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Syndrome of Inappropriate ADH Secretion: Sensitivity and Specificity

Introduction: SIADH a major cause of hyponatremia and represents the condition when a euvolemic patient has increased ADH causing inappropriate retention of free water. The diagnosis is important as the treatment is fluid restriction rather than normal saline infusion.

For a review of the diagnosis, see http://cjasn.asnjournals.org/cgi/content/full/3/4/1175 (PMID 18434618)

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Tags: Endocrine Tag this Diagnosis.

Differential Diagnoses include: Hypovolemia

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Elderly patients with hyponatremia 31% 110 consecutive cases: 31% SIADH patients, 23% patients with hyponatremia due to diuretics, 18% potomania patients, 15% salt depleted patients, 5% salt depleted SIADH patients, 5% patients with a salt loosing syndrome and 3% patients with hyponatremia of unknown origin

Int Urol Nephrol. 2001;32(3):475-93. PMID: 11583374

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The sensitivity and specificity of findings for Syndrome of Inappropriate ADH Secretion are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %. Post-Test Probability (Predictive Value): %. Switch to display mode.
**Note that calculating probabilities from more than one finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)
Specific Findings
FindingResult SensitivitySpecificity
[ + ] Fractional Excretion of Sodium + 0 - 68%100%
Sensitive Findings
FindingResult SensitivitySpecificity
[ + ] Urine Sodium + 0 - 90%70%
Poorly Diagnostic Findings
FindingResult SensitivitySpecificity
[ + ] Plasma Urea + 0 - 80%80%
[ + ] Fractional Excretion of Urea + 0 - 52%80%
[ + ] Uric Acid + 0 - 73%59%
[ + ] Clinical Assessment of Volume Status + 0 - 48%53%