The Syndrome of Inappropriate Secretion of Anti-Diuretic Hormone (SIADH) and Brucellosis

Abstract

BackgroundOur study aimed to demonstrate the frequency of the syndrome of inappropriate ADH secretion (SIADH) and associated factors during the course of brucellosis in children and adolescents.Material/MethodsThe study included children and adolescents aged 0–18 years old diagnosed with brucellosis between 2012 and 2014. The data were collected from patient charts. The diagnosis of brucellosis was made based on titrations >1:160 in standard Wright tube agglutination tests and/or positive culture tests. SIADH diagnosis was made based on the following criteria: euvolemic hyponatremia, serum Na+ <135 mmol/L, presence of serum hypoosmolarity (serum osmolarity <275 mOsm/L), increased urinary sodium (>25 mmol/L with normal dietary salt intake), low uric acid (<2 mg/dL), absence of kidney, thyroid or adrenal disease, and any anti-diuretic use.ResultsThe study included 160 children and adolescents with mean age of 9.58±3.95 years (range: 2–18 years) including 70 girls (43.8%) and 90 boys (56.2%). When the patients were stratified based on SIADH, it was found that SIADH was present in 35 patients (21.9%). SIADH was associated with elevated glucose (p<0.001), ALT (p<0.05), AST (p<0.05), LDH (p<0.001), CRP (p<0.001), and MPV (p<0.001); and decreased potassium (p<0.05), chloride (p<0.001), albumin (p<0.001), total protein (p<0.05), and hemoglobin (p<0.05) levels.ConclusionsOur study reports on the frequency, clinical characteristics, predisposing factors, and management of SIADH that can develop in children and adolescents diagnosed with brucellosis.

A 10-year retrospective comparative analysis of the clinical features of brucellosis in children and adults

“…In this study, some patients (12.90%) developed hyponatremia. In addition, Bala et al [20]. proposed that hyponatremia may be caused by inappropriate secretion of the antidiuretic hormone due to infection with Brucella.…”

Brucellosis manifesting as reversible ataxia caused by SIADH-related hyponatremia

“…Prevalence of SIADH in the setting of brucellosis was reported to be as high a 54 % [ 5 ]. A study done on pediatric patients with brucellosis revealed that brucellosis patients with SIADH have significantly higher levels of glucose, inflammatory markers, and liver enzymes [ 6 ]. Generally, fluid restriction and treating brucellosis are enough to manage brucellosis-related SIADH.…”

“…Generally, fluid restriction and treating brucellosis are enough to manage brucellosis-related SIADH. In contrast, acute symptomatic hyponatremia warrants prompt diagnosis and treatment to avoid neurological complication [ 7 , 6 ].…”

Kidney Disease in Brucellosis

“…Syndrome of inappropriate secretion of ADH (SIADH), which presented with hyponatremia in a euvolemic patient without other electrolyte abnormality has been reported in patients with brucellosis. Bala et al [14] in a study of 160 children and adolescent with SIADH reported 21.9% prevalence of SIADH. Urinary sodium (>25 mmol/L) with normal dietary salt intake, low uric acid (<2 mg/dL), the absence of kidney, thyroid or adrenal disease, and history of diuretic use were the criteria for diagnosis.…”