Best practice & research. Clinical endocrinology & metabolism最新文献

Hyponatraemic encephalopathy Hyponatraemic脑病。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-10-15 DOI: 10.1016/j.beem.2025.102062

Volker Rolf Burst (Board certified in Internal Medicine, Nephrology, Intensive Care Medicine, Emergency Medicine) , Victor Suárez (Board certified in Internal Medicine, Nephrology, Anesthesiology, Emergency Medicine)

{"title":"Hyponatraemic encephalopathy","authors":"Volker Rolf Burst (Board certified in Internal Medicine, Nephrology, Intensive Care Medicine, Emergency Medicine) , Victor Suárez (Board certified in Internal Medicine, Nephrology, Anesthesiology, Emergency Medicine)","doi":"10.1016/j.beem.2025.102062","DOIUrl":"10.1016/j.beem.2025.102062","url":null,"abstract":"<div><div>The most important clinical feature of hyponatraemia is its effect on the central nervous system. It is crucial to be familiar with the pathophysiological concepts of hypotonic stress and the various defence mechanisms against it. In many cases, the signs and symptoms associated with hyponatraemia are mild and will go undiscovered by both physician and patient. In some situations, however, the complications are severe and may lead to irreversible damage to the brain. The time course as well as the magnitude of the decline of sodium levels determine the severity of symptoms. Development of hyponatraemia within less than 48 h is called acute hyponatraemia and is associated with a more severe clinical picture while chronic hyponatraemia is often less dramatic. In this chapter, the acute and chronic changes and perturbations of the central nervous system in hyponatraemia as well as their clinical presentation – summarized as hyponatraemic encephalopathy – will be reviewed.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102062"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hyponatraemia and cancer 低钠血症和癌症。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-11-06 DOI: 10.1016/j.beem.2025.102066

Laura Naldi (Biotechnologist) , Benedetta Fibbi (Consultant endocrinologist) , Giada Marroncini (Biologist) , Dario Norello (Consultant endocrinologist) , Alessandro Peri (Consultant endocrinologist)

{"title":"Hyponatraemia and cancer","authors":"Laura Naldi (Biotechnologist) , Benedetta Fibbi (Consultant endocrinologist) , Giada Marroncini (Biologist) , Dario Norello (Consultant endocrinologist) , Alessandro Peri (Consultant endocrinologist)","doi":"10.1016/j.beem.2025.102066","DOIUrl":"10.1016/j.beem.2025.102066","url":null,"abstract":"<div><div>Hyponatraemia is the most common electrolyte alteration in cancer patients and the main cause is the syndrome of inappropriate antidiuresis. In this context, arginine vasopressin secretion can be due to ectopic secretion by tumoral cells or to drugs, including chemotherapeutics. It is known that hyponatraemia is associated with a worse prognosis in cancer. Conversely, the correction of serum [Na<sup>+</sup>] is associated with a favourable effect on the disease’s outcome. Basic research provided evidence that reduced [Na<sup>+</sup>] activates several intracellular pathways in cancer cells, which lead to an increased growth and invasiveness. Interestingly, vasopressin receptor antagonists, mainly used for the treatment of hyponatraemia secondary to the syndrome of inappropriate antidiuresis and in polycystic kidney disease, effectively reduced cancer cell proliferation in <em>in vitro</em> and <em>in vivo</em> experiments. Although this needs to be confirmed on clinical grounds, it is tempting to hypothesize that vasopressin receptor antagonists might have a possible role in future anti-cancer strategies.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102066"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pathophysiology and aetiologies of hypernatremia 高钠血症的病理生理学和病因学。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-10-25 DOI: 10.1016/j.beem.2025.102064

Juliana Beaudette Drummond , Lucas Guilherme de Oliveira Freitas , Izabella Silva Freitas , Raquel de Mattos Romanowski , Beatriz Santana Soares

