The never-ending story of hyponatremia: a current problem to overcome
  • Benedetta Marigliano
    Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
  • Luigi Scuro
    UOC Pronto Soccorso e Medicina d’Urgenza, Azienda Ospedaliera San Camillo – Forlanini, Rome, Italy


Hyponatremia, syndrome of inappropriate ADH secretion, cerebral salt-wasting syndrome


Hyponatremia is a common complication in patients undergoing neurosurgery. If undiagnosed, it has a negative prognostic impact. The two dominant causes of refractory hyponatremia include syndrome of inappropriate ADH secretion (SIADH) and cerebral salt wasting syndrome (CSWS). Discrimination between the two types of disease is not always obvious. We present a case of undiagnosed chronic hyponatremia caused by CSWS after neurosurgery, which not only resulted in a longer hospital stay but also slowed the patient’s postoperative recovery. Meticulous clinical evaluation and the performance of appropriate laboratory tests are therefore essential not only for decisive treatment, but also for the establishment of comprehensive diagnostic algorithms that allow timely diagnosis and decisive therapy.



  • Althaus AE, Krapf R. Quality and cost considerations in hyponatraemic patients needing hospitalization. Swiss Med Wkly 2018;148:w14662.
  • Guerrero R, Pumar A, Soto A, Pomares MA, Palma S, Mangas MA, et al. Early hyponatremia after pituitary surgery: cerebral salt-wasting syndrome. Eur J Endocrinol 2007;156:611-616.
  • Cui H, Guangyu H, Yang S, Lv Y, Jiang Z, Gang X, et al. Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in neurological patients. Front Neurosci 2019;13:1770.
  • Misra UK, Kalita J, Kumar M. Safety, and efficacy of fludrocortisone in the treatment of cerebral salt wasting in patients with tuberculous meningitis: a randomized clinical trial. JAMA Neurol 2018;75:1383-1391.
  • Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 2006;116:S36-42.
  • Casulari LA, Costa KN, Albuquerque R, Naves LA, Suzuki K, Domingues L. Differential diagnosis and treatment following pituitary surgery. J Neurosurg Sci 2004;48:11-18.
  • Bitew S, Imbriano L, Miyawaki N, Fishbane S, Maesaka JK. More on renal salt wasting without cerebral disease: response to saline infusion. Clin J Am Soc Nephrol 2009;4:309-315.
  • Berendes E, Walter M, Cullen P, Prien T, Van Aken H, Horsthemke J, et al. Secretion of brain natriuretic peptide in patients with aneurysmal subaracnoid haemorrhage. Lancet 1997;349:245-249.
  • Maesaka JK, Imbriano LJ, Mattana J, Gallagher D, Bade N, Sharif S. Differentiating SIADH from cerebral/renal salt wasting: failure of the volume approach and need for a new approach to hyponatremia. J Clin Med 2014;3:1373-1385.
  • Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342:1581-1589.
  • Views: 265
    HTML downloads: 14
    PDF downloads: 108

    Published: 2024-06-10
    Issue: 2024: Vol 11 No 7 (view)

    How to cite:
    Marigliano B, Scuro L. The never-ending story of hyponatremia: a current problem to overcome. EJCRIM 2024;11 doi:10.12890/2024_004609.

    Most read articles by the same author(s)