Impaired water excretion in myxedema

DeRubertis, Frederick R.; Michelis, Michael F.; Bloom, Marvin E.; Mintz, Daniel H.; Field, James B.; Davis, Bernard B.

doi:10.1016/0002-9343(71)90322-6

Cited by 167 publications

(71 citation statements)

References 52 publications

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“…31 In uncomplicated hypothyroidism there appears to be little elevation of plasma AVP levels. However, as the hypothyroidism becomes more severe, the EABV can decrease sufficiently to stimulate AVP secretion secondarily via baroreceptor mechanisms.…”

Section: Nephrogenic Syndrome Of Inappropriate Antidiuresismentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

519

498

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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Section: Nephrogenic Syndrome Of Inappropriate Antidiuresismentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

519

498

View full text Add to dashboard Cite

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“…This is most likely due to reduced cardiac output in this disorder, which can lead to the release of antidiuretic hormone via the carotid sinus baroreceptors. 9,10 The glomerular filtration is also decreased in hypothyroidism. This can directly diminish free water excretion by diminishing water delivery to the diluting segments.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of thyroid and adrenal functions in patients with hyponatremia

Katoch¹,

Brar

Singh³

2013

Medical Journal Armed Forces India

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Altered sensoriumHypoadrenalism Hypothyroidism a b s t r a c t Background: Hyponatremia is frequently detected as a cause in patients admitted to command Hospital Kolkata with altered sensorium. We evaluated these patients to rule out two common endocrine causes as etiological factors i.e. hypothyroidism and hypoadrenalism.Method: We studied 100 patients over a period of two years in all seasons who were admitted to hospital with altered sensorium and found to have hyponatremia as a cause, after ruling out other causes of altered sensorium as per inclusion and exclusion criteria.They were subjected to thyroid and adrenal evaluation in addition to detailed history, clinical examination and lab evaluation as per study protocol.Results: Total 100 patients were enrolled in the study. The age of patients varied from 31 years to more than 70 years. Majority of patients were between the age group of 41e60 years (49 patients.Males were predominant in the study. Only 8 patients were detected to have hypothyroidism requiring replacement therapy and only 2 patients had adrenal insufficiency. 48 patients had drug induced hyponatremia and 42 idiopathic hyponatremia. No seasonal variation was noted.Conclusion: Thiazide diuretic intake as antihypertensive drug was found to be a major cause of hyponatremia. Most of the patients in this group were using thiazide diuretics. In idiopathic group the cause of hyponatremia can be hypothesized as multifactorial. The hot and humid climate of Kolkata and other coastal regions made them more vulnerable to develop hyponatremia. Hypothyroidism and hypoadrenalism were not found to be major causes of unexplained hyponatremia.ª 2013, Armed Forces Medical Services (AFMS). All rights reserved.

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“…In addition, our results suggested the integrity of the PRA-aldosterone axis. Most studies detect a decrease in the elimination of a water loading in hypothyroid patients, (DeRubertis et al 1971, Skowsky & Kikuchi 1978, Laczi et al 1987, Iwasaki et al 1990, Ota et al 1994) and a lower plasma osmolality than euthyroid individuals (Laczi et al 1987, Iwasaki et al 1990, Barna et al 1994, Ota et al 1994.…”

Section: Discussionmentioning

confidence: 99%

“…Other possible explanations could be an increase in the sensitivity to AVP, although some experimental studies in rats suggest, in fact, that there is a resistance to its action (Seif et al 1979, Kim et al 1987. Another possibility is the action of other AVPindependent mechanisms at the level of the renal tubule, such as the decrease of urine flow at the distal tubule (DeRubertis et al 1971, Emmanouel et al 1974, Laczi et al 1987 or both morphological (Davis et al 1983) or functional (Michael et al 1976, Garg & Tisher 1985, Kim et al 1987 abnormalities of the distal tubule in hypothyroidism. It has been suggested that in some hyponatremia cases with characteristics of inappropriate secretion of ADH and with decreased AVP, there may be an increase in a non-filiated substance with an action similar to AVP (Robertson et al 1982, Kern et al 1986).…”

Section: Discussionmentioning

confidence: 99%

Water metabolism disturbances at different stages of primary thyroid failure

Villabona¹,

Rosel²,

Navarro³

et al. 2001

Journal of Endocrinology

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The aim of the present study was to study salt and water metabolism in thyroid deficiency.We performed an oral water loading test (OWL) and a hypertonic 5% saline infusion test (HSI) in 16 patients with overt primary hypothyroidism before replacement treatment (PRE group) and after, in eight patients with subclinical hypothyroidism (SUB group) and in 16 normal individuals (CG group).In the PRE group, a lower free water clearance was detected in the OWL (P<0·022), with lower plasma osmolality (OWL: P<0·005; HSI: P<0·001) and arginine vasopressin (AVP) (OWL: P<0·001; HSI: P<0·001) than the CG group, across both tests; they normalized with the replacement treatment. The same plasma abnormalities were detected in the SUB group with the HSI. Although the AVP and thirst thresholds did not differ between the groups, the lag between them was lower in the PRE (4·1 3·2 mOsm/kg) and SUB group (2·6 2·1 mOsm/ kg) than in the CG group (13·3 9·2 mOsm/kg) (P<0·05). There were no differences in atrial natriuretic hormone (ANH), plasma renin activity (PRA) and plasma aldosterone among the groups.These results indicate that plasma hypo-osmolality and low levels of AVP are present in primary hypothyroidism, and indeed are already present in the subclinical phase of the disease. An overlap between the thresholds of thirst and AVP seem to play a role in these abnormalities, but ANH, PRA and plasma aldosterone do not appear to contribute.

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Impaired water excretion in myxedema

Cited by 167 publications

References 52 publications

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Evaluation of thyroid and adrenal functions in patients with hyponatremia

Water metabolism disturbances at different stages of primary thyroid failure

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