Shepshelovich Daniel, Leibovitch Chiya, Klein Alina, Zoldan Shirit, Shochat Tzippy, Green Hefziba, Rozen-Zvi Benaya, Lahav Meir, Gafter-Gvili Anat
Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
Eur J Intern Med. 2016 Jul;32:60-4. doi: 10.1016/j.ejim.2016.03.008. Epub 2016 Mar 24.
To determine the proportion of patients for whom the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the presenting symptom of an underlying disorder, to describe the yield of different diagnostic modalities for patients with SIADH and an unknown etiology, and to define patients for whom such a workup is indicated.
A single center retrospective study including all patients diagnosed with SIADH without an apparent etiology in a large community hospital and tertiary center between 1.1.07 and 1.1.13. Two physicians reviewed every patient's medical file for predetermined relevant clinical data.
Eleven of the 99 patients without an apparent etiology for SIADH at presentation were found to have an underlying cause on workup. Yield of performed workup was low, with a pathology demonstrated on 0%-30.8% of tests according to the different modalities used. Patients with presumed idiopathic SIADH at presentation who were later found to have a specific etiology were younger than patients with true idiopathic SIADH, had a significantly shorter duration of hyponatremia prior to SIADH diagnosis, had higher urine osmolality and a clinical presentation suggestive of an undiagnosed disorder.
Our findings support a clinically-based approach to patients with idiopathic SIADH, rather than an extensive routine workup for all patients.
确定抗利尿激素分泌不当综合征（SIADH）作为潜在疾病首发症状的患者比例，描述针对病因不明的SIADH患者不同诊断方式的诊断率，并明确需要进行此类检查的患者。
一项单中心回顾性研究，纳入了2007年1月1日至2013年1月1日期间在一家大型社区医院和三级中心被诊断为无明显病因的SIADH的所有患者。两名医生查阅了每位患者的病历以获取预先确定的相关临床数据。
99例初诊时无明显病因的SIADH患者中，有11例在检查后发现存在潜在病因。所进行检查的诊断率较低，根据使用的不同方式，检查显示有病理改变的比例在0%至30.8%之间。初诊时推测为特发性SIADH但后来发现有特定病因的患者比真正特发性SIADH患者更年轻，在SIADH诊断前低钠血症的持续时间明显更短，尿渗透压更高，且临床表现提示存在未确诊的疾病。
我们的研究结果支持对特发性SIADH患者采用基于临床的方法，而不是对所有患者进行广泛的常规检查。
