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Syndrome of Inappropriate Secretion of Antidiuretic

Hormone (SIADH)
By James L. Lewis, III , MD, Brookwood Baptist Health and Saint
Vincent’s Ascension Health, Birmingham

The syndrome of inappropriate secretion of antidiuretic hormone (develops when too much antidiuretic
hormone (vasopressin) is released by the pituitary gland under certain inappropriate conditions, causing
the body to retain uid and lower the blood sodium level by dilution.

(See also Overview of Electrolytes and Overview of Sodium's Role in the Body.)
Vasopressin (also called antidiuretic hormone) helps regulate the amount of water in the body by controlling how
much water is excreted by the kidneys. Vasopressin decreases water excretion by the kidneys. As a result, more water
is retained in the body, which dilutes the level of sodium in the body. A low level of sodium is called hyponatremia.
The pituitary gland appropriately produces and releases vasopressin when the blood volume (amount of uid in the
blood vessels) or blood pressure goes down or when levels of electrolytes (such as sodium) become too high
blood vessels) or blood pressure goes down or when levels of electrolytes (such as sodium) become too high.
Secretion of vasopressin is termed inappropriate if it occurs when
Blood volume is normal or high

Blood pressure is normal or high

Electrolyte concentrations are low

Other appropriate reasons for vasopressin release are not present

When vasopressin is released in these situations, the body retains too much uid, and the sodium level in blood
decreases.

Causes
Many conditions increase the risk of developing SIADH. SIADH may result when vasopressin is produced outside the
pituitary gland, as occurs in some lung and other cancers. SIADH is common among older people and is fairly common
among people who are hospitalized.
SIADH has a long list of possible causes that typically require additional tests to uncover.

Kue

What Causes SIADH?

Type of
Examples
Disorder
Abscesses in the brain
Bleeding (hemorrhage) within the
layers of tissue covering the brain
Encephalitis (in ammation of the
brain)
Brain or
Guillain-Barré syndrome
nervous
Head injury
system
Hypothalamus disorders,
including tumors (rare)
Meningitis
Strokes
Tumors
Acute respiratory failure
Lung Pneumonia
Tuberculosis
Brain cancer
Lung cancer
Cancers Lymphoma
Pancreatic cancer
Cancer of the small intestine
Surgery
Other
Undernutrition
SIADH = syndrome of inappropriate secretion
of antidiuretic hormone.
Symptoms
Symptoms of SIADH tend to be those related to the low sodium level in blood (hyponatremia) that accompanies it.
Symptoms include sluggishness and confusion.

Diagnosis
Blood and urine tests

Doctors suspect SIADH based on a person’s circumstances and symptoms.

Blood and urine tests are done to measure the sodium and potassium levels and to determine how concentrated the
blood and urine are (osmolality). Doctors also rule out other possible causes of excess vasopressin (such as pain,
stress, drugs, or cancer).
Once SIADH is diagnosed, doctors try to identify the cause and address it so the sodium level slowly returns to normal.

Treatment
Restriction of uid intake

Doctors restrict uid intake and treat the cause if possible. People with SIADH need treatment of hyponatremia for the
long term.
Intravenous uids, including uids containing very high concentrations of sodium (hypertonic saline), are sometimes
given. Such treatments must be given carefully to avoid rapid increases in the sodium level.
If the sodium level in blood continues to decrease or does not increase despite restriction of uid intake, doctors may
prescribe drugs such as demeclocycline or lithium, which decrease the e ect of vasopressin on the kidneys, or drugs
such as conivaptan and tolvaptan, which block vasopressin receptors and prevent the kidneys from responding to
vasopressin.
Last full review/revision September 2018 by James L. Lewis, III, MD

© 2018 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)