What is the definition of Syndrome of Inappropriate Antidiuretic Hormone Secretion?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water.

ADH is a substance produced naturally in an area of the brain called the hypothalamus. It is then released by the pituitary gland at the base of the brain.

What are the alternative names for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

SIADH; Inappropriate secretion of antidiuretic hormone; Syndrome of inappropriate ADH release; Syndrome of inappropriate antidiuresis

What are the causes for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

There are many reasons why the body needs to make a lot of ADH. Common situations when ADH is released into the blood when it should not be produced (inappropriate) include:

  • Medicines, such as certain seizure drugs, antidepressants, cancer drugs, opiates (less often), and heart, diabetes, and blood pressure drugs
  • Surgery under general anesthesia
  • Disorders of the brain, such as injury, infections, and stroke
  • Brain surgery in the region of the hypothalamus
  • Tuberculosis, cancer, chronic infections, and lung disease, such as pneumonia
  • Substance abuse

Rare causes include:

  • Rare diseases of the hypothalamus or pituitary
  • Leukemia and cancer of the small intestine, pancreas, and brain
  • Mental disorders

What are the symptoms for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

With SIADH, the urine is very concentrated. Not enough water is excreted and there is too much water in the blood. This dilutes many substances in the blood such as sodium. A low blood sodium level is the most common cause of symptoms of too much ADH.

Often, there are no symptoms from a mildly low sodium level. More symptoms occur the lower the level of the sodium.

When symptoms do occur, they may include any of the following:

  • Nausea and vomiting
  • Headache
  • Problems with balance that may result in falls
  • Mental changes, such as confusion, memory problems, strange behavior
  • Seizures or coma, in severe cases

What are the current treatments for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

Treatment depends on the cause of the problem. For example, surgery is done to remove a tumor producing ADH. Or, if a medicine is the cause, its dosage may be changed or another medicine may be tried.

In all cases, the first step is to limit fluid intake. This helps prevent excess fluid from building up in the body. Your provider will tell you what your total daily fluid intake should be. The restriction is not just for water, but for almost all fluids (coffee, tea, juice, soda, etc.).

If you have severe symptoms, it is a medical emergency. This is usually treated with salt solution (3% saline) given through an IV into the veins (intravenous) in the hospital.

Medicines may be needed to block the effects of ADH on the kidneys so that excess water is excreted by the kidneys. These medicines may be given as pills or as injections given into the veins.

What is the outlook (prognosis) for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

Outcome depends on the condition that is causing the problem. Low sodium that occurs rapidly, in less than 48 hours (acute hyponatremia), is more dangerous than low sodium that develops slowly over time. When sodium level falls slowly over days or weeks (chronic hyponatremia), the brain cells have time to adjust and the acute symptoms such as brain swelling don't occur. Chronic hyponatremia is associated with nervous system problems such as poor balance and poor memory. Many causes of SIADH are reversible. Rapid correction of chronic hyponatremia can also cause dangerous complications (osmotic demyelination).

What are the possible complications for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

In severe cases, low sodium can lead to:

  • Decreased consciousness, hallucinations or coma
  • Brain herniation
  • Death

When should I contact a medical professional for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

When your body's sodium level drops too much, it can be a life-threatening emergency. Call your provider right away if you have symptoms of this condition.

REFERENCES

Atteih S, Ratner J. Endocrinology. In: Kleinman K, Mcdaniel L, Molloy M, eds. The Harriet Lane Handbook. 22nd ed. Philadelphia, PA: Elsevier; 2021:chap 10.

Hannon MJ, Thompson CJ. Vasopressin, diabetes insipidus, and the syndrome of inappropriate antidiuresis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 18.

Verbalis JG. Disorders of water balance. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 15.

  • Condition: Hyponatremia
  • Journal: Advances in therapy
  • Treatment Used: Tolvaptan
  • Number of Patients: 252
  • Published —
This study tested the safety and efficacy of using tolvaptan to treat patients with hyponatremia.
  • Journal: The Pan African medical journal
  • Published —
Disorders of sodium balance in COVID-19 patients: two Tunisian patients report.
Clinical Trial
  • Status: Recruiting
  • Phase: Phase 2
  • Intervention Type: Drug
  • Participants: 30
  • Start Date: October 2021
Urea for Chronic Hyponatremia: A Pilot Study
Clinical Trial
  • Status: Recruiting
  • Phase: N/A
  • Intervention Type: Dietary Supplement
  • Participants: 17
  • Start Date: October 8, 2021
Effect of Protein Supplementation on Plasma Sodium Levels and Urinary Urea Excretion in Patients With SIAD - a Monocentric Open- Label Proof-of-concept Study -The TREASURE Study