Nephrology Book


Syndrome Inappropriate ADH Secretion

Aka: Syndrome Inappropriate ADH Secretion, Syndrome of Inappropriate Antidiuretic Hormone, Inappropriate ADH Syndrome, SIADH, Medication Causes of SIADH
  1. See Also
    1. Hyponatremia
    2. Hyperosmolar Hyponatremia
    3. Normoosmolar Hyponatremia
    4. Hypoosmolar Hyponatremia
    5. Hypervolemic Hypoosmolar Hyponatremia
    6. Hypovolemic Hypoosmolar Hyponatremia
    7. Isovolemic Hypoosmolar Hyponatremia
    8. Hyponatremia Management
    9. Sodium and Water Homeostasis
  2. Causes: General
    1. Malignancy
      1. Small Cell Lung Cancer (most common ectopic ADH source)
      2. Duodenal Cancer
      3. Pancreatic Cancer
      4. Head and neck cancers
    2. Lung disease
      1. Bacterial Pneumonia
      2. Empyema
      3. Legionella pneumonia
      4. Pulmonary Tuberculosis
      5. Acute Respiratory Distress Syndrome (ARDS) or other Acute Respiratory Failure
    3. Neurologic disorders
      1. Brain Abscess
      2. Brain Tumor
      3. Bacterial Meningitis
      4. Subarachnoid Hemorrhage
      5. Subdural Hematoma
      6. Cerebrovascular Accident
      7. Head Injury
      8. Multiple Sclerosis
      9. Guillain-Barre Syndrome
    4. Miscellaneous causes
      1. Psychiatric illness
      2. Rocky Mountain Spotted Fever
        1. Hyponatremia is common in this uncommon Tick Borne Illness
      3. Post-operative period
        1. Young women have postoperative ADH levels 40x higher than postmenopausal women
        2. Young women are at higher risk of postoperative hyponatremic encephalopathy
  3. Causes: Medications
    1. Cardiovascular agents
      1. Amiodarone
      2. Clofibrate
      3. Thiazide Diuretics (e.g. Hydrochlorothiazide)
    2. Neuropsychiatric agents
      1. Amitriptyline (Elavil)
      2. Barbiturates
      3. Carbamazepine (Tegretol)
      4. Chlorpromazine (Thorazine)
      5. Haloperidol
      6. Selective Serotonin Reuptake Inhibitors
      7. Thiothixene
      8. Thioridazine
    3. Analgesics
      1. Morphine Sulfate and other Opioids
      2. NSAIDs
    4. Chemotherapeutic agents
      1. Vinca alkaloids (e.g. Vincristine)
      2. Platinum Chemotherapy (e.g. Cisplatin)
      3. Other Alkylating Agents (e.g. Cyclophosphamide)
    5. Miscellaneous agents
      1. Nicotine
      2. Theophylline
    6. Sulfonylureas
      1. Chlorpropamide
      2. Tolbutamide
  4. Differential Diagnosis
    1. SIADH is a diagnosis of exclusion
    2. Isovolemic Hypoosmolar Hyponatremia
    3. Non-osmotic causes for ADH secretion
      1. Hypovolemic Hypoosmolar Hyponatremia
    4. Causes of Decreased urine diluting capacity
  5. Symptoms
    1. Nausea or Vomiting
    2. Constipation
    3. Muscle Weakness
  6. Labs
    1. Hyponatremia
      1. See Isovolemic Hypoosmolar Hyponatremia
    2. Urine Osmolality > 100 mOsm/kg water
      1. Dilution not maximized despite serum hypoosmolality
    3. Urine Sodium > 20-30 mEq/L
    4. Serum Osmolality decreased <280 mOsm
    5. Hypouricemia (Serum Uric Acid <4 mg/dl)
    6. Antidiuretic Hormone (ADH) elevated
  7. Management
    1. Treating underlying cause is key in SIADH
      1. Example: Treat underlying Bronchogenic Carcinoma
      2. Relevant Consultation (e.g. oncology, nephrology)
    2. Overall strategy
      1. See Isovolemic Hypoosmolar Hyponatremia
      2. Fluid restriction (<1000 to 1500 ml/day)
      3. Diuretics
        1. Furosemide (Lasix)
        2. Potassium-Sparing Diuretics
      4. Slow Serum Sodium correction
        1. See Hyponatremia Management
        2. Do not correct more quickly than 12 mEq/L in 24 hours or 18 mEq/L in 48 hours
      5. Avoid Normal Saline infusion
        1. May worsen Hyponatremia with Fluid Shifts intravascularly
    3. SIADH refractory to above measures
      1. Induce Nephrogenic Diabetes Insipidus
      2. Demeclocycline (600-1200 mg/day)
      3. Lithium Carbonate 300 mg PO tid
      4. Tolvaptan (Samsca)
        1. Selective Vasopressin (V2) receptor Antagonist
        2. Increases free water excretion
        3. Adverse effects: Hepatotoxin
  8. References
    1. Le and Drogell (2015) Crit Dec Emerg Med 29(11): 13-19
    2. Kone in Tisher (1993) Nephrology, p. 87-100
    3. Levinsky in Wilson (1991) Harrison's IM, p. 281-84
    4. Preston (2011) Acid-Base, Fluids and Electrolytes, Medmaster, Miami
    5. Rose (1989) Acid-Base and Electrolytes, p. 601-38
    6. Goh (2004) Am Fam Physician 69:2387-94 [PubMed]
    7. Higdon (2018) Am Fam Physician 97(11):741-8 [PubMed]
    8. Braun (2015) Am Fam Physician 91(5): 299-307 [PubMed]

Inappropriate ADH Syndrome (C0021141)

Definition (NCI) A syndrome characterized by abnormal secretion of antidiuretic hormone in conjunction with neoplastic growth occurring anywhere in the body.
