Pathophysiology and etiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH) . If water intake exceeds the reduced urine output, the ensuing water retention leads to the development of hyponatremia.
The SIADH should be suspected in any patient with hyponatremia, hypoosmolality, and a urine osmolality above 100 mosmol/kg. In SIADH, the urine sodium concentration is usually above 40 meq/L, the serum potassium concentration is normal, there is no acid-base disturbance, and the serum uric acid concentration is frequently low . (See "Diagnostic evaluation of adults with hyponatremia".)
The pathophysiology and etiology of SIADH will be reviewed here. The treatment of this disorder is discussed separately. (See "Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat".)
Pathogenesis of hyponatremia — The plasma sodium concentration (PNa) is a function of the ratio of the body's content of exchangeable sodium and potassium (NaE and KE) and total body water (TBW) as described by Edelman's classic equation:
PNa ≈ (NaE + KE)/Total body waterTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Pathogenesis of hyponatremia
- Patterns of ADH secretion
- Determinants of urine output
- - Solute excretion
- - Escape from the effect of ADH
- CNS disturbances
- Pulmonary disease
- Hormone deficiency
- Hormone administration
- HIV infection
- Hereditary SIADH
- CEREBRAL SALT WASTING
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