Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Abstract

The differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) in patients with neurological disorders has been a perplexing clinical controversy. The purpose of this review is to summarize the characteristics and risk factors of patients with different types of neurological disorders complicated by hyponatremia (HN) and review various methods to distinguish SIADH from CSWS. Common neurological disorders with high rates of HN include subarachnoid hemorrhage (SAH), traumatic brain injuries, stroke, cerebral tumors, central nervous system (CNS) infections, and Guillain-Barré syndrome (GBS), which have their own characteristics. Extracellular volume (ECV) status of patients is a key point to differentiate SIADH and CSWS, and a comprehensive assessment of relevant ECV indicators may be useful in differentiating these two syndromes. Besides, instead of monitoring the urinary sodium excretion, more attention should be paid to the total mass balance, including Na+, K+, Cl−, and extracellular fluid. Furthermore, the dynamic detection of fractional excretions (FE) of urate before and after correction of HN and a short-term infusion of isotonic saline solution may be useful in identifying the etiology of HN. As for brain natriuretic peptide (BNP) or N-terminal prohormone of BNP (NT-proBNP), more prospective studies and strong evidence are needed to determine whether there is a pertinent and clear difference between SIADH and CSWS.

Occurrence of Chordoid Glioma With Sodium Ion Metabolism Disorder 5 Years After Meningioma Surgery and Whole-Exome Sequencing: A Case Report and Literature Review

“…Central diabetes insipidus, SIADH and cerebral salt wasting syndrome are the main reasons for craniocerebral surgery in the treatment of sodium metabolism imbalance. Nevertheless, intravenous fluids, administration of dehydration drugs, and total parenteral nutrition may also cause (Brimioulle et al, 2008 ; Overgaard-Steensen and Ring, 2013 ; Ball and Iqbal, 2015 ; Edate and Albanese, 2015 ; Cuesta et al, 2016 ; Cui et al, 2019 ) ( Table 2 ). Coexistence of these conditions complicates diagnosis and management.…”

Distant Organ Damage in Acute Brain Injury

“…On the contrary, brain trauma can also cause the opposite effect—syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH has been recognized as a common aetiology of hyponatremia in SAH, TBI and ischemic stroke patients, resulting in hyponatremia with no symptoms of water depletion [ 27 , 28 ]. Water-electrolyte imbalance in acute brain injury patients will be described in more details further in the text.…”

“…Berendes et al found that patients with SAH have much higher brain natriuretic peptide (BNP) concentrations than controls [ 127 ]. BNP leads to natriuresis that is followed by excretion of water [ 27 ]. CSWS patients, therefore, are hypovolemic and hyponatraemic.…”

High Incidence of Hyponatremia in Patients Operated for Nonsellar/Suprasellar Supratentorial Tumors—A Prospective Observational Study

“…[7][8][9][10][11] The incidence of hyponatremia is between 8 and 35% in brain tumors. 12 Various studies have also shown a high incidence of hyponatremia in supratentorial tumors. However, these studies have included patients with sellar/suprasellar tumors only.…”