From the Guidelines
Elevated antidiuretic hormone (ADH) levels can result from various physiological and pathological conditions, with the most common cause being the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which occurs when ADH is released despite normal or low serum osmolality, as noted in studies such as 1. The causes of elevated ADH levels can be categorized into several groups, including:
- SIADH, which can be triggered by certain medications, including antidepressants, antipsychotics, carbamazepine, cyclophosphamide, and opioids, as well as various malignancies, especially small cell lung cancer, which can produce ectopic ADH 2.
- Central nervous system disorders, such as meningitis, encephalitis, brain tumors, stroke, and head trauma, which can disrupt normal hypothalamic regulation of ADH, as discussed in 3.
- Pulmonary conditions, including pneumonia, tuberculosis, and acute respiratory distress syndrome, which may also elevate ADH levels, as mentioned in 4.
- Normal physiological responses to hypovolemia, hypotension, or high serum osmolality, as well as conditions like adrenal insufficiency and hypothyroidism, which can stimulate ADH release, as noted in 5.
- Pain, stress, and nausea, which are potent non-osmotic stimuli for ADH release, as discussed in 6. Understanding these causes is essential for proper diagnosis and management of fluid and electrolyte disorders associated with elevated ADH, and the most recent and highest quality study, 1, provides guidance on the diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome, which are all related to elevated ADH levels.
From the FDA Drug Label
SIADH (syndrome of inappropriate antidiuretic hormone) The FDA drug label mentions SIADH as one of the underlying causes of euvolemic or hypervolemic hyponatremia, which is associated with elevated antidiuretic hormone (ADH) levels.
- Heart failure and liver cirrhosis are also mentioned as underlying causes of hyponatremia, but it is not directly stated that they cause elevated ADH levels. The label does not provide a comprehensive list of causes of elevated ADH levels, only mentioning SIADH as one possible cause 7.
From the Research
Causes of Elevated ADH Levels
The causes of elevated antidiuretic hormone (ADH) levels can be attributed to various factors, including:
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 8, 9, 10
- Use of drugs that induce secretion of the hormone 9
- Old age, which is a risk factor for the development of SIADH 9
- Intracranial disease or injury, particularly in children 11
- Non-osmolar stimuli, such as hypovolemia, hypotension, and heart failure 11
- Baroreceptor-mediated ADH release in the presence of hyponatremia and hypo-osmolality 11
Conditions Associated with Elevated ADH Levels
Elevated ADH levels can be associated with various conditions, including:
- Hyponatremia, which is the most common electrolyte disorder encountered in the clinical setting 12, 10
- Congestive heart failure 12
- Hepatic cirrhosis 11
- Nephrotic syndrome 11
- Glucocorticoid or thyroxine deficiency 11
- Diuretic therapy 8
Diagnosis and Treatment of Elevated ADH Levels
The diagnosis of elevated ADH levels involves excluding physiological release of ADH in response to non-osmolar and osmolar factors 11. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide, and saline infusion 10. Vasopressin-2 receptor antagonists have also been introduced as a treatment option for SIADH, which can specifically target the underlying pathophysiology of the condition 10.