Definition (MSH) A condition of HYPONATREMIA and renal salt loss attributed to overexpansion of BODY FLUIDS resulting from sustained release of ANTIDIURETIC HORMONES which stimulates renal resorption of water. It is characterized by normal KIDNEY function, high urine OSMOLALITY, low serum osmolality, and neurological dysfunction. Etiologies include ADH-producing neoplasms, injuries or diseases involving the HYPOTHALAMUS, the PITUITARY GLAND, and the LUNG. This syndrome can also be drug-induced.
Concepts Pathologic Function (T046)
MSH D007177
ICD10 E22.2
SnomedCT 55004003, 389983008
English ADH Syndrome, Inappropriate, Antidiuretic Hormone, Inappropriate Secretion, Inappropriate ADH Syndrome, Schwartz Bartter Syndrome, Schwartz-Bartter Syndrome, SIADH, Syndrome, Inappropriate ADH, Syndrome, Schwartz-Bartter, SYNDROME OF INAPP ADH SECRETION, Inappropriate ADH, SIAD - Syn inappr antidiuresis, SIADH - Synd inappr secret ADH, SIADH - Syndrome of inappropriate secretion of ADH, Syndrome inappr secretion ADH, Syndrome inapprop antidiuresis, ANTIDIURETIC HORMONE INAPPROPRIATE SECRETION SYNDROME <SIADH>, Syndrome of inappropriate antidiuretic hormone (SIADH), SYNDROME INAPPROPRIATE ADH SIADH SECRET, ANTIDIURETIC HORMONE INAPPROPRIATE SECRET, INAPPROPRIATE VASOPRESSIN SECRET SYNDROME, Syndrome of Inappropriate Antidiuretic Hormone Secretion, Inappropriate Antidiuretic Hormone Secretion Syndrome, inappropriate ADH secretion, syndrome of inappropriate secretion of antidiuretic hormone (diagnosis), syndrome of inappropriate secretion of antidiuretic hormone, inappropriate ADH syndrome (SIADH), SIADH (syndrome of inappropriate antidiuretic hormone), Syndrome of inapp ADH secretion, Inapprop. ADH secretion syndrome, ADH inappropriate, ADH inappropriate secretion, Inappropriate ADH secretion, Syndrome inappropriate ADH, Inappropriate vasopressin secretion, ANTIDIURETIC HORMONE INAPPROPRIATE SECRETION SYNDROME SIADH, Syndrome of Inappropriate ADH (SIADH) Secretion, Inappropriate Vasopressin Secretion Syndrome, Inappropriate ADH Syndrome [Disease/Finding], adh inappropriate syndrome, adh inappropriate secretion, inappropriate adh, siadhs, siadh, adh inappropriate syndromes, inappropriate adh secretion, Inappropriate antidiuretic hormone secretion, Syndrome of inappropriate antidiuretic hormone secretion, Syndrome of inappropriate secretion of antidiuretic hormone (disorder), Syndrome of Inappropriate Vasopressin Secretion, Schwartz-Bartter syndrome, Syndrome of inappropriate ADH production, Syndrome of inappropriate vasopressin secretion, SIAD - Syndrome of inappropriate antidiuresis, SIADH - Syndrome of inappropriate secretion of antidiuretic hormone, Syndrome of inappropriate antidiuresis, Syndrome of inappropriate secretion of antidiuretic hormone, Syndrome of inappropriate vasopressin secretion (disorder), SIADH; (syndrome of inappropriate secretion of antidiuretic hormone), hormone secretion; antidiuretic, inadequate (syndrome), hormone; secretion, antidiuretic, inappropriate (syndrome), inadequate; secretion antidiuretic hormone (syndrome), inappropriate secretion of antidiuretic hormone; syndrome, secretion; hormone, antidiuretic, inappropriate (syndrome), syndrome; inappropriate secretion of antidiuretic hormone, antidiuretic; hormone syndrome (SIADH), antidiuretic; hormone, inappropriate secretion (SIADH), Schwarz-Bartter syndrome, Syndrome of inappropriate secretion of ADH
