The syndrome of inappropriate secretion of antidiuretic hormone

https://doi.org/10.1016/0002-9343(67)90096-4Get rights and content

Abstract

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been examined and reviewed. Typically, it is characterized by hyponatreinia without dehydration, urinary sodium loss and hypertonicity of the urine. Atypically, urinary sodium loss may be absent and urinary tonicity may be below that of serum; the only requirement is that the urine be less than maximally dilute.

The syndrome is found with various tumors, notably oat cell carcinoma of the bronchus, which probably produce antidiuretic substance directly, and in a wide variety of disorders affecting the central nervous system or the lungs, in which there is probably abnormal release of endogenous antidiuretic hormone. The syndrome is also seen occasionally in patients with adrenal, thyroid or pituitary insufficiency. The possible role of the inappropriate release of antidiuretic hormone in all these disorders and in the hyponatremia which can occur postoperatively or in congestive heart failure or cirrhosis, requires further definition by new, specific assay technics.

References (154)

  • R.C. de Sousa et al.

    Inappropriate secretion of vasopressin

    Lancet

    (1965)
  • C.P. Claxton et al.

    Hyponatremia from inappropriate antidiuretic hormone elaboration in carcinoma of the lung

    J. Thoracic & Cardiovasc. Surg.

    (1966)
  • A.H. Gowenlock et al.

    Oat-cell carcinoma of the bronchus secreting 5-hydroxytryptophan

    Lancet

    (1964)
  • E. Greenberg et al.

    A review of unusual systemic manifestations associatedwith carcinoma

    Am. J. Med.

    (1964)
  • J.P. Knochel et al.

    Excretion of aldosterone in inappropriate secretion of antidiuretic hormone following head trauma

    Metabolism

    (1965)
  • M.G. Perlroth et al.

    Acute intermittent porphyria

    Am. J. Med.

    (1966)
  • W.B. Schwartz et al.

    Further observations on hyponatremia and renal sodium loss probably resulting from inappropriate secretion of antidiuretic hormone

    New England J. Med.

    (1960)
  • H.K. Ivy

    Renal sodium loss and bronchogenic carcinoma

    Arch. Int. Med.

    (1961)
  • G.D. Ludwig et al.

    Hyponatremia in acute intermittent porphyria probably resulting from inappropriate secretion of antidiuretic hormone

    Ann. New York Acad. Sc.

    (1963)
  • H.T. Haden et al.

    Cerebral hyponatremia with inappropriate antidiuretic hormone syndrome

    Am. J. M. Sc.

    (1965)
  • J.M. Stormont et al.

    Severe hyponatremia associated with pneumonia

    Metabolism

    (1962)
  • Cl. Poyart et al.

    Hyponatrémie avec natriurie conservée par trouble de l'élimination de l'eau libre au cours d'un syndrome de Guillain-Barré

    Rev. Franc, étud. clin. et biol.

    (1964)
  • J.J. Grantham et al.

    Asymptomatic hyponatremia and broncho-, genic carcinoma: the deleterious effects of diuretics

    Am. J. M. Sc.

    (1965)
  • A. Leaf et al.

    Evidence in man that urinary electrolyte loss induced by pitressin is a function of water retention

    J. Clin. Invest.

    (1953)
  • O. Wrong

    The relationship between water retention and electrolyte excretion following administration of antidiuretic hormone

    Clin. Sc.

    (1956)
  • J.R. Jaenike et al.

    The renal response to sustained administration of vasopressin and water in man

    J. Clin. Endocrinol.

    (1961)
  • E.B. Verney

    Croonian lecture: antidiuretic hormone and factors which determine its release

  • F.C. Bartter et al.

    The regulation of aldosterone secretion in man: the role of fluid volume

    J. Clin. Invest.

    (1956)
  • J.M. Stormont et al.

    The genesis of hyponatremia associated with marked overhydration and water intoxication

    Circulation

    (1961)
  • N.W. Carter et al.

