{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:57:26Z","timestamp":1790870246018,"version":"4.1.0"},"reference-count":0,"publisher":"Bioscientifica","issue":"12","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The diagnosis of syndrome of inappropriate anti-diuresis requires the exclusion of secondary adrenal insufficiency (AI) among patients with euvolemic hyponatremia (EuVHNa). Studies have suggested that about 2.7\u20133.8% of unselected patients presenting to the emergency room with EuVHNa have undiagnosed AI and it is as high as 15% among patients admitted to specialized units for evaluation of hyponatremia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To study the prevalence of AI among in-patients with EuVHNa in a general medical ward setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective, single-center observational study conducted among general medical in-patients with EuVHNa, defined as patients with a serum sodium &lt;135 mmol\/L, clinical euvolemia and urine spot sodium &gt;30 mmol\/L. Additionally, patients with recent vomiting, current renal failure, diuretic use and those with uncontrolled hyperglycemia were excluded. Adrenal functions were assessed by a modified adrenocorticotropic hormone (ACTH) stimulation test called the Acton Prolongatum\u2122 stimulation test (APST). A cut-off cortisol value of &lt;18 mg\/dL after 60 min of ACTH injection was used to diagnose AI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred forty-one patients were included and underwent an APST. APST suggested 20\/141 (14.2%) had undiagnosed AI. The commonest cause of AI (9\/20) was secondary AI because of the use of steroids including inhaled steroids and indigenous medicines contaminated with steroids. In 5 (3.5%) patients hypopituitarism was newly diagnosed. Despite primary AI (PAI) not commonly presenting as EuVHNa, 2\/20 patients had PAI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI is much commoner in our country, among in-patients with EuVHNa primarily driven by exogenous steroid use and undiagnosed hypopituitarism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-21-0500","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T13:01:05Z","timestamp":1637154065000},"page":"1623-1631","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":8,"title":["Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia"],"prefix":"10.1530","volume":"10","author":[{"given":"Amit","family":"Kumar","sequence":"first","affiliation":[{"name":"1Department of Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ghosh","sequence":"additional","affiliation":[{"name":"2Department of Biochemistry, Christian Medical College and Hospital, Ludhiana, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1755-5523","authenticated-orcid":true,"given":"Jubbin Jagan","family":"Jacob","sequence":"additional","affiliation":[{"name":"3Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","container-title":["Endocrine Connections"],"original-title":[],"link":[{"URL":"https:\/\/ec.bioscientifica.com\/view\/journals\/ec\/10\/12\/EC-21-0500.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ec.bioscientifica.com\/downloadpdf\/journals\/ec\/10\/12\/EC-21-0500.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:45:01Z","timestamp":1784555101000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/ec\/article\/10\/12\/1623-1631\/204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,1]]},"references-count":0,"journal-issue":{"issue":"12"},"URL":"https:\/\/doi.org\/10.1530\/ec-21-0500","relation":{},"ISSN":["2049-3614"],"issn-type":[{"value":"2049-3614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,1]]}}}