Daniel Shepshelovich1, Chiya Leibovitch2, Alina Klein2, Shirit Zoldan2, Tzippy Shochat3, Hefziba Green4, Benaya Rozen-Zvi4, Meir Lahav5, Anat Gafter-Gvili6. 1. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Shepshelovich@yahoo.com. 2. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 3. Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel. 5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 6. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
Abstract
PURPOSE: To determine the proportion of patients for whom the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the presenting symptom of an underlying disorder, to describe the yield of different diagnostic modalities for patients with SIADH and an unknown etiology, and to define patients for whom such a workup is indicated. METHODS: A single center retrospective study including all patients diagnosed with SIADH without an apparent etiology in a large community hospital and tertiary center between 1.1.07 and 1.1.13. Two physicians reviewed every patient's medical file for predetermined relevant clinical data. RESULTS: Eleven of the 99 patients without an apparent etiology for SIADH at presentation were found to have an underlying cause on workup. Yield of performed workup was low, with a pathology demonstrated on 0%-30.8% of tests according to the different modalities used. Patients with presumed idiopathic SIADH at presentation who were later found to have a specific etiology were younger than patients with true idiopathic SIADH, had a significantly shorter duration of hyponatremia prior to SIADH diagnosis, had higher urine osmolality and a clinical presentation suggestive of an undiagnosed disorder. CONCLUSIONS: Our findings support a clinically-based approach to patients with idiopathic SIADH, rather than an extensive routine workup for all patients.
PURPOSE: To determine the proportion of patients for whom the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the presenting symptom of an underlying disorder, to describe the yield of different diagnostic modalities for patients with SIADH and an unknown etiology, and to define patients for whom such a workup is indicated. METHODS: A single center retrospective study including all patients diagnosed with SIADH without an apparent etiology in a large community hospital and tertiary center between 1.1.07 and 1.1.13. Two physicians reviewed every patient's medical file for predetermined relevant clinical data. RESULTS: Eleven of the 99 patients without an apparent etiology for SIADH at presentation were found to have an underlying cause on workup. Yield of performed workup was low, with a pathology demonstrated on 0%-30.8% of tests according to the different modalities used. Patients with presumed idiopathic SIADH at presentation who were later found to have a specific etiology were younger than patients with true idiopathic SIADH, had a significantly shorter duration of hyponatremia prior to SIADH diagnosis, had higher urine osmolality and a clinical presentation suggestive of an undiagnosed disorder. CONCLUSIONS: Our findings support a clinically-based approach to patients with idiopathic SIADH, rather than an extensive routine workup for all patients.
Authors: Anna L Królicka; Adrianna Kruczkowska; Magdalena Krajewska; Mariusz A Kusztal Journal: Int J Environ Res Public Health Date: 2020-07-23 Impact factor: 3.390
Authors: Christina Bal; Daniela Gompelmann; Michael Krebs; Lukasz Antoniewicz; Claudia Guttmann-Ducke; Antje Lehmann; Christopher Oliver Milacek; Maximilian Robert Gysan; Peter Wolf; Maaia-Margo Jentus; Irene Steiner; Marco Idzko Journal: PLoS One Date: 2022-10-13 Impact factor: 3.752