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What’s SIADH?

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SIADH is a condition where there are high levels of antidiuretic hormone (ADH) in the body, leading to water retention and low blood sodium levels. It can be caused by cancer, drugs, infections, and brain injury. Symptoms include mental confusion, fatigue, and life-threatening complications. Treatment involves medications that block ADH activity and therapies appropriate for the underlying cause.

SIADH stands for inappropriate antidiuretic hormone hypersecretion syndrome. It is characterized by very high levels of antidiuretic hormone (ADH) in the body, which can lead to water retention and low blood sodium levels. SIADH can be caused by many factors, including different types of cancer, drugs such as chlorpropamide, infections, and brain injury. When ADH levels are too high, a person can experience mental confusion, extreme physical fatigue, and life-threatening lung, brain, and heart complications. The condition is usually treated with medications that block ADH activity and therapies appropriate for the underlying cause.

The ADH secreted by the pituitary gland contributes to the proper functioning of the kidneys. It helps regulate the levels of water, sodium, potassium and other important minerals in the blood and urine. When there is too much of the hormone due to SIADH, the body holds onto water and large amounts of sodium are excreted in the urine. The resulting low sodium levels can wreak havoc on many of the body’s systems and organs.

This syndrome is often caused by cancerous tumors, especially small cell lung cancers. Tumors can either start making and releasing their own ADH or signal the pituitary to increase secretion. Some medications for depression, diabetes, blood pressure, and other conditions can also trigger the release of ADH. Lung disease and central nervous system infections have also been linked to the development of SIADH.

Symptoms become prevalent when sodium levels become very low. Fatigue, headache, restlessness, and nausea are common. A person may also experience painful muscle cramps and spasms, mental confusion, and mild hallucinations. If left untreated, the condition can cause seizures and loss of consciousness. The kidneys, liver, lungs and heart can shut down if emergency care is not available.

Doctors diagnose this condition by examining the levels of sodium in blood and urine samples. If the underlying cause isn’t already known, imaging scans, kidney biopsies, and further blood tests may be needed to look for tumors and infections. Critically ill patients may need oxygen therapy, dialysis, and intravenous fluids while diagnostic tests are performed. ADH receptor agonists, drugs that block how ADH works, are usually given in the hospital to bring sodium levels back to normal.

Once the cause is discovered, long-term treatment plans can be devised. Cancer patients may need to have surgery, radiation or chemotherapy, and people with severe infections may need antibiotics and other medications. A patient may need to continue taking ADH receptor agonists and limit fluid intake during treatment. When the cause is found early and treated appropriately, most people are able to recover from SIADH.

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