Evidence map›Paper›PMID 42598993›Full record

ArticleEndocrine connections2026

Immune checkpoint inhibitor-associated severe hyponatremia: evidence mapping of SIADH-like phenotypes and endocrine immune-related adverse events.

Fangfei Guo, Songchen Han, Zhihui Xue, Wenlong Chen, Yunjiu Gou

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In one paragraph

Article in Endocrine connections, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Fangfei GuoDepartment of Cardiac Surgery, Gansu Provincial Hospital , Lanzhou, China.
Songchen HanDepartment of Thoracic Surgery, Gansu Provincial Hospital , Lanzhou, China.ORCID 0009-0003-4185-0108
Zhihui XueSunan County People's Hospital , Zhangye, China.
Wenlong ChenGansu University of Chinese Medicine , Lanzhou, China.
Yunjiu GouDepartment of Thoracic Surