Skip to main content

Advertisement

SpringerLink
Log in

Endocrinopathy-induced euvolemic hyponatremia

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Euvolemic hyponatremia results from either the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, or adrenal insufficiency. Furthermore, the criteria for diagnosis of SIADH entail the exclusion of hypothyroidism and hypoadrenalism. We aim to assess the yield of euvolemic hyponatremia workup focusing on underlying endocrinopathies in a real-world setting. A single-center retrospective study includes all patients diagnosed with euvolemic hyponatremia in a tertiary hospital between 1.1.2007 and 1.1.2013. Demographic, clinical, and laboratory data were collected from medical charts. Euvolemic hyponatremia was detected in 564 patients. Thyroid function was tested in 69% (391/564) and adrenal function was assessed in 29% (164/564) of cases. Endocrinopathy-induced euvolemic hyponatremia was diagnosed in nine (1.6%) patients: three patients were diagnosed with hypothyroidism-induced hyponatremia, three with adrenal insufficiency as an underlying cause, and three with central hypothyroidism and central hypoadrenalism. All nine had medical history and symptoms suggestive of endocrine deficiencies other than the hyponatremia, which resolved within 1–3 days after administration of hormone replacement therapy. Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. However, in this real-world study, only a limited number of patients underwent a full ascertainment of hypoadrenalism and hypothyroidism, which was diagnosed only in patients with additional findings supportive of these endocrinopathies; a higher rate of undiagnosed endocrinopathies cannot be ruled out. As both hypoadrenalism and hypothyroidism are easily treatable, potentially life-threatening conditions, there are insufficient data to change current recommendation for their universal evaluation in patients with euvolemic hyponatremia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Spasovski G, Vanholder R, Allolio B et al (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 170:G1–G47

    Article  CAS  PubMed  Google Scholar 

  2. Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119:S30–S35

    Article  CAS  PubMed  Google Scholar 

  3. Verbalis JG, Goldsmith SR, Greenberg A et al (2013) Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 126:S1–S42

    Article  PubMed  Google Scholar 

  4. Ellison DH, Berl T (2007) The syndrome of inappropriate antidiuresis. N Engl J Med 356:2064–2072. https://doi.org/10.1056/NEJMcp066837

    Article  CAS  PubMed  Google Scholar 

  5. Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542. https://doi.org/10.1016/0002-9343(57)90224-3

    Article  CAS  PubMed  Google Scholar 

  6. Bornstein SR, Allolio B, Arlt W et al (2016) Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101:364–389. https://doi.org/10.1210/jc.2015-1710

    Article  CAS  PubMed  Google Scholar 

  7. Shepshelovich D, Leibovitch C, Klein A et al (2016) Yield of workup for patients with idiopathic presentation of the syndrome of inappropriate antidiuretic hormone secretion. Eur J Intern Med 32:60–64. https://doi.org/10.1016/j.ejim.2016.03.008

    Article  PubMed  Google Scholar 

  8. Hillier TA, Abbott RD, Barrett EJ (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403. https://doi.org/10.1016/S0002-9343(99)00055-8

    Article  CAS  PubMed  Google Scholar 

  9. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

    Article  PubMed  PubMed Central  Google Scholar 

  10. Barnes A, Li JYZ, Gleadle JM (2017) Lack of appropriate investigations in making a diagnosis of syndrome of inappropriate antidiuretic hormone. Intern Med J 47:336–338. https://doi.org/10.1111/imj.13364

    Article  PubMed  Google Scholar 

  11. Tzoulis P, Bouloux PM (2015) Inpatient hyponatraemia: adequacy of investigation and prevalence of endocrine causes. Clin Med 15:20–24

    Article  Google Scholar 

  12. Greenberg A, Verbalis JG, Amin AN et al (2015) Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int 88:167–177. https://doi.org/10.1038/ki.2015.4

    Article  PubMed  PubMed Central  Google Scholar 

  13. Katoch CDS, Brar KS, Singh B (2013) Evaluation of thyroid and adrenal functions in patients with hyponatremia. Med J Armed Forces India 69:237–240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cuesta M, Garrahy A, Slattery D et al (2016) The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study. Clin Endocrinol (Oxf) 85:836–844. https://doi.org/10.1111/cen.13128

    Article  CAS  Google Scholar 

  15. Murray JS, Jayarajasingh R, Perros P (2001) Lesson of the week: deterioration of symptoms after start of thyroid hormone replacement. BMJ 323:332–333

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Fonseca V, Brown R, Hochhauser D et al (1986) Acute adrenal crisis precipitated by thyroxine. Br Med J (Clin Res Ed) 292:1185–1186

    Article  CAS  Google Scholar 

  17. Shaikh M, Lewis P, Kirk J (2007) Thyroxine unmasks Addison’s disease. Acta Paediatr 93:1663–1665. https://doi.org/10.1111/j.1651-2227.2004.tb00860.x

    Article  Google Scholar 

  18. Wolf P, Beiglböck H, Smaijs S et al (2017) Hypothyroidism and hyponatremia: rather coincidence than causality. Thyroid 27:611–615. https://doi.org/10.1089/thy.2016.0597

