Professional Documents
Culture Documents
Excess
vasopressin/syndrome
of
inappropriate antidiuretic hormone
The syndrome of inappropriate ADH (SIADH)
refers to the release of vasopressin when
normal regulatory mechanisms should restrict
its secretion into the circulation (Case
history 5.5). This is a difficult and dangerous
clinical
situation
(Box
5.12)
where
hyponatraemia and low osmolality can cause
irreversible brain damage and death.
Symptoms and signs
concentration
after
an infusion of hypertonic saline. Most
endocrinologists still rely on the water deprivation
test
and
the
use of the vasopressin analogue,
desmopressin
(Table 5.6).
Treatment
Oxytocin
The major roles of oxytocin are during
birth and breast-feeding (see Chapter
7). It is also emerging as a brain
neurotransmitter with roles in modulating behaviour and overeating.
Effects and mechanism of action
Oxytocin has two main sites of action:
the
uterus
and the mammary gland. It is the
hormone
of
parturition, literally meaning quick birth.
It
increases
the contraction of the myometrium
during labour
Nephrogenic DI
Causes
Causes
CNS tumours
Head trauma
Idiopathic
Investigated by the water deprivation test
Conducted over 8 h during the day with repeated measurements of weight and serum (S OSM) and urine
(UOSM) osmolality
Terminate test if body weight falls 5% (dangerous) and allow the patient to drink DI
diagnosed if:
SOSM rises to 293 mOsm/kg (normal: 283-293 mOsm/kg); U OSM remains 300 mOsm/kg
Desmopressin (a synthetic vasopressin analogue) is given to distinguish between cranial and
nephrogenic DI**:
Cranial DI, urine now concentrates to 750 mOsm/kg
Nephrogenic DI, urine still fails to concentrate, U OSM remains 750 mOsm/kg
Hypokalaemia and hypercalcaemia can suggest nephrogenic DI
Psychogenic polydipsia (i.e. habitual excess water intake): S OSM should remain 293 mOsm/kg,
commonly with partial concentration of urine. If S OSM remains normal and UOSM fails to concentrate with
continued urine output, suspect covert drinking
Treatment
Ensure an intact sense of thirst and free access to fluid
Desmopressin provides hormone replacement for cranial DI
*Syndromes arising from gene mutations are due to loss of function.
**If desmopressin has been administered at the end of the water deprivation test, restrict fluid intake to <500 mL over the next
8h to avoid risk of profound hyponatraemia (e.g. in cranial DI or polydipsic patients).