Italian Secrezione inappropriata di ormone antidiuretico, Ormone antidiuretico inappropriato, Secrezione inappropriata di vasopressina, Inappropriata secrezione di ormone antidiuretico, Sindrome da inappropriata secrezione di ADH, Secrezione inappropriata di ADH, Sindrome da inappropriata secrezione di ormone antidiuretico, Sindome da inappropriata secrezione di vasopressina, Sindrome da insufficiente produzione di ADH (SIADH), Sindrome della secrezione inadeguata dell'ormone antidiuretico, SIADH, Sindrome di Schwartz-Bartter, Sindrome da inappropriata secrezione di ADH (SIADH), Sindrome da insufficiente produzione di ADH
Dutch deficiënte ADH secretie, syndroom van ADH secretiedeficiëntie, deficiënte ADH secretiesyndroom, ADH-deficiëntie, deficiëntie ADH, ADH-secretiedeficiëntie, deficiënte vasopressinesecretie, syndroom van ADH-deficiëntie, schwartz-barttersyndoom, SIADH; (syndroom van inadequate secretie van antidiuretisch hormoon), antidiuretisch; hormoon, inadequate secretie (SIADH), antidiuretisch; hormoon-syndroom (SIADH), hormoon; secretie, antidiuretisch, inadequaat (syndroom), hormoonsecretie; antidiuretisch, inadequaat (syndroom), inadequaat; secretie antidiuretisch hormoon (syndroom), inadequate secretie van antidiuretisch hormoon; syndroom, secretie; hormoon, antidiuretisch, inadequaat (syndroom), syndroom; inadequate secretie van antidiuretisch hormoon, Syndroom van inadequate secretie van antidiuretisch hormoon [SIADH], antidiuretisch hormoon-secretiedeficiëntie, ADH-syndroom, inappropriate, Antidiuretisch hormoon, inadequate secretie, Inadequate-vasopressinesecretiesyndroom, Inappropriate ADH-syndroom, SIADH, Schwartz-Bartter-syndroom, Syndroom, inappropriate ADH-
French Taux d'ADH inapproprié, Syndrome d'antidiurèse inappropriée, Syndrome de sécrétion inapprop d'ADH, Sécrétion d'ADH inappropriée, Syndrome d'ADH inappropriée, Syndrome de sécrétion inapp d'ADH, Sécrétion inappropriée d'hormone antidiurétique, Sécrétion inappropriée de vasopressine, SECRETION INAPPROPRIEE D'ADH, TROUBLE DE LA SECRETION D'ADH, Sécrétion d'hormone antidiurétique inappropriée, SIADH, Syndrome de Schwartz-Bartter, Syndrome de sécrétion inappropriée d'ADH (SIADH), Syndrome de sécrétion inappropriée d'ADH, Syndrome de sécrétion inappropriée d'hormone antidiurétique
German unangemessene ADH-Sekretion, unangemessene Vasopressin-Sekretion, ADH unangemessene Sekretion, unangemessenes ADH, Syndrom unangemessene ADH-Sekretion, ADH unangemessen, unangemess. ADH-Sekretion Syndrom, Syndrom unangemess ADH-Sekretion, SYNDROM BARTTER, SYNDROM DER INADAEQUATEN ADH SEKR, Syndrom der inadaequaten Sekretion von Adiuretin, unangemessene antidiuretische Hormonsekretion, SIADH, Schwartz-Bartter-Syndrom, ADH-Sekretionssyndrom, inadäquates, Antidiuretisches Hormon, inadäquate Sekretion, Inadäquate ADH-Sekretion, Syndrom, Inadäquates Vasopressinsekretionssyndrom, Syndrom der inadäquaten ADH-Sekretion