    Article  CAS  PubMed  Google Scholar 

  19. Vannucci L, Parenti G, Simontacchi G et al (2017) Hypothyroidism and hyponatremia: data from a series of patients with iatrogenic acute hypothyroidism undergoing radioactive iodine therapy after total thyroidectomy for thyroid cancer. J Endocrinol Invest 40:49–54. https://doi.org/10.1007/s40618-016-0525-6

    Article  CAS  PubMed  Google Scholar 

  20. Ching Sun GE, Pantalone KM, Hatipoglu B (2012) Hypothyroidism as a cause of hyponatremia: fact or fiction? Endocr Pract 18:894–897. https://doi.org/10.4158/ep12130.or

    Article  Google Scholar 

  21. Schwarz C, Leichtle AB, Arampatzis S et al (2012) Thyroid function and serum electrolytes: does an association really exist? Swiss Med Wkly 142:w13669. https://doi.org/10.4414/smw.2012.13669

    Article  PubMed  Google Scholar 

  22. Lee JE, Kim SK, Han KH et al (2014) Risk factors for developing hyponatremia in thyroid cancer patients undergoing radioactive iodine therapy. PLoS One 9:e106840. https://doi.org/10.1371/journal.pone.0106840

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hanna FW, Scanlon MF (1997) Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 350:755–756. https://doi.org/10.1016/S0140-6736(05)62563-9

    Article  CAS  PubMed  Google Scholar 

  24. Hammami MM, Almogbel F, Hammami S et al (2013) Acute severe hypothyroidism is not associated with hyponatremia even with increased water intake: a prospective study in thyroid cancer patients. BMC Endocr Disord 13:27. https://doi.org/10.1186/1472-6823-13-27

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Carlo J, Dayrit P, Cunanan EC, Kho SA (2016) Prevalence of hyponatremia in hypothyroid patients during radioactive 131 I ablation for differentiated thyroid cancer: single institution experience. Endocrinol Metab 31:410–415. https://doi.org/10.3803/EnM.2016.31.3.410

    Article  Google Scholar 

  26. Hanna FW, Scanlon MF (1997) Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 350:755–756

    Article  Google Scholar 

  27. Baajafer FS, Hammami MM, Mohamed GED (1999) Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest 22:35–39

    Article  CAS  PubMed  Google Scholar 

  28. Liamis G, Filippatos TD, Liontos A, Elisaf MS (2017) Management of endocrine disease: hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol 176:R15–R20

    Article  CAS  PubMed  Google Scholar 

  29. Pantalone K, Hatipoglu B (2014) Hyponatremia and the thyroid: causality or association? J Clin Med 4:32–36

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shepshelovich D, Schechter A, Calvarysky B et al (2017) Medication-induced SIADH: distribution and characterization according to medication class. Br J Clin Pharmacol 83:1801–1807. https://doi.org/10.1111/bcp.13256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Erkut ZA, Pool C, Swaab DF (1998) Glucocorticoids suppress corticotropin-releasing hormone and vasopressin expression in human hypothalamic neurons. J Clin Endocrinol Metab 83:2066–2073. https://doi.org/10.1210/jcem.83.6.4881

    Article  CAS  PubMed  Google Scholar 

  32. Raff H (1987) Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 252:R635–R644

    CAS  PubMed  Google Scholar 

  33. Oelkers W (1989) Hyponatremia and inappropriate secretion of vasopressin (antidiuretic hormone) in patients with hypopituitarism. N Engl J Med 321:492–496. https://doi.org/10.1056/NEJM198908243210802

    Article  CAS  PubMed  Google Scholar 

  34. Liamis G, Milionis HJ, Elisaf M (2011) Endocrine disorders: causes of hyponatremia not to neglect. Ann Med 43:179–187. https://doi.org/10.3109/07853890.2010.530680

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St, 49100, Petah-Tikva, Israel

    Talia Diker-Cohen, Dana Yelin, Anat Gafter-Gvili & Daniel Shepshelovich

  2. Institute of Endocrinology, Diabetes and Metabolism, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel

    Amit Akirov & Eyal Robenshtok

  3. Department of Nephrology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel

    Benaya Rozen-Zvi

  4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Benaya Rozen-Zvi, Dana Yelin, Amit Akirov, Eyal Robenshtok, Anat Gafter-Gvili & Daniel Shepshelovich

Authors
  1. Talia Diker-Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benaya Rozen-Zvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dana Yelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amit Akirov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eyal Robenshtok
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anat Gafter-Gvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Shepshelovich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Talia Diker-Cohen.

Ethics declarations

Conflict of interest

The authors declare that they have no confict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of retrospective study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Diker-Cohen, T., Rozen-Zvi, B., Yelin, D. et al. Endocrinopathy-induced euvolemic hyponatremia. Intern Emerg Med 13, 679–688 (2018). https://doi.org/10.1007/s11739-018-1872-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-018-1872-4

Keywords

Search

Navigation