The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single‐centre study

Cuesta, Martín; Garrahy, Aoife; Slattery, David; Gupta, Saket; Hannon, Anne Marie; Forde, Hannah; McGurren, Karen; Sherlock, Mark; Tormey, William; Thompson, Christopher J.

doi:10.1111/cen.13128

Cited by 51 publications

(39 citation statements)

References 40 publications

(86 reference statements)

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“…HEN was most commonly due to cardiac failure (n=129, 46.9%), renal disease (n=67, 24.2%), hepatic disease (n=62, 22.4%) and obstructive uropathy (n=17, 6.1%). The aetiology in the SIAD cohort of 573 has already been described in detail . The commonest causes were central nervous system pathology (n=148, 26%), pulmonary diseases (n=111, 19%) and malignancy (n=105, 18%).…”

Section: Resultssupporting

confidence: 74%

“…The only intervention by the study investigators was to ensure that the minimum recommended criteria for correct classification of hyponatraemia was obtained within 48 hours. If the initial clinical and biochemical parameters suggested underlying SIAD, laboratory parameters to exclude hypothyroidism and hypoadrenalism were collected, as previously described . As this was a noninterventional, observational study, treatment decisions were left to the supervising medical teams.…”

Section: Methodsmentioning

confidence: 97%

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Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Cuesta

Garrahy

Slattery

et al. 2017

Clinical Endocrinology

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Section: Resultssupporting

confidence: 74%

Section: Methodsmentioning

confidence: 97%

Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Cuesta

Garrahy

Slattery

et al. 2017

Clinical Endocrinology

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“…Finally, 4/70 patients with euvolaemic hyponatraemia (6%) had hyponatraemia secondary to adrenal suppression consequent upon exogenous glucocorticoid administration. We have previously shown that 3.8% patients presenting with all‐cause SIAD were reclassified as having hyponatraemia secondary to steroid insufficiency after careful assessment of cortisol dynamics . The figure in this paper is a little higher, most likely due to the higher prevalence of inhaled or oral steroids for the treatment of obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 63%

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Cuesta

Slattery

Goulden

et al. 2019

Clinical Endocrinology

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Summary Objective Hyponatraemia is common in community‐acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill‐defined. We aimed to define the causation of hyponatraemia in CAP. Design Prospective, single‐centre, observational study of all patients with CAP and hyponatraemia (≤ 130 mmol/L) during a 9‐month period. Patients The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub‐cohort of patients with SIAD (n = 10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2). Measurements In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality. Results In study 1, 143/1723(8.3%) of CAP patients had hyponatraemia (≤130 mmol/L). About 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (P < 0.01). In Study 2, plasma sodium concentration normalized in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis. Conclusions Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalize with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.

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“…In a large, prospective and well-defined cohort of euvolaemic hyponatraemia in a tertiary centre, undiagnosed secondary adrenal insufficiency co-occurred in 3.8% of cases initially diagnosed as SIAD. 36 Acute glucocorticoid insufficiency should also be considered as the cause of hyponatraemia in any patient with acute neurotrauma and in patients who have been receiving long-term glucocorticoid therapy.…”

mentioning

confidence: 99%

Hyponatraemia – presentations and management

2017

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Hyponatraemia is the most common electrolyte disturbance encountered in clinical practice. It is associated with signifi cant morbidity and mortality, thus appropriate investigation and treatment is essential. Hyponatraemia presents with a spectrum of clinical presentations ranging from no symptoms to life-threatening neurological sequelae. Hyponatraemia has multiple aetiologies and distinguishing the underlying aetiology facilitates appropriate treatment. This review provides an overview of the presentations and approaches to management of this common clinical condition. IntroductionHyponatraemia (defined as serum sodium <135 mmol/L) is the most common electrolyte abnormality and is encountered in all areas of clinical practice.1 Hyponatraemia is associated with increased morbidity and mortality.2 The assessment of patients with hyponatraemia can pose a clinical challenge and strategies for its management are often suboptimal. In recent years, expert guidance and recommendations have been published that provide an evidence-based approach to diagnosis and treatment of hyponatraemia 3,4 although it should be highlighted that highquality evidence is lacking for many aspects of hyponatraemia management. Additionally, new therapies have emerged promising a more targeted approach to regulating body water and sodium balance in certain patients with hyponatraemia. EpidemiologyHyponatraemia occurs in approximately 15-30% of hospitalised patients, with 1-2% of patients having a serum sodium level <125 mmol/L. 5,6 In addition, hyponatraemia is often underreported in the hospital setting. 7 In the intensive care unit, approximately 25-30% of patients will have a serum sodium <134 mmol/L. 8,9 In neurosurgical units, hyponatraemia is reported in up to 50% of patients with subarachnoid haemorrhage in retrospective 2 and prospective studies.10 Hyponatraemia is also a common occurrence in ABSTRACT Hyponatraemia -presentations and management heart failure with an incidence of approximately 20% in patients hospitalised for heart failure. 11 Age-related changes and chronic diseases are often associated with abnormalities in water homeostasis. Miller et al 12 have reported that more than 50% of nursing home residents had at least one episode of hyponatraemia over a 12-month study period. Morbidity and mortality associated with hyponatraemiaHyponatraemia is associated with increased morbidity and mortality. Acute severe symptomatic hyponatraemia is a medical emergency that carries a high mortality rate if not addressed acutely. A recent prospective observational study found a positive correlation of serum sodium and mortality, with a serum sodium <125 mmol/L associated with a substantial 1-year mortality, recurrence of hyponatraemia and rehospitalisation rate.13 'Asymptomatic' chronic mild hyponatraemia has previously been thought to be clinically insignificant; however, recent evidence shows that mild chronic 'asymptomatic' hyponatraemia, particularly in an older population, may contribute to impaired cognition, 14 increased risk o...

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The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single‐centre study

Abstract: In a large, prospective and well-defined cohort of euvolaemic hyponatraemia, undiagnosed secondary adrenal insufficiency co-occurred in 3·8% of cases initially diagnosed as SIAD. Undiagnosed pituitary disease was responsible for 1·5% of cases presenting as euvolaemic hyponatraemia.

Cited by 51 publications

References 40 publications

Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Hyponatraemia – presentations and management

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