Síndrome de secreção inapropriada de hormônio antidiurético
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- ausência de hipovolemia
- ausência de hipervolemia
- ausência dos sinais de insuficiência adrenal ou hipotireoidismo
- náuseas
- vômitos
- estado mental alterado
- cefaleia
- convulsão
- coma
Outros fatores diagnósticos
- sem história de uso recente de diuréticos
Fatores de risco
- idade >50 anos
- doenças pulmonares (por exemplo, pneumonia)
- residentes de instituições asilares
- estado pós-operatório
- neoplasias malignas
- medicamento associado à indução da SIHAD
- distúrbio do sistema nervoso central (SNC)
- exercício de resistência
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- sódio sérico
- osmolalidade sérica
- ureia sérica
- osmolalidade urinária
- sódio urinário
Investigações a serem consideradas
- prova terapêutica com infusão de soro fisiológico
- ácido úrico sérico
- excreção fracionada de sódio
- excreção fracionada de ureia
- hormônio estimulante da tireoide (TSH) sérico
- nível de cortisol sérico
- arginina-vasopressina (AVP) sérica
Algoritmo de tratamento
sintomas graves
sintomas leves a moderados
assintomático com sódio ≥125 mmol/L (≥125 mEq/L)
síndrome de secreção inapropriada de hormônio antidiurético (SIHAD) crônica persistente
Colaboradores
Autores
Megan Dixon, MD
Nephrologist
Arizona Kidney Disease and Hypertension Center
Phoenix
AZ
Declarações
MD declares that she has no competing interests.
Yeonghau Howard Lien, MD, PhD
Professor Emeritus of Medicine
Division of Nephrology
University of Arizona
Tucson
AZ
Disclosures
YHL is an author of a reference cited in this topic.
Peer reviewers
Maryam Gondal, MD
Assistant Professor
Nephrology
Yale University
New Haven
CT
Disclosures
MG declares that she has no competing interests.
Judith H. Veis, MD
Associate Director
Nephrology
Washington Hospital Center
Washington
DC
Disclosures
JHV declares that she has no competing interests.
Laurie Solomon, MD, FRCP
Consultant Nephrologist
Renal Unit
Lancashire Teaching Hospitals
Fulwood
Preston
UK
Disclosures
LS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Gross P. Clinical management of SIADH. Ther Adv Endocrinol Metab. 2012 Apr;3(2):61-73.Full text Abstract
Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014 Mar;170(3):G1-47.Full text Abstract
Ball S, Barth J, Levy M, et al. Society for Endocrinology endocrine emergency guidance: emergency management of severe symptomatic hyponatraemia in adult patients. Endocr Connect. 2016 Sep;5(5):G4-6.Full text Abstract
Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 suppl 1):S1-42.Full text Abstract
Ellison DH, Berl T. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007 May 17;356(20):2064-72.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Pseudo-hiponatremia
- Hipovolemia
- Síndrome cerebral perdedora de sal
More DifferentialsGuidelines
- Emergency management of severe symptomatic hyponatraemia in adult patients
- Clinical practice guideline on diagnosis and treatment of hyponatraemia
More Guidelines
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