Transient Syndrome of Inappropriate Antidiuretic Hormone Secretion During Pregnancy

Syndrome of inappropriate ADH secretion in a woman with preeclampsia

“…[1][2][3][4][5] As with our patient, four cases had proteinuria within the nephrotic range of >3 g in 24 h. All women demonstrated a prompt normalisation of sodium post partum.…”

“…Hyponatraemia in association with preeclampsia is less common; there being only a handful of published cases. [1][2][3][4][5] We report the case of a preeclamptic patient who developed hyponatraemia, which was not treated until the fifth day of her admission. This delay resulted in a further drop in her serum sodium.…”

The role of hyponatremia in preeclampsia

“…All of these lead to in a decrease in serum sodium concentration and serum osmolality by approximately 5 mEq/L and 10 mOsm/kg, respectively [21][22][23]. Although mild hyponatremia is part of the normal physiology of pregnancy, other factors may exacerbate this decline in serum sodium levels such as sodium restriction, polydipsia or inappropriate hypotonic intravenous fluid therapy [11,17]. Nausea, vomiting, and pain that are commonly seen in pregnancy and labour can stimuli AVP secretion.…”

“…It was a complicated case that including increased extracellular volume due to nephrotic proteinuria and then non-osmolar release of ADH lead by effective arterial volume depletion due to preeclampsia and hypoalbuminemia as some cases that described before [7,8]. One of the other theories of which try to demonstrate hyponatremia in preeclampsia is impaired releasing of vasopressinase due to placental dysfunction [11,27]. Before this, a mechanism had been proposed that related to oxytocin, vasopressin and their products were raised by premature contractions and preterm labor [22].…”

“…We concluded that our patient had a hypervolemic, hypoosmolar, severe and chronic hyponatremia and nephrotic syndrome. In the published cases, eight pregnancies developed hypervolemic hyponatremia [6][7][8][9][10], five pregnancies had SIADH (Syndrome of Inappropriate Antidiuretic Hormone) with all criterias [3,[11][12][13][14] six patients were presented with nephrotic syndrome [7,8,13,14] and one case complicated by HELLP syndrome [15].…”