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01-08-2017 | Editorial

Syndrome of inappropriate antidiuresis should it be managed by specialised endocrinologists?

Authors: Aoife Garrahy, Chris J. Thompson

Published in: Endocrine | Issue 2/2017

Excerpt

The syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatraemia in hospitalised patients, accounting for 43% of patients with a plasma sodium concentration of <130 mmol/l [1]. Although there are virtually no data on mortality in SIAD, mortality in all-cause hyponatraemia has been reported to be elevated in almost every paper on the subject [2‐4]. Hyponatraemic patients are also vulnerable to morbidity related to falls [5], fractures [6] and osteoporosis [7]. In the absence of separate studies in SIAD, it is widely accepted that patients who have hyponatraemia due to SIAD are vulnerable to the same risk of the morbidities and mortality associated with all-cause hyponatraemia. This has prompted considerable interest in whether treatment of hyponatreamia can improve outcomes in SIAD. …

M. Cuesta, A. Garrahy, D. Slattery, S. Gupta, A.M. Hannon, H. Forde, K. McGurren, M. Sherlock, W. Tormey, C.J. Thompson, The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study. Clin. Endocrinol. (Oxf). 85(6), 836–844 (2016). doi:10.1111/cen.13128 CrossRefPubMed

G. Corona, C. Giuliani, G. Parenti, D. Norello, J.G. Verbalis, G. Forti, M. Maggi, A. Peri, Moderate hyponatremia is associated with increased risk of mortality: evidence from a meta-analysis. PLoS ONE 8(12), e80451 (2013). doi:10.1371/journal.pone.0080451 CrossRefPubMedPubMedCentral

I. Sturdik, M. Adamcova, J. Kollerova, T. Koller, Z. Zelinkova, J. Payer, Hyponatraemia is an independent predictor of in-hospital mortality. Eur. J. Intern. Med. 25(4), 379–382 (2014). doi:10.1016/j.ejim.2014.02.002 CrossRefPubMed

S.S. Waikar, D.B. Mount, G.C. Curhan, Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am. J. Med. 122(9), 857–865 (2009). doi:10.1016/j.amjmed.2009.01.027 CrossRefPubMedPubMedCentral

B. Renneboog, W. Musch, X. Vandemergel, M.U. Manto, G. Decaux, Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am. J. Med. 119(1), 71.e71–e78 (2006). doi:10.1016/j.amjmed.2005.09.026 CrossRef

S. Kinsella, S. Moran, M.O. Sullivan, M.G. Molloy, J.A. Eustace, Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin. J. Am. Soc. Nephrol. 5(2), 275–280 (2010). doi:10.2215/cjn.06120809 CrossRefPubMedPubMedCentral

J.G. Verbalis, J. Barsony, Y. Sugimura, Y. Tian, D.J. Adams, E.A. Carter, H.E. Resnick, Hyponatremia-induced osteoporosis. J. Bone Miner. Res. 25(3), 554–563 (2010). doi:10.1359/jbmr.090827 CrossRefPubMed

J.G. Verbalis, S.R. Goldsmith, A. Greenberg, C. Korzelius, R.W. Schrier, R.H. Sterns, C.J. Thompson, Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am. J. Med. 126(10 Suppl 1), S1–S42 (2013). doi:10.1016/j.amjmed.2013.07.006 CrossRefPubMed

G. Spasovski, R. Vanholder, B. Allolio, D. Annane, S. Ball, D. Bichet, G. Decaux, W. Fenske, E.J. Hoorn, C. Ichai, M. Joannidis, A. Soupart, R. Zietse, M. Haller, S. van der Veer, W. Van Biesen, E. Nagler, Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur. J. Endocrinol. 170(3), G1–G47 (2014). doi:10.1530/eje-13-1020 CrossRefPubMed

10.

P. Tzoulis, P.M. Bouloux, Inpatient hyponatraemia: adequacy of investigation and prevalence of endocrine causes. Clin. Med. 15(1), 20–24 (2015). doi:10.7861/clinmedicine.15-1-20 CrossRef

11.

R.W. Schrier, P. Gross, M. Gheorghiade, T. Berl, J.G. Verbalis, F.S. Czerwiec, C. Orlandi, Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N. Eng. J. Med. 355(20), 2099–2112 (2006). doi:10.1056/NEJMoa065181 CrossRef

12.

J.G. Verbalis, S. Adler, R.W. Schrier, T. Berl, Q. Zhao, F.S. Czerwiec, Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion. Eur. J. Endocrinol. 164(5), 725–732 (2011). doi:10.1530/eje-10-1078 CrossRefPubMedPubMedCentral

13.

P. Tzoulis, H. Carr, E. Bagkeris, P.M. Bouloux, Improving care and outcomes of inpatients with syndrome of inappropriate antidiuresis (SIAD): a prospective intervention study of intensive endocrine input vs. routine care. Endocrine 55(2), 539–546 (2017). doi:10.1007/s12020-016-1161-9 CrossRefPubMed

14.

A. Peri, J. Verbalis, A. Greenberg, G. Johannsson, S. Ball, J.O. Jorgensen, J. Chiodo, Management of euvolemic hyponatremia attributed to SIADH in the hospital: interim results from a prospective, observational, multi-center, global registry. Presented at European Congress of Endocrinology, Copenhagen, Denmark 2013. Endocrine Abstracts (2013) 32 OC1.6

15.

P. Tzoulis, R. Evans, A. Falinska, M. Barnard, T. Tan, E. Woolman, R. Leyland, N. Martin, R. Edwards, R. Scott, K. Gurazada, M. Parsons, D. Nair, B. Khoo, P.M. Bouloux, Multicentre study of investigation and management of inpatient hyponatraemia in the UK. Postgrad. Med. J. 90(1070), 694–698 (2014). doi:10.1136/postgradmedj-2014-132885 CrossRefPubMedPubMedCentral

16.

A. Greenberg, J.G. Verbalis, A.N. Amin, V.R. Burst, J.A. Chiodo 3rd, J.R. Chiong, J.F. Dasta, K.E. Friend, P.J. Hauptman, A. Peri, S.H. Sigal, Current treatment practice and outcomes. Report of the Hyponatremia Registry. Kidney Int. 88(1), 167–177 (2015). doi:10.1038/ki.2015.4 CrossRefPubMedPubMedCentral

17.

J.G. Verbalis, A. Greenberg, V. Burst, J.P. Haymann, G. Johannsson, A. Peri, E. Poch, J.A. Chiodo 3rd, J. Dave, Diagnosing and treating the syndrome of inappropriate antidiuretic hormone secretion. Am. J. Med. 129(5), 537.e539–537.e523 (2016). doi:10.1016/j.amjmed.2015.11.005 CrossRef

18.

P. Grant, J. Ayuk, P.M. Bouloux, M. Cohen, I. Cranston, R.D. Murray, A. Rees, N. Thatcher, A. Grossman, The diagnosis and management of inpatient hyponatraemia and SIADH. Eur. J. Clin. Invest. 45(8), 888–894 (2015). doi:10.1111/eci.12465 CrossRefPubMedPubMedCentral

Title: Syndrome of inappropriate antidiuresis should it be managed by specialised endocrinologists?
Authors: Aoife Garrahy
Chris J. Thompson
Publication date: 01-08-2017
Publisher: Springer US
Published in: Endocrine / Issue 2/2017
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-017-1304-7

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