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Published in: Internal and Emergency Medicine 5/2018

01-08-2018 | IM - ORIGINAL

Endocrinopathy-induced euvolemic hyponatremia

Authors: Talia Diker-Cohen, Benaya Rozen-Zvi, Dana Yelin, Amit Akirov, Eyal Robenshtok, Anat Gafter-Gvili, Daniel Shepshelovich

Published in: Internal and Emergency Medicine | Issue 5/2018

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Abstract

Euvolemic hyponatremia results from either the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, or adrenal insufficiency. Furthermore, the criteria for diagnosis of SIADH entail the exclusion of hypothyroidism and hypoadrenalism. We aim to assess the yield of euvolemic hyponatremia workup focusing on underlying endocrinopathies in a real-world setting. A single-center retrospective study includes all patients diagnosed with euvolemic hyponatremia in a tertiary hospital between 1.1.2007 and 1.1.2013. Demographic, clinical, and laboratory data were collected from medical charts. Euvolemic hyponatremia was detected in 564 patients. Thyroid function was tested in 69% (391/564) and adrenal function was assessed in 29% (164/564) of cases. Endocrinopathy-induced euvolemic hyponatremia was diagnosed in nine (1.6%) patients: three patients were diagnosed with hypothyroidism-induced hyponatremia, three with adrenal insufficiency as an underlying cause, and three with central hypothyroidism and central hypoadrenalism. All nine had medical history and symptoms suggestive of endocrine deficiencies other than the hyponatremia, which resolved within 1–3 days after administration of hormone replacement therapy. Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. However, in this real-world study, only a limited number of patients underwent a full ascertainment of hypoadrenalism and hypothyroidism, which was diagnosed only in patients with additional findings supportive of these endocrinopathies; a higher rate of undiagnosed endocrinopathies cannot be ruled out. As both hypoadrenalism and hypothyroidism are easily treatable, potentially life-threatening conditions, there are insufficient data to change current recommendation for their universal evaluation in patients with euvolemic hyponatremia.
Literature
1.
go back to reference Spasovski G, Vanholder R, Allolio B et al (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 170:G1–G47CrossRefPubMed Spasovski G, Vanholder R, Allolio B et al (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 170:G1–G47CrossRefPubMed
2.
go back to reference Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119:S30–S35CrossRefPubMed Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119:S30–S35CrossRefPubMed
3.
go back to reference Verbalis JG, Goldsmith SR, Greenberg A et al (2013) Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 126:S1–S42CrossRefPubMed Verbalis JG, Goldsmith SR, Greenberg A et al (2013) Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 126:S1–S42CrossRefPubMed
11.
go back to reference Tzoulis P, Bouloux PM (2015) Inpatient hyponatraemia: adequacy of investigation and prevalence of endocrine causes. Clin Med 15:20–24CrossRef Tzoulis P, Bouloux PM (2015) Inpatient hyponatraemia: adequacy of investigation and prevalence of endocrine causes. Clin Med 15:20–24CrossRef
13.
15.
go back to reference Murray JS, Jayarajasingh R, Perros P (2001) Lesson of the week: deterioration of symptoms after start of thyroid hormone replacement. BMJ 323:332–333CrossRefPubMedPubMedCentral Murray JS, Jayarajasingh R, Perros P (2001) Lesson of the week: deterioration of symptoms after start of thyroid hormone replacement. BMJ 323:332–333CrossRefPubMedPubMedCentral
16.
go back to reference Fonseca V, Brown R, Hochhauser D et al (1986) Acute adrenal crisis precipitated by thyroxine. Br Med J (Clin Res Ed) 292:1185–1186CrossRef Fonseca V, Brown R, Hochhauser D et al (1986) Acute adrenal crisis precipitated by thyroxine. Br Med J (Clin Res Ed) 292:1185–1186CrossRef
26.
go back to reference Hanna FW, Scanlon MF (1997) Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 350:755–756CrossRef Hanna FW, Scanlon MF (1997) Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 350:755–756CrossRef
27.
go back to reference Baajafer FS, Hammami MM, Mohamed GED (1999) Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest 22:35–39CrossRefPubMed Baajafer FS, Hammami MM, Mohamed GED (1999) Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest 22:35–39CrossRefPubMed
28.
go back to reference Liamis G, Filippatos TD, Liontos A, Elisaf MS (2017) Management of endocrine disease: hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol 176:R15–R20CrossRefPubMed Liamis G, Filippatos TD, Liontos A, Elisaf MS (2017) Management of endocrine disease: hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol 176:R15–R20CrossRefPubMed
32.
go back to reference Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252:R635–R644PubMed Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252:R635–R644PubMed
Metadata
Title
Endocrinopathy-induced euvolemic hyponatremia
Authors
Talia Diker-Cohen
Benaya Rozen-Zvi
Dana Yelin
Amit Akirov
Eyal Robenshtok
Anat Gafter-Gvili
Daniel Shepshelovich
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine / Issue 5/2018
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-018-1872-4

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