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FEATURE ARTICLE
• CJON Writing Mentorship Program Paper •
Syndrome of Inappropriate Antidiuretic
Hormone Secretion in Malignancy: Review
and Implications for Nursing Management
Lori A. Langfeldt, RN, BSN, OCN ®, and Mary E. Cooley, PhD, CRNP, CS
yponatremia is a comADH acts on the V2 receptors,
mon fluid and electrowhich are located in the collectHyponatremia is a common fluid and electrolyte disturlyte disturbance in
ing ducts (Robertson, 2001). The
bance in adults with cancer. Although a number of etioloadults with cancer. Hyponatreensuing reaction from the ADH
gies are associated with hyponatremia, the syndrome of
mia has many causes, including
and V2 complex causes water
inappropriate antidiuretic hormone (SIADH) secretion is
channels to be inserted into the
the primary tumor, metastasis,
apical cell membrane, making
diagnostic procedures, and
one of the most common underlying causes. Early sympthe cell permeable to water
therapeutic interventions, or it
toms often associated with SIADH are subtle but, if left
(Haapoja, 2000; Robertson).
can result as a secondary comuntreated, may progress to life-threatening seizures,
This promotes water reabsorpplication (Berghmans, 1996;
tion and decreases urine output
McDonald & Dubrose, 1993).
coma, and death. Because oncology nurses have frequent
(Haapoja; Poe & Taylor, 1989).
Although the syndrome of inapand ongoing contact with patients, they are in an ideal
The third mechanism of action
propriate antidiuretic hormone
position to recognize patients who are at increased risk for
occurs in the cardiovascular sys(SIADH) secretion is a rare
SIADH and those who present with early symptoms. Betem. The body is able to sense
paraneoplastic syndrome (ocshifts in the circulating blood volcurring in 1%–2% of adults with
ginning signs and symptoms are mild and can be mistakume and blood pressure by the
cancer), it is a common underenly attributed to other causes. This article reviews the
stretch receptors in the left atrium
lying etiology for hyponatremia
pathophysiology of SIADH, associated risk factors, signs
and baroceptors in the aortic arch
(Poe & Taylor, 1989). In fact,
and symptoms, diagnosis, treatment, and nursing care.
and carotid sinus (Terpstra &
several studies have identified
Terpstra, 2000). These receptors
that SIADH is among the most
Key Words: inappropriate ADH syndrome; hyponatrerelease atrial natriuretic peptide
common reasons for hyponatremia; carcinoma, small cell
(ANP) in response to increased
mia and accounts for up to oneatrial pressure (Smeltzer & Bare,
third of cases (Anderson, Chung,
Kluge, & Schrier, 1985; Berghmans, physeal system. ADH is produced in special 2002). ANP acts on the distal tubule and colPaesmans, & Body, 2000; Miller, Hecker, neurosecretory cells in the supraoptic and lecting ducts to decrease water and sodium
Friedlander, & Carter, 1996). Therefore, on- paraventricular nuclei of the posterior hypo- chloride reabsorption (Guyton & Hall, 1996).
The fourth mechanism is the stimulation
cology nurses must be knowledgeable about thalamus (Keenan, 1999; Terpstra & Terpthis syndrome. This article provides a review stra). ADH is stored and released by the pos- of the limbic system. ADH production is inof the pathophysiology, risk factors, signs terior pituitary gland (Batcheller, 1994). The creased by limbic stimulation (Terpstra &
and symptoms, diagnosis, treatment, and ap- production and release of ADH is regulated Terpstra, 2000). The limbic system is an inpropriate nursing management of patients by receptors located in the kidneys, heart, and terconnected complex of basal brain function,
brain. Normally, ADH is secreted in response and its control center is the hypothalamus
with SIADH.
to increased serum osmolality and decreased (Guyton & Hall, 1996). One major function
plasma volume (Finley, 1998a). The release of the limbic system is to control behavior,
Pathophysiology
of ADH is inhibited by low plasma volume but it also controls many internal functions,
Sodium and water balance is tightly regu- or an increased circulating blood volume. including osmolality of body fluids (Guyton
lated in narrow physiologic ranges. Four When serum osmolality reaches 295 mOsm/ & Hall). Stimulation of the limbic system, by
mechanisms are involved in the regulation of kg, arginine vasopressin (AVP), the biologic
sodium and water (Terpstra & Terpstra, active form of ADH, is released (Haapoja,
Submitted February 2003. Accepted for pub2000). The first mechanism is the secretion 2000; Metheny, 1982; Terpstra & Terpstra).
lication March 3, 2003.
and regulation of antidiuretic hormone
The second mechanism of action occurs
(ADH) from the hypothalamus-neurohypo- in the kidneys (Terpstra & Terpstra, 2000). Digital Object Identifier: 10.1188/03.CJON.425-430
H
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 7, NUMBER 4 • SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION IN MALIGNANCY
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