Endocrine Abstracts

Hyponatremia often presents significant challenges in both its differential diagnosis and management. This presentation will address key concepts and recent developments to assist clinicians in overcoming these challenges. Pathophysiologically, hyponatremia is marked by an excess of arginine vasopressin (AVP), which can be “appropriate” in response to hypovolemia or “inappropriate” due to underlying conditions, medications, or other triggers. The most common cause of inappropriate AVP secretion is the syndrome of inappropriate antidiuresis (SIAD). This presentation will offer a practical diagnostic approach to hyponatremia, aiming to differentiate its various underlying causes, including SIAD. In terms of treatment, the key distinction is whether hyponatremia is acute and symptomatic—requiring immediate intervention with hypertonic saline—or chronic, where overcorrection must be avoided to prevent osmotic demyelination. The management of chronic hyponatremia should focus on the underlying cause while also addressing the water excess. Fluid restriction remains the first-line treatment for SIAD, although additional therapies are often needed to promote free water excretion. Recent years have seen the emergence of new treatment options, such as oral urea, high-protein diets, SGLT2 inhibitors, and tolvaptan. This presentation will review the scientific evidence supporting these developments and provide practical guidance for clinicians on how to implement them.