Be aware of the effects of glucocorticoids on SIADH

Abstract

Rationale: Hyponatremia is one of the most common electrolyte disorders in clinic. Due to the complicated etiology and the nonspecific clinical manifestations, the diagnosis of hyponatremia is a complicated process. A variety of clinical disorders can cause inappropriately increased antidiuretic hormone (ADH) secretion, leading to inappropriate water retention and consequent hyponatremia. The most common cause of hyponatremia in hospital inpatients is syndrome of inappropriate antidiuretic (SIADH). The action of glucocorticoid against pituitary posterior lobe can reduce the secretion of ADH. However, the effect of hormone on diuretic hormone during treatment has been less reported. Patient concerns and diagnosis: The patient in this case report was misdiagnosed as anterior pituitary hypofunction because of the long-term glucocorticoid therapy was effective in this patient, and the patient was finally diagnosed as SIADH after reassessment. The patient is a 76-year-old male with long-term symptomatic hyponatremia after traumatic brain injury (TBI). The patient has been consistently diagnosed as anterior pituitary hypofunction. Based on the diagnosis, glucocorticoid replacement therapy was administered. The serum sodium of the patient gradually increased to normal level after hydrocortisone intravenous injection but dropped again after switch to hydrocortisone oral administration. Through examination and analysis of the patient status during the five-time hospitalization, syndrome of inappropriate antidiuretic hormone (SIADH) was considered. Interventions: Water intake limitation and oral furosemide and antisterone were administered after glucocorticoid therapy was stopped. Outcome: The serum sodium level of the patient gradually increased and maintained within normal range based on his clinical follow-up. Lessons: For hyponatremia with effective glucocorticoid treatment, SIADH should still be excluded.

Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study

“…Our study adds further evidence for the association of COVID-19 and SIADH in larger cohort study, and we also noticed a high percent of non-invasive ventilation use in hyponatremia patients, suggesting the possible relationship between SIADH and PPV. However, our hyponatremia patients also have higher rate of antibiotics and corticosteroid use, effect of glucocorticoids [25] or antibiotics [26] on SIADH have also been elucidated. These treatments may be causative, but need further investigation.…”

Acute Parvovirus Infection Unmasking a Craniopharyngioma Causing Hypopituitarism

“…The negative standard low dose ACTH test was likely negative due to the acute or sub-acute central hypocortisolism with preserved adrenal function. High urine sodium and osmolality, euvolemic status support this "SIADH like" state, known to be caused by hypocortisolism [16] and quick normalization of serum sodium levels after water restriction, thyroid and glucocorticoid replacement therapy support this diagnosis [17].…”