{"title":"Pathophysiology and aetiologies of hypernatremia","authors":"Juliana Beaudette Drummond , Lucas Guilherme de Oliveira Freitas , Izabella Silva Freitas , Raquel de Mattos Romanowski , Beatriz Santana Soares","doi":"10.1016/j.beem.2025.102064","DOIUrl":"10.1016/j.beem.2025.102064","url":null,"abstract":"<div><div>Hypernatremia is a disorder of water balance defined by a serum sodium concentration above 145 mEq/L. It reflects a relative deficiency of free water rather than sodium excess. Under physiological conditions, hypothalamic osmoreceptors maintain plasma osmolality through stimulation of arginine vasopressin release- which promotes renal water conservation- and stimulation of thirst, which drives fluid intake. Hypernatremia develops when these defences fail due to impaired vasopressin secretion or action, diminished thirst, or inability to access water. The resultant hyperosmolality causes osmotic efflux of water from brain cells, leading to cerebral shrinkage and neurological dysfunction. Hypernatremia is most often observed in hospitalized patients, particularly the elderly, the critically ill, and those with impaired consciousness, and is associated with substantial morbidity and mortality. Unreplaced water loss, renal or extrarenal, is the predominant cause, whereas sodium overload is a less frequent mechanism. Accurate diagnosis and carefully titrated correction of water deficit are essential to prevent neurological injury.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102064"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New potential treatment options for syndrome of inappropriate antidiuresis 不适当抗利尿综合征新的潜在治疗选择。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-10-08 DOI: 10.1016/j.beem.2025.102055

Sophie Monnerat

{"title":"New potential treatment options for syndrome of inappropriate antidiuresis","authors":"Sophie Monnerat","doi":"10.1016/j.beem.2025.102055","DOIUrl":"10.1016/j.beem.2025.102055","url":null,"abstract":"<div><div>The syndrome of inappropriate antidiuresis (SIAD) is caused by increased renal water retention due to excessive arginine vasopressin (AVP) release from the posterior pituitary, enhanced kidneys sensitivity to AVP, or ectopic secretion of AVP or AVP-like peptides. Consequently, augmenting water clearance is a key therapeutic strategy, achievable either through osmotic diuresis or aquaresis. Osmotic diuresis has traditionally been induced with oral urea powder, however, two randomized placebo-controlled trials have demonstrated that glucosuria, induced by the SGLT2 inhibitor empagliflozin, effectively raises plasma sodium levels in both inpatients and outpatients with SIAD. An indirect urea-driven osmotic diuresis has also been observed in a controlled open-label study evaluating high-protein supplementation in outpatients with chronic SIAD. Aquaresis can be achieved with AVP receptor antagonists (vaptans) and, to a lesser extent, with loop diuretics. Moreover, preclinical and preliminary clinical data suggest that apelin, an endogenous neuropeptide that counteracts AVP in salt and water homeostasis, is effective in increasing plasma sodium levels in SIAD.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102055"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The treatment of acute symptomatic hyponatraemia in the hospital setting 急性症状性低钠血症在医院的治疗。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-12-09 DOI: 10.1016/j.beem.2025.102079

Rebecca Prince , Irina Chifu , Muhammad Fahad Arshad

引用次数: 0

Hyponatremia: Pathophysiology of different etiologies 低钠血症：不同病因的病理生理学。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2026-02-09 DOI: 10.1016/j.beem.2026.102084

Joseph G. Verbalis

{"title":"Hyponatremia: Pathophysiology of different etiologies","authors":"Joseph G. Verbalis","doi":"10.1016/j.beem.2026.102084","DOIUrl":"10.1016/j.beem.2026.102084","url":null,"abstract":"<div><div>Hyponatremia is the most frequently encountered electrolyte disorder in clinical practice. Understanding the pathophysiology of the many different etiologies of hyponatremia is essential for appropriate diagnosis and therapy of hyponatremic disorders. Hyponatremia can occur by an increase in total body water (TBW), a decrease in body Na<sup>+</sup> or K<sup>+</sup>, or any combination of these. In many cases, more than one of these mechanisms is operant. Therefore, a classification system to separate the various etiologies of hyponatremia should be based on factors other than the level of serum [Na<sup>+</sup>] itself. An assessment of extracellular fluid volume (ECF) volume provides the most useful working classification of the etiology of the hyponatremia, because a low serum [Na<sup>+</sup>] can be associated with a decreased, normal, or increased ECF volume. This chapter describes the known pathophysiologies associated with the three major classes of hyponatremia: Hyponatremia with decreased ECF volume (hypovolemic hyponatremia); Hyponatremia with increased ECF volume (hypervolemic hyponatremia); and Hyponatremia with normal ECF volume (euvolemic hyponatremia). For each disorder, both preclinical (translational) and clinical research studies is summarized to fully understand the factors involved with each disorder. Understanding the pathophysiology responsible for the development of hyponatremia with different etiologies is essential for informed evaluation and effective treatment of hyponatremic patients.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102084"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Special considerations of hyponatremia in the elderly patient 老年患者低钠血症的特殊考虑。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-09-26 DOI: 10.1016/j.beem.2025.102040

