Differentiating appropriate antidiuretic hormone secretion, inappropriate antidiuretic hormone secretion and cerebral salt wasting: the common, uncommon, and misnamed

  title={Differentiating appropriate antidiuretic hormone secretion, inappropriate antidiuretic hormone secretion and cerebral salt wasting: the common, uncommon, and misnamed},
  author={Scott A. Rivkees},
  journal={Current Opinion in Pediatrics},
  • S. Rivkees
  • Published 1 August 2008
  • Medicine
  • Current Opinion in Pediatrics
Purpose of review Causes of hyponatremia in children include the syndrome of appropriate antidiuretic hormone secretion, the syndrome of inappropriate antidiuretic hormone secretion and cerebral salt wasting. The purpose of this review is to distinguish these possibilities, focusing on cerebral salt wasting. Recent findings Most cases of hyponatremia in children are due to the syndrome of appropriate antidiuretic hormone secretion. The syndrome of inappropriate antidiuretic hormone secretion… 
yndrome d ’ antidiurèse inappropriée ( sécrétion inappropriée d ’ hormone ntidiurétique ) he syndrome of inappropriate antidiuresis
Urea appears at present as the first-line treatment of hyponatremia in SIAD, and vaptans have demonstrated their good tolerance and their efficacy on the Adresse e-mail : thierry.frouget@chu-rennes.fr.
Syndrome of inappropriate antidiuresis and cerebral salt wasting syndrome: are they different and does it matter?
  • M. Moritz
  • Medicine, Biology
    Pediatric Nephrology
  • 2012
The syndrome of inappropriate antidiudresis (SIAD) and cerebral salt wasting (CSW) are similar conditions with the main difference being the absence or presence of volume depletion, but carefully conducted studies in patients with CNS disease have indicated that CSW may be more common than SIAD.
Renal salt-wasting syndrome in children with intracranial disorders
The key to diagnosis of renal salt-wasting lies in the assessment of extra-cellular volume status: the central venous pressure is currently considered the yardstick for measuring fluid volume status in subjects with intracranial disorders and hyponatremia.
Cerebral salt-wasting syndrome in a patient with status epilepticus: a rare association
A 46-year-old gentleman who was admitted to intensive care unit (ICU) with status epilepticus and developed hyponatraemia during course of his ICU stay, diagnosed as CSWS and managed with normal saline and fludrocortisone is presented.
[A Case of Severe Hyponatremia Caused by Renal Salt Wasting Syndrome in Oropharyngeal Cancer].
A male with advanced oropharyngeal cancer is presented, who was treated with radiotherapy with concurrent administration of cisplatin and who underwent a total of three episodes of severe hyponatremia, due to the syndrome of inappropriate antidiuretic hormone secretion after surgery for a bone fracture.
Chronic Hyponatremia Due to the Syndrome of Inappropriate Antidiuresis (SIAD) in an Adult Woman with Corpus Callosum Agenesis (CCA)
A rare case of chronic hyponatremia associated with the syndrome of inappropriate antidiuresis associated with CCA is reported that demonstrates the importance of correct diagnosis, management, and clinical follow-up of the SIAD, including bone densitometry.
Recent advances in the management of hyponatremia in cancer patients
The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia, and the use of serum and urine parameters that distinguish SIAD from other etiologies is discussed.
Clinical Approach to Sodium Homeostasis Disorders in Children with Pituitary-Suprasellar Tumors
The main challenge in the management of sodium homeostasis disorders in children with pituitary-suprasellar tumors is to promptly distinguish the AVP release disorder at the base of the sodium imbalance and treat it correctly by avoiding rapid sodium fluctuations.
Etiology of postoperative hyponatremia following pediatric intracranial tumor surgery.
Cerebral salt wasting was more common following intracranial tumor surgery and was associated with younger age and female sex, making appropriate diagnosis and treatment imperative to prevent morbidity.


Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion
The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS.
Cerebral Salt-Wasting Syndrome: Does It Exist?
A review of renal/CSWS reveals three studies involving hyponatremic neurosurgical patients who had decreased blood volume, decreased central venous pressure, and inappropriately high urinary sodium concentrations in the majority of them, suggesting that CSWS was more common than SIADH in neuros surgical patients.
Hyponatremia hypo-osmolarity in neurosurgical patients. “Appropriate secretion of ADH” and “Cerebral salt wasting syndrome”
Here, the aetiology seems to be a renal salt loss, eventually in relation to a natriuric factor (e.g. atrial natriuretic factor), justifying the term: “Cerebral salt wasting syndrome”.
Cerebral salt wasting in children. The need for recognition and treatment.
These patients showed true salt wasting associated with acute or chronic CNS injury, with hormonal patterns consistent with "inappropriate" ANH secretion and distinct from the SIADH.
Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
Blood volume determinations were made in 12 unselected neurosurgical patients with intracranial disease who fulfilled the laboratory criteria for SIADH and ten patients had significant decreases in their red blood cell mass, plasma volume, and total blood volume.
[Does cerebral salt wasting syndrome exist?].
The word "cerebral" in CSWS is probably not a good term and it would be better to talk about appropriate or non-appropriate natriuretic response, depending on the level of blood pressure, the volemia, and the presence or not of natriUREtic peptides.
Mineralocorticoid Deficiency in Post-Operative Cerebral Salt Wasting
Fludrocortisone supplementation should be considered in CSW, as excessive natriuresis is controlled, and electrolytes are easily restored, avoiding life-threatening complications of this complex disorder.
Acute symptomatic hyponatremia and cerebral salt wasting after head injury: an important clinical entity.
The case of a 4.5-year-old boy presenting with major head injury who at day 6 after admission had generalized tonic-clonic seizures caused by severe acute hyponatremia, and highly increased levels of atrial natriuretic peptide (ANP) confirmed the diagnosis of CSW.
The hyponatremic patient: a systematic approach to laboratory diagnosis.
Levels of hormones (thyroid-stimulating hormone and cortisol) and arterial blood gases should be determined in difficult cases of hyponatremia and in patients with normal or elevated effective serum osmolality in the hypo-osmolar state.