Investigation Of NT-proBNP Level In Hyponatremia Due To Endocrine Causes
Research Article
DOI:
https://doi.org/10.5281/zenodo.11352692Keywords:
NT-proBNP, Syndrome of inappropriate secretion of ADH, Hyponatremia, Hypophyseal insufficiencyAbstract
Introtuction: Inappropriate ADH secretion syndrome and pituitary insufficiency are endocrine causes of hyponatremia. The main reason in both groups is the direct or indirect increase in ADH secretion.Fluid retention occurs with the increase in ADH secretion. Fluid retention leads to cardiac strain, and it is thought that it may cause increased secretion of BNP and NT-proBNP .
Aim: Studies on the effects of natriuretic peptides on hyponatremia are scarce due to endocrine causes. The relationship between thyroid hormone disorders and Brain natriuretic peptide (BNP) has been examined in existing studies. Within the scope of this research.we aimed to elucidate the relationship between NT-proBNP and hyponatremia in inappropriate ADH secretion syndrome and pituitary insufficiency.
Method: This prospective study included 14 patients with hyponatremia, inappropriate ADH secretion syndrome, nine patients with pituitary insufficiency who applied to our institution, and 21 healthy volunteers with no systemic disease and serum sodium levels within the normal range. Laboratory tests of the patient group (fasting blood sugar, serum sodium level, spot urine sodium, creatinine, urine osmolarity, and anterior pituitary hormones of patients with suspected pituitary insufficiency) were recorded from the patient files .
Results: Basal sodium levels were statistically significant among the three groups. The median basal sodium level was 127 (meq/l) in the pituitary insufficiency group, 124 (meq/l) in the inappropriate ADH secretion syndrome group, and 138 (meq/l) in the control group (p<0.0001). The median NT-proBNP level was found to be 671 (pg/ml) in the pituitary insufficiency group, 499 (pg/ml) in the inappropriate ADH secretion syndrome group, and 119 (pg/ml) in the control group (p<0.0001). As a result of ROC analysis, serum NT-proBNP values were found to have diagnostic value in predicting hyponatremia due to endocrinological reasons (inappropriate ADH secretion syndrome and pituitary insufficiency) (AUC:0.87 95% confidence interval 0.763 – 0.977, p<0.0001). This value's recommended limit value is 141 (sensitivity: 91.3% and specificity: 66.7%).
Conclusion: This research elaborated that while plasma sodium levels were low in the inappropriate ADH secretion syndrome and pituitary insufficiency groups, the NT-proBNP levels were higher, showing a statistically significant difference between the three groups.
References
Workeneh BT, Meena P, Christ-Crain M, Rondon-Berrios H. Hyponatremia Demystified: Integrating Physiology to Shape Clinical Practice. Adv Kidney Dis Health. 2023;30(2):85-101. doi:10.1053/j.akdh.2022.11.004
Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocr Rev. 2023;44(5):819-861. doi:10.1210/endrev/bnad010
Sterns RH, Rondon-Berrios H, Adrogué HJ, et al. Treatment Guidelines for Hyponatremia: Stay the Course. Clin J Am Soc Nephrol. Published online June 28, 2023. doi:10.2215/CJN.0000000000000244
Adrogué HJ, Madias NE. The Syndrome of Inappropriate Antidiuresis. N Engl J Med. 2023;389(16):1499-1509. doi:10.1056/NEJMcp2210411
Tsutsui H, Albert NM, Coats AJS, et al. Natriuretic peptides: role in the diagnosis and management of heart failure: a scientific statement from the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. Eur J Heart Fail. 2023;25(5):616-631. doi:10.1002/ejhf.2848
Ibrahim NE, Januzzi JL Jr. NT-proBNP Concentrations in the Community: Elevation, Deficiency, and Everything in Between. JACC Heart Fail. 2024;12(1):64-66. doi:10.1016/j.jchf.2023.08.014
Adamo M, Pagnesi M, Mebazaa A, et al. NT-proBNP and high intensity care for acute heart failure: the STRONG-HF trial. Eur Heart J. 2023;44(31):2947-2962. doi:10.1093/eurheartj/ehad335
Samad M, Malempati S, Restini CBA. Natriuretic Peptides as Biomarkers: Narrative Review and Considerations in Cardiovascular and Respiratory Dysfunctions. Yale J Biol Med. 2023;96(1):137-149. doi:10.59249/NCST6937
Bayes-Genis A, Docherty KF, Petrie MC, et al. Practical algorithms for early diagnosis of heart failure and heart stress using NT-proBNP: A clinical consensus statement from the Heart Failure Association of the ESC. Eur J Heart Fail. 2023;25(11):1891-1898. doi:10.1002/ejhf.3036
Schultz M, Faber J, Kistorp C, et al. N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) in different thyroid function states. Clin Endocrinol (Oxf). 2004;60(1):54-59. doi:10.1111/j.1365-2265.2004.01941.x
Ertugrul DT, Yavuz B, Ata N, et al. Decreasing brain natriuretic peptide levels after treatment for hyperthyroidism. Endocr J. 2009;56(9):1043-1048. doi:10.1507/endocrj.k09e-159
Oelkers W. Hyponatremia and inappropriate secretion of vasopressin (antidiuretic hormone) in patients with hypopituitarism. N Engl J Med. 1989;321(8):492-496. doi:10.1056/NEJM198908243210802
Popp KH, Athanasoulia-Kaspar AP, Stalla GK. Hypophyseninsuffizienz – das Einmaleins in Diagnostik und Therapie [Pituitary insufficiency: basics in diagnosis and therapy]. Dtsch Med Wochenschr. 2023;148(7):386-394. doi:10.1055/a-1853-5881
Tobin G, Chacko AG, Simon R. Evaluation of NT-ProBNP as a marker of the volume status of neurosurgical patients developing hyponatremia and natriuresis: A pilot study. Neurol India. 2018;66(5):1383-1388. doi:10.4103/0028-3886.241401
Yasir M, Mechanic OJ. Syndrome of Inappropriate Antidiuretic Hormone Secretion. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 6, 2023.
Seay NW, Lehrich RW, Greenberg A. Diagnosis and Management of Disorders of Body Tonicity-Hyponatremia and Hypernatremia: Core Curriculum 2020. Am J Kidney Dis. 2020;75(2):272-286. doi:10.1053/j.ajkd.2019.07.014
Sayan S, Kotan D. Levels of brain natriuretic peptide as a marker for the diagnosis and prognosis of acute ischemic stroke. Arch Med Sci Atheroscler Dis. 2016;1(1):e16-e22. doi:10.5114/amsad.2016.59751
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Medica Ruha
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.