Julie Refardt

{"title":"Special considerations of hyponatremia in the elderly patient","authors":"Julie Refardt","doi":"10.1016/j.beem.2025.102040","DOIUrl":"10.1016/j.beem.2025.102040","url":null,"abstract":"<div><div>Hyponatremia is the most common electrolyte disorder, particularly in older adults. Its high prevalence in this population is driven by underlying conditions such as heart and kidney failure, as well as by factors like polypharmacy and malnutrition. Rising global temperatures have also been linked to increased hyponatremia rates. Chronic hyponatremia is associated with elevated risks of falls, osteoporosis, fractures, cognitive and muscular impairment, and mortality. Despite these adverse outcomes, the condition is often underdiagnosed and undertreated, partly due to the complexity of its evaluation. Simplified, step-by-step diagnostic algorithms in future guidelines may help address this gap. Evidence increasingly supports the clinical benefits of correcting hyponatremia, prompting investigation into novel therapies. Among these, SGLT2 inhibitors and protein supplementation are especially promising, offering efficacy not only in raising plasma sodium but also in providing broader health benefits. This review explores the impact of hyponatremia in the elderly, summarizes its leading causes, and evaluates diagnostic strategies alongside the advantages and limitations of current treatment options.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102040"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic algorithm of hyponatremia 低钠血症的诊断算法。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-10-08 DOI: 10.1016/j.beem.2025.102053

Rose Lin , Mathis Grossmann , Annabelle M. Warren

引用次数: 0

Treatment of chronic hyponatremia and controversy about osmotic demyelination syndrome 慢性低钠血症的治疗及渗透脱髓鞘综合征的争议。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2025-11-06 DOI: 10.1016/j.beem.2025.102067

Julia Beck

{"title":"Treatment of chronic hyponatremia and controversy about osmotic demyelination syndrome","authors":"Julia Beck","doi":"10.1016/j.beem.2025.102067","DOIUrl":"10.1016/j.beem.2025.102067","url":null,"abstract":"<div><div>Treatment of chronic hyponatremia requires careful diagnostic evaluation of the underlying etiology to adapt the treatment accordingly. Isotonic saline remains the cornerstone for hypovolemic hyponatremia, whereas fluid restriction and loop diuretics are preferred in hypervolemic states. Corticosteroid replacement is the first-line therapy in hyponatremia due to adrenal insufficiency. In the euvolemic syndrome of inappropriate antidiuresis, first-line treatment is fluid restriction, with additional oral urea or vasopressin receptor antagonists as second-line options. Novel strategies such as protein supplementation and SGLT2 inhibitors offer promising adjuncts. The most feared complication of hyponatremia treatment is osmotic demyelination syndrome, with highest risk in patients with severe hyponatremia (≤105 mmol/L), alcoholism, malnutrition, liver disease, or hypokalemia. Current guidelines recommend limiting sodium correction to ≤ 10–12 mmol/L per 24 h (≤8 mmol/L in high-risk patients). Ongoing research aims to investigate future treatment options and to foster evidence on correction limits to improve outcomes in patients with chronic hyponatremia.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"40 1","pages":"Article 102067"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disorders of water balance (hyponatremia and hypernatremia) 水平衡紊乱（低钠血症和高钠血症）。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.beem.2026.102080

Endocrinologist Mirjam Christ-Crain Endocrinologist

引用次数: 0