SIADH: The Daily PANCE Blueprint

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SIADH: The Daily PANCE Blueprint

A 70-year-old on SSRIs presents with confusion and mild gait instability. Sodium is 121. Physical exam shows normal JVP and moist mucous membranes. Labs reveal urine osm >100 mOsm/kg, urine Na >40 mEq/L, and normal thyroid and adrenal studies. Most likely diagnosis?

A. SIADH
B. Adrenal insufficiency
C. Hypothyroidism
D. Psychogenic polydipsia
E. CHF

Answer and topic summary

The answer is SIADH

SIADH produces euvolemic hyponatremia with inappropriately concentrated urine (osm >100) and urine sodium >40 due to persistent ADH secretion despite normal volume status.

  • Adrenal insufficiency – Hyponatremia + hyperkalemia, hypotension; cortisol deficiency increases ADH but other abnormalities would be present.
  • Hypothyroidism – Hyponatremia usually mild; TSH abnormal.
  • Psychogenic polydipsia – Urine osm <100 due to maximal dilution.
  • CHF – Hypervolemic state with edema, elevated JVP, low urine sodium (<20).
View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Endocrine Neoplasms ⇒ Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

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