Portuguese Síndrome de hormona antidiurética inapropriada, Síndrome de secreção de HAD inapropriada, Secreção inapropriada de HAD, Síndrome de HAD inapropriada, HAD inapropriada, Síndrome de secreção inapropriada de HAD, Secreção inapropriada de vasopressina, SASHAD, SINDROME DA SECR INAPROPR DE ADH, Secreção inapropiada de hormona antidiurética, SIHAD, Secreção Inadequada de Hormônio Antidiurético, Síndrome da Secreção Inadequada de Vasopressina, Síndrome de Schwartz-Bartter, Síndrome de Secreção Inadequada de HAD
Spanish SIADH, Secreción inadecuada de ADH, Síndrome de secreción inadecuada de ADH, Secreción inapropiada de vasopresina, ADH, SINDROME SECRECION INADECUAD, síndrome de secreción inadecuada de vasopresina (trastorno), síndrome de secreción inadecuada de vasopresina, síndrome de secreción inadecuada de HAD, síndrome de secreción inadecuada de hormona antidiurética, síndrome de secreción inadecuada de ADH, SIHAD (trastorno), síndrome de secreción inapropiada de ADH, SIHAD, ADH inapropiada, síndrome de Schwartz - Bartter, Secreción inadecuada de hormona antidiurética, SSIDH, Secreción Inadecuada de Hormona Antidiurética, Síndrome de Schwartz-Bartter, Síndrome de Secreción Inadecuada de ADH, Síndrome de Secreción Inapropiada de Vasopresina
Japanese SIADH, ADH不適合分泌, 抗利尿ホルモン分泌不適合症候群, バソプレシン不適合分泌, 抗利尿ホルモン不適合分泌, コウリニョウホルモンフテキゴウブンピ, バソプレシンフテキゴウブンピツ, ADHフテキゴウブンピ, バソプレシンフテキゴウブンピ, SIADH, コウリニョウホルモンフテキゴウブンピツ, コウリニョウホルモンブンピツフテキゴウショウコウグン, ADHフテキゴウブンピツ, コウリニョウホルモンフテキゴウブンピショウコウグン, コウリニョウホルモンブンピフテキゴウショウコウグン, コウリニョウホルモンフテキゴウブンピツショウコウグン, シュワルツ・バーター症候群, ADH不適合分泌症候群, ADH過剰分泌症候群, シュワルツ・バーター症候群, シュワルツバーターショウコウグン, ADH分泌異常症候群, Schwartz-Bartter症候群, 不適切ADH症候群, 抗利尿ホルモン分泌異常, 抗利尿ホルモン分泌異常症候群, 抗利尿ホルモン過剰分泌症候群, ADH分泌異常症, Schwarz-Bartter症候群, シュワルツ-バーター症候群, 抗利尿ホルモン不適合分泌症候群
Swedish SIADH
Czech SIADH, syndrom nepřiměřené sekrece ADH, Nevhodná sekrece vasopresinu, Nepřiměřená sekrece ADH, Syndrom nevhodné sekrece ADH, Nevhodná sekrece ADH, Syndrom nevhodné sekrece antidiuretického hormonu, Nepřiměřený ADH, Syndrom nevhodného ADH, Nevhodný ADH, Schwartz-Bartter syndrom, syndrom nepřiměřené sekrece antidiuretického hormonu, Schwartzův-Bartterův syndrom
Finnish Antidiureettisen hormonin epäasianmukaisen erityksen oireyhtymä
Korean 항이뇨 호르몬 분비 이상 증후군
Polish Zespół nieprawidłowego ADH, Wydzielanie hormonu antydiuretycznego nieprawidłowe, Zespół Schwartza-Barttera, SIADH
Hungarian nem megfelelő ADH termelés, Túlzott vasopressin secretio, Túlzott ADH-elválasztásos syndroma, Túlzott antidiuretikus hormon secretio, Inadekvat ADH secretiós syndroma, Inadekvát ADH-secretiós syndroma, SIADH, Inadequat ADH secretiós syndroma, ADH-túltermelés, Túlzott ADH, Schwartz-Bartter syndroma
Norwegian Inadekvat ADH-sekresjon, Redusert utskilling av antidiuretisk hormon, Schwartz-Bartters syndrom, SIADH-syndrom, Inadekvat ADH-utskilling, SIADH, Inadekvat sekresjon av antidiuretisk hormon
Derived from the NIH UMLS (Unified Medical Language System)

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