Syndrome of inappropriate antidiuretic hormone pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Syndrome of inappropriate antidiuretic hormone production is a condition in which the body develops an excess of water and a decrease in the concentration of electrolytes. SIADH may be caused by a central nervous system diseases, cancers, pulmonary diseases, or some drugs.

Pathophysiology

The normal function of antidiuretic hormone (ADH) on the kidneys is to control the amount of water reabsorbed by kidney nephrons. ADH acts in the distal portion of the renal tubule (distal convoluted tubule) as well as on the collecting duct and causes the retention of water. Owing to the water retention, dilution of the blood and hyponatremia occurs.

Pathogenesis

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  • In general, the plasma sodium concentration is the primary osmotic determinant of AVP release. In SIADH, there is non physiological secretion of AVP. There is enhanced water reabsorption, leading to dilutional hyponatremia.

Genetics

Associated conditions

Gross pathology

There are no gross pathology findings associated with SIADH, however SIADH may be associated with squamous cell carcinoma of the lung, which exhibits the following gross pathology findings:

Squamous cell carcinoma of the lung, source: radiopedia.org


Microscopic pathology

There are no microscopic findings associated with SIADH, however SIADH may be associated with squamous cell carcinoma of the lung, which exhibits the following microscopic pathology findings:[6][7]

Squamous cell carcinoma of the lung, source: librepathology.com


References

  1. Pillai BP, Unnikrishnan AG, Pavithran PV (2011). "Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder". Indian J Endocrinol Metab. 15 Suppl 3: S208–15. doi:10.4103/2230-8210.84870. PMC 3183532. PMID 22029026.
  2. Tian W, Fu Y, Garcia-Elias A, Fernández-Fernández JM, Vicente R, Kramer PL, Klein RF, Hitzemann R, Orwoll ES, Wilmot B, McWeeney S, Valverde MA, Cohen DM (2009). "A loss-of-function nonsynonymous polymorphism in the osmoregulatory TRPV4 gene is associated with human hyponatremia". Proc. Natl. Acad. Sci. U.S.A. 106 (33): 14034–9. doi:10.1073/pnas.0904084106. PMC 2729015. PMID 19666518.
  3. Onitilo AA, Kio E, Doi SA (2007). "Tumor-related hyponatremia". Clin Med Res. 5 (4): 228–37. doi:10.3121/cmr.2007.762. PMC 2275758. PMID 18086907.
  4. Castillo JJ, Vincent M, Justice E (2012). "Diagnosis and management of hyponatremia in cancer patients". Oncologist. 17 (6): 756–65. doi:10.1634/theoncologist.2011-0400. PMC 3380874. PMID 22618570.
  5. Dóczi T, Tarjányi J, Huszka E, Kiss J (1982). "Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after head injury". Neurosurgery. 10 (6 Pt 1): 685–8. PMID 7110540.
  6. "www.iarc.fr" (PDF).
  7. Kadota K, Nitadori J, Woo KM, Sima CS, Finley DJ, Rusch VW, Adusumilli PS, Travis WD (2014). "Comprehensive pathological analyses in lung squamous cell carcinoma: single cell invasion, nuclear diameter, and tumor budding are independent prognostic factors for worse outcomes". J Thorac Oncol. 9 (8): 1126–39. doi:10.1097/JTO.0000000000000253. PMC 4806792. PMID 24942260.


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