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Syndrome of inappropriate antidiuretic hormone secretion (SIADH), also known as the syndrome of inappropriate antidiuresis (SIAD), [2] is characterized by a physiologically inappropriate release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an ectopic non-pituitary source, such as an ADH-secreting tumor in the lung. [1]
The cornerstone of therapy for SIADH is reduction of water intake. If hyponatremia persists, then demeclocycline (an antibiotic with the side effect of inhibiting ADH) can be used. SIADH can also be treated with specific antagonists of the ADH receptors, such as conivaptan or tolvaptan. [citation needed] Another cause is psychogenic polydipsia. [3]
The term "cerebral hyponatremia" was suggested in the work of Epstein, et al. 1961. Inappropriate release of endogenous vasopressin is probably responsible for hyponatremia in tuberculous meningitis. Inability to excrete water normally is also a feature of the salt wasting of certain hyponatremic patients with pulmonary tuberculosis.
Although hyponatremia is a fairly common condition, many patients have only mildly decreased blood sodium. Dr. Jeff Hersh explains the cause of hyponatremia, and how it should be treated Skip to ...
Normal volume hyponatremia, wherein the increase in ADH is secondary to either physiologic but excessive ADH release (as occurs with nausea or severe pain) or inappropriate and non-physiologic secretion of ADH, that is, syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH).
In general, hyponatremia is usually asymptomatic until severe. [10] Typical laboratory findings for tea and toast syndrome include a low serum osmolality (hypotonicity) with normal urine osmolality since antidiuretic hormone levels are normal. A common laboratory finding for the tea and toast phenomenon is manifestation as hyponatremia.
This means that psychogenic polydipsia may lead to test results (e.g. in a water restriction test) consistent with diabetes insipidus or SIADH, leading to misdiagnosis. [14] Dry mouth is often a side effect of medications used in the treatment of some mental disorders, rather than being caused by the underlying condition. [15]
The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). [ 10 ] [ 12 ] [ 13 ] The use of demeclocycline in SIADH was first reported in 1975, [ 14 ] and, in 1978, a larger study found it to be more effective and better tolerated than lithium ...