title: Malignancy associated SIADH: Characterization and clinical implications.
abstract: OBJECTIVE
  To determine the distribution of etiologies for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients with active malignancies and to characterize them according to the different etiologies.
  
  
  METHODS
  A single center retrospective study including all patients with active malignancies diagnosed with SIADH in a large community hospital and tertiary center between 1 January 2007 and 1 January 2013. Two physicians reviewed every patient's medical file for predetermined relevant clinical data.
  
  
  RESULTS
  The study cohort included 204 patients. 74.4% of those with solid tumors had metastatic disease. Most patients (149, 73%) had malignancy associated SIADH, while 55 (27%) had SIADH due to other etiologies. All of the major malignancy types were implicated in SIADH. Patients with breast cancer without lung or brain involvement were significantly less likely to be diagnosed with malignancy associated SIADH compared with other malignancies [Odds ratio (OR) 0.031, 95% CI 0.003-0.25, p < 0.001]. Patients with malignancy associated SIADH had lower serum sodium concentrations on short-term follow-up (p = 0.024) and significantly shorter median survival (58 vs. 910 days, p < 0.001). Short-term hyponatremia correction was associated with better survival.
  
  
  CONCLUSIONS
  SIADH is associated with most malignancy types. Physicians caring for patients with breast cancer without lung or brain involvement diagnosed with SIADH without an obvious etiology should consider obtaining lung and brain imaging to rule out undiagnosed metastatic spread. Patients with malignancy associated SIADH have considerably worse outcomes compared to cancer patient with SIADH due to other etiologies. Short-term sodium concentration can be used as a prognostic marker for these patients.
authors.affiliation: a Institute of Oncology , Davidoff Center, Rabin Medical Center , Petach Tikva , Isarel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: H
authors.initials: H
authors.lastname: Goldvaser
authors.affiliation: b Department of Nephrology , Rabin Medical Center , Petah-Tikva , Israel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: B
authors.initials: B
authors.lastname: Rozen-Zvi
authors.affiliation: a Institute of Oncology , Davidoff Center, Rabin Medical Center , Petach Tikva , Isarel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: R
authors.initials: R
authors.lastname: Yerushalmi
authors.affiliation: c Medicine A , Beilinson Hospital, Rabin Medical Center , Petach Tikva , Israel.|d Institute of Hematology , Davidoff Center, Rabin Medical Center , Petach Tikva , Israel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: A
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: d Institute of Hematology , Davidoff Center, Rabin Medical Center , Petach Tikva , Israel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: M
authors.initials: M
authors.lastname: Lahav
authors.affiliation: c Medicine A , Beilinson Hospital, Rabin Medical Center , Petach Tikva , Israel.|e Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: D
authors.initials: D
authors.lastname: Shepshelovich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D007177:Inappropriate ADH Syndrome / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D012964:Sodium