ECE2016 Eposter Presentations Pituitary - Clinical (83 abstracts)
“The incidence of central adrenal insufficiency in euvolaemic hyponatraemia. Results of a large prospective study”
Martín Cuesta 1 , David Slattery 1 , Aoife Garrahy 1 , Anne Marie Hannon 1 , Elizabeth Tatro 1 , Saket Gupta 1 , Mark Sherlock 3 , William Tormey 2 & Christopher J Thompson 1
1Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 2Department of Chemical Pathology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 3Department of Endocrinology, The Adelaide and Meath Hospital, Dublin, Ireland.
Context: The syndrome of inappropriate antidiuresis(SIAD) is the commonest cause of hyponatraemia. Data on the aetiology of SIAD is mainly derived from retrospective studies, often with poor ascertainment of minimum criteria for correct diagnosis. Although central adrenal insufficiency(CAI) is known to cause euvolaemic hyponatraemia, the incidence of undiagnosed CAI in SIAD is unknown.
Objective: To establish the incidence of CAI in SIAD.
Design: Prospective, single-centre study from January 1st to October 1st 2015.
Patients: 1323 admissions with hyponatraemia were prospectively evaluated; 573 (43.4%) classified as SIAD. Full ascertainment of the criteria for diagnosis of SIAD was obtained in 83% of patients.
Methods: Patients underwent a short synacthen test (SST) if 09:00 hour cortisol was<300 nmol/l. The diagnosis of CAI was stablished with symptoms of adrenal insufficiency and a 09:00 hour cortisol<100 nmol/l, or cortisol peak following SST<500 nmol/l.
Results: CNS diseases were the commonest cause of SIAD (n=148.26%) followed by pulmonary diseases (n=111.19%) malignancy (n=105.18%) and drugs (n=47.8%). 14/573 (2.4%) had CAI. 7/14 (50%) were related to recent exogenous glucocorticoid administration; 6 patients (42%) had new onset hypopituitarism; (pituitary apoplexy, n=1, ipilimumab induced hypophysitis, n=1, pituitary metastasis, n=1, traumatic brain injury (TBI), n=1, viral meningitis, n=1 and new diagnosis of empty sella syndrome, n=1). One other had CAI possibly due to previous TBI. 4 patients (28%) had a clinical diagnosis of acute adrenal crisis. Hyponatraemia resolved in 10/14 (71%) of patients following treatment with glucocorticoids, but 4 patients remained hyponatraemic at hospital discharge. In this subgroup, the underlying causes were possibly SIAD due to bronchiectasis (N=1), COPD (N=1) metastatic malignancy (N=1) and Venlafaxine (N=1).
Conclusion: In this large, well-characterized, prospective cohort of SIAD patients, the incidence of CAI was 2.4%; undiagnosed primary pituitary disease occurred in 1% of patients. Screening for CAI is an essential component of the diagnostic approach in SIAD.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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