Internal and Emergency Medicine

, Volume 13, Issue 5, pp 679–688 | Cite as

Endocrinopathy-induced euvolemic hyponatremia

  • Talia Diker-CohenEmail author
  • Benaya Rozen-Zvi
  • Dana Yelin
  • Amit Akirov
  • Eyal Robenshtok
  • Anat Gafter-Gvili
  • Daniel Shepshelovich


Euvolemic hyponatremia results from either the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, or adrenal insufficiency. Furthermore, the criteria for diagnosis of SIADH entail the exclusion of hypothyroidism and hypoadrenalism. We aim to assess the yield of euvolemic hyponatremia workup focusing on underlying endocrinopathies in a real-world setting. A single-center retrospective study includes all patients diagnosed with euvolemic hyponatremia in a tertiary hospital between 1.1.2007 and 1.1.2013. Demographic, clinical, and laboratory data were collected from medical charts. Euvolemic hyponatremia was detected in 564 patients. Thyroid function was tested in 69% (391/564) and adrenal function was assessed in 29% (164/564) of cases. Endocrinopathy-induced euvolemic hyponatremia was diagnosed in nine (1.6%) patients: three patients were diagnosed with hypothyroidism-induced hyponatremia, three with adrenal insufficiency as an underlying cause, and three with central hypothyroidism and central hypoadrenalism. All nine had medical history and symptoms suggestive of endocrine deficiencies other than the hyponatremia, which resolved within 1–3 days after administration of hormone replacement therapy. Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. However, in this real-world study, only a limited number of patients underwent a full ascertainment of hypoadrenalism and hypothyroidism, which was diagnosed only in patients with additional findings supportive of these endocrinopathies; a higher rate of undiagnosed endocrinopathies cannot be ruled out. As both hypoadrenalism and hypothyroidism are easily treatable, potentially life-threatening conditions, there are insufficient data to change current recommendation for their universal evaluation in patients with euvolemic hyponatremia.


Hypothyroidism Adrenal insufficiency Hyponatremia SIADH Thyroid Cortisol 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no confict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of retrospective study formal consent is not required.


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Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Medicine A, Beilinson HospitalRabin Medical CenterPetah-TikvaIsrael
  2. 2.Institute of Endocrinology, Diabetes and Metabolism, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
  3. 3.Department of Nephrology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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