic hypoosmolality, in the absence of hypovolemia (with or without a third space), hypotension, renal or heart failure, cirrhosis of the liver, hypothyroidism, adrenal insufficiency, vomiting, or other non-osmotic stimuli of ADH secretion. The response of ADH to the infusion of hypertonic saline divides SIADH into 4 different types. In type D, there is no alteration in ADH secretion. Rather, the defect is the maintained permeability of kidney aquaporin-2 channels to water. Activating mutations of the V2 receptor have been identified. The most frequent cause of SIADH is the use of drugs that induce secretion of the hormone. Old age is per se a risk factor for its development. SIADH is underdiagnosed, and hospitalization often worsens the clinical situation, due to an iatrogenic excess in the use of oral and i.v. liquids, often hypotonic, together with a reduction in salt intake. Treatment is directed towards normalization of natremia when possible, together with the avoidance of both hyponatremic encephalopathy as well as the osmotic demyelinization syndrome. Cases of "appropriate" secretion of ADH with normovolemic hyponatremia and high mortality rates should be treated with the same urgency as SIADH--such is the case of post-surgical hyponatremia., (Copyright © 2010 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.)
- Published
- 2010
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