    Hyponatremia in cerebral disease resulting from the inappropriate secretion of antidiuretic hormone

    New England J. Med.

    (1961)
  • B.F. Bower et al.

    Bronchogenic carcinoma with inappropriate antidiuretic activity in plasma and tumor

    New England J. Med.

    (1964)
  • E.J. Ross

    Hyponatraemic syndromes associated with carcinoma of the bronchus

    Quart. J. Med.

    (1963)
  • R.T. Williams

    Carcinoma of bronchus with hyponatraemia and dermatomyositis

    Brit. M. J.

    (1963)
  • J.R. Rees et al.

    Hyponatraemia and impaired renal tubular function with carcinoma of bronchus

    The Lancet

    (1960)
  • H.O. Heinemann et al.

    Inappropriate renal sodium loss reverted by vena cava obstruction

    Ann. Int. Med.

    (1966)
  • J.H.K. Vogel

    Aldosterone in cerebral salt wasting

    Circulation

    (1963)
  • R.C. de Sousa et al.

    Le syndrome de Schwartz-Bartter: Carcinome du poumon avec sécrétion inadéquate d'hormone antidiurétique

    Schweiz. med. Wchnschr.

    (1964)
  • G.V. Clift et al.

    Syndrome of inappropriate vasopressin secretion

    Arch. Int. Med.

    (1966)
  • R.D. Utiger

    Inappropriate antidiuresis and carcinoma of the lung: detection of arginine vasopressin in tumor extracts by immunoassay

    J. Clin. Endocrinol.

    (1966)
  • H. Weiss et al.

    Hyponatremia resulting from apparently inappropriate secretion of antidiuretic hormone in patients with pulmonary tuberculosis

    Am. Rev. Resp. Dis.

    (1965)
  • E. Lebacq et al.

    La sécrétion inappropriée d'hormone antidiurétique dans les cas de tumeurs thoraciques anaplastiques de type oat-cell

    Ann. endocrinol.

    (1964)
  • N.F. Jones et al.

    The mechanism of increased sodium excretion during water loading with 2.5 per cent dextrose and vasopressin

    Clin. Sc.

    (1963)
  • H.E. de Wardener et al.

    Studies on the efferent mechanism of the sodium diuresis which follows the administration of intravenous saline in the dog

    Clin. Sc.

    (1961)
  • N.G. Levinsky et al.

    The mechanism of sodium diuresis after saline infusion in the dog

    J. Clin. Invest.

    (1963)
  • J.H. Dirks et al.

    The effect of saline infusion on sodium reabsorption by the proximal tubule of the dog

    J. Clin. Invest.

    (1965)
  • W.J. Cirksena et al.

    Effect of thoracic cava obstruction on response of proximal tubule sodium reabsorption to saline infusion

    J. Clin. Invest.

    (1966)
  • J.O. Davis et al.

    Effect of chronic pitressin administration on electrolyte excretion in normal dogs and in dogs with experimental ascites

    Endocrinology

    (1954)
  • N.G. Levinsky et al.

    Changes in urine concentration during prolonged administration of vasopressin and water

    Am. J. Physiol.

    (1959)
  • F.C. Rector et al.

    Pitfalls in the use of micropuncture for the localization of diuretic action

    Ann. New York Acad. Sc.

    (1966)
  • Bossert, W. and Schwartz, W. B. Relation of pressure and flow to control of sodium reabsorption in proximal tubule. Am....
  • Cited by (0)

    This study was supported in part by Grants H-759 and HE5309 from the National Heart Institute and by the Samuel Bass Fund for Kidney Research.

    1

    From the Clinical Endocrinology Branch, National Heart Institute, National Institutes of Health, Bethesda, Maryland.

    2

    From the Department of Medicine, Tufts University School of Medicine and the Renal Service, New England Medical Center Hospitals, Boston, Massachusetts.

    View full text