Syndrome of inappropriate antidiuretic hormone secretion

Last revised by Daniel J Bell on 20 Oct 2021

The syndrome of inappropriate antidiuretic hormone secretion (SIADH or SIAD) (also known as Schwartz-Bartter syndrome) was initially described in patients with lung cancer who developed hyponatremia associated with continued urinary sodium loss. The result is often dilutional hyponatremia in which the sodium remains normal but total body fluid increases.

Inappropriate (excessive) release of antidiuretic hormone (ADH), now known as arginine-vasopressin (AVP), may be caused by 4,6

The optimal therapy for SIADH is to treat the underlying cause. If this is not possible, or if the disease has become refractory, other treatment methods are available such as water restriction, demeclocycline therapy, or in severe cases infusion of hypertonic saline together with furosemide during careful monitoring.

In 1957 the celebrated American nephrologist William B Schwartz (1923-2009) 8 and colleagues (including the American endocrinologist Frederic Bartter ((1914–1983) 7), first described the syndrome of inappropriate antidiuretic hormone secretion. ‘Inappropriate’ was employed because of the observed loss of the normal linkage between ADH secretion and serum osmolality 4,5.

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