Endocrine Abstracts

SIADH is the commonest cause of hyponatraemia in hospital practice SIADH must be distinguished from hypovolaemic and hypervolaemic hyponatraemia, and a diagnosis of euvolaemic hyponatraemia is established, the main differential is between SIADH and glucocorticoid deficiency.Not all cases of SIADH require active management. Drug induced SIADH usually responds to drug withdrawal, though active management may speed up return to eunatraemia if the drug has a...

The initial report of the syndrome of Inappropriate Antidiuresis (SIAD) was published as recently as 1960 in the American Journal of Medicine. Schwartz and colleagues described an elegant series of physiological studies, in which two patients with hyponatraemia and lung carcinoma were shown to have an inability to excrete a water load, and who responded to water restriction with a rise in plasma sodium concentration. They termed this syndrome SIADH; in the 60 years since then,...

Hyponatraemia is the commonest electrolyte abnormality in hospitalised patients and every published series has demonstrated that hyponatraemia is associated with increased mortality and substantial morbidity, including longer duration of hospital stay. The debate between the contribution between hyponatraemia and the causative condition to the increased mortality remains to be resolved, but increasing evidence points to an independent association with hyponatraemia. It is not ...

Traumatic brain injury is well recognised to cause pituitary dysfunction. Although data suggests that this is uncommon after mild head injury (GCS 14–15), the consensus from a large number of papers, using different assays and methods of testing, is that 15–30% of long term survivors of TBI have pituitary dysfunction. This offers the option of medical therapy after TBI, to improve quality of life and, potentially, improve rehabilitation.In the ...

Hyponatraemia is the commonest electrolyte abnormality in hospitalised patients, with a prevalence of 20–30% and particularly high incidence in neurosurgical, pulmonary, geriatric, intensive care and oncology units. Up to 6% of patients have severe hyponatraemia (plasma sodium <125 mmol/l). A wealth of data is available which indicates that severe hyponatraemia is associated with cerebral irritation, causing confusion, coma and seizures, and significant excess mortali...

Hyponatraemia is the commonest electrolyte abnormality in acute hospital admissions. The presence of hyponatraemia is a negative prognostic factor which is associated with increased duration of hospital stay and increased mortality; mortality rates exceed 50% when plasma sodium concentration is <115 mmol/l. Errors in establishing the aetiology of hyponatraemia have been shown to lead to inappropriate treatment, with adverse outcomes, so accurate diagnosis is an essential p...

A large body of evidence has accumulated to indicate that between 20–30% of survivors of acute traumatic brain injury (TBI) develop permanent pituitary dysfunction. Growth hormone (GH) deficiency is the commonest abnormality documented in most studies followed by ACTH and gonadotrophin deficiency and hyperprolactinaemia, with TSH deficiency least common. In contrast to other forms of pituitary disease, the classical hierarchy of pituitary hormone failure is not always see...

A 58-year-old male was admitted through the emergency department with symptomatic severe euvolemic hyponatremia. Biochemistry was consistent with SIAD (plasma sodium (pNa) 107 mmol/l, plasma osmolality 230 mOsm/kg, urine sodium 36 mmol/l, urine osmolality (UOsm) 638 mOsm/kg, 0900 h plasma cortisol 484 nmol/l and thyroid function tests normal). Chest X-ray was normal but CT thorax confirmed a lung mass suspicious for malignancy. As the patient had symptoms of cerebral irritatio...

Introduction: Hen corticosteroids are utilised for their anti-inflammatory properties, adrenocortical atrophy may result. Abrupt steroid withdrawal or intercurrent illness can precipitate acute adrenal crisis. We report two cases of adrenal crisis which resulted from withdrawal of immunosuppressive steroid therapy.Case report: i) A 74-year-old gentleman was admitted with hypotension (BP 80/40), severe hyponatremia (Na:118 mmol/l) and acute renal failure ...

Adrenocortical carcinoma (ACC) is a rare malignant tumour arising from the adrenal cortex, with an estimated annual incidence of one to two patients per million. Ectopic ACCs are extremely rare. They are believed to arise from cortical fragments arrested during embryologic migration and have been found close to the adrenal gland or along the path of gonadal descent. The majority of ACCs are sporadic, however, ACC has been linked with genetic disease processes, including multip...