Yield of workup for patients with idiopathic presentation of the syndrome of inappropriate antidiuretic hormone secretion

Published:March 23, 2016DOI:https://doi.org/10.1016/j.ejim.2016.03.008

      Highlights

      • Most patients with SIADH of unknown etiology do not have an underlying disorder.
      • Consequently, yield of diagnostic modalities is low for these patients.
      • The yield of diagnostic workup is higher in young patients with recent onset of SIADH.
      • Our data suggest that extensive workup is not required for most of these patients.

      Abstract

      Purpose

      To determine the proportion of patients for whom the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the presenting symptom of an underlying disorder, to describe the yield of different diagnostic modalities for patients with SIADH and an unknown etiology, and to define patients for whom such a workup is indicated.

      Methods

      A single center retrospective study including all patients diagnosed with SIADH without an apparent etiology in a large community hospital and tertiary center between 1.1.07 and 1.1.13. Two physicians reviewed every patient's medical file for predetermined relevant clinical data.

      Results

      Eleven of the 99 patients without an apparent etiology for SIADH at presentation were found to have an underlying cause on workup. Yield of performed workup was low, with a pathology demonstrated on 0%–30.8% of tests according to the different modalities used. Patients with presumed idiopathic SIADH at presentation who were later found to have a specific etiology were younger than patients with true idiopathic SIADH, had a significantly shorter duration of hyponatremia prior to SIADH diagnosis, had higher urine osmolality and a clinical presentation suggestive of an undiagnosed disorder.

      Conclusions

      Our findings support a clinically-based approach to patients with idiopathic SIADH, rather than an extensive routine workup for all patients.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Schwartz W.B.
        • Bennett W.
        • Curelop S.
        • Bartter F.C.
        A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone.
        Am J Med. 1957; 23: 529-542
        • Ellison D.H.
        • Berl T.
        Clinical practice. the syndrome of inappropriate antidiuresis.
        N Engl J Med. May 17, 2007; 356: 2064-2072
        • Verbalis J.G.
        • Goldsmith S.R.
        • Greenberg A.
        • Korzelius C.
        • Schrier R.W.
        • Sterns R.H.
        • et al.
        Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations.
        Am J Med. Oct 2013; 126: S1-42
        • Spasovski G.
        • Vanholder R.
        • Allolio B.
        • Annane D.
        • Ball S.
        • Bichet D.
        • et al.
        Clinical practice guideline on diagnosis and treatment of hyponatraemia.
        Eur J Endocrinol. Feb 25, 2014; 170: G1-47https://doi.org/10.1530/EJE-13-1020
        • Gross P.
        Clinical management of SIADH.
        Ther Adv Endocrinol Metab. Apr 2012; 3: 61-73
        • Schrier R.W.
        • Berl T.
        Nonosmolar factors affecting renal water excretion.
        N Engl J Med. 1975; 292: 141-145
        • Hsu C.Y.
        • Chen C.L.
        • Huang W.C.
        • Lee P.T.
        • Fang H.C.
        • Chou K.J.
        Retrospective evaluation of standard diagnostic procedures in identification of the causes of new-onset syndrome of inappropriate antidiuresis.
        Int J Med Sci. Jan 10, 2014; 11: 192-198
        • Shepshelovich D.
        • Leibovitch C.
        • Klein A.
        • Zoldan S.
        • Milo G.
        • Shochat T.
        • et al.
        The syndrome of inappropriate antidiuretic hormone secretion: distribution and characterization according to etiologies.
        Eur J Intern Med. Nov 9, 2015; ([pii: S0953–6205(15)00349–0])https://doi.org/10.1016/j.ejim.2015.10.020
        • Hirshberg B.
        • Ben Yehuda A.
        The syndrome of inappropriate antidiuretic hormone in the elderly.
        Am J Med. 1997; 103: 270-273
        • Sabatino Jr., J.J.
        • Werner J.K.
        • Newsome S.D.
        A rare case of hyponatremia from a hypothalamic lesion in a patient with multiple sclerosis.
        Mult Scler. 2015; 21: 662-665
        • Yu E.A.
        • Snydman L.K.
        • Rencic J.
        Ramsay Hunt syndrome presenting with ataxia and syndrome of inappropriate antidiuretic hormone secretion.
        Am J Med. 2014; 127: e9-10
        • Kuriakose S.
        • Umadevi N.
        • Mathew S.
        • Supriya N.
        • Aravindan K.
        • Smitha D.
        • et al.
        Neuroendocrine carcinoma of the cervix presenting as intractable hyponatremic seizures due to paraneoplastic SIADH-a rare case report and brief review of the literature.
        Ecancermedicalscience. Jul 31, 2014; 8: 450
        • Hwang K.
        • Jeon D.H.
        • Jang H.N.
        • Bae E.J.
        • Lee J.S.
        • Cho H.S.
        • et al.
        Inappropriate antidiuretic hormone syndrome presenting as ectopic antidiuretic hormone-secreting gastric adenocarcinoma: a case report.
        Med Case Rep. Jun 12, 2014; 8: 185
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • Zhang Y.L.
        • Castro III, A.F.
        • Feldman H.I.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Hillier T.A.
        • Abbott R.D.
        • Barrett E.J.
        Hyponatremia: evaluating the correction factor for hyperglycemia.
        Am J Med. Apr 1999; 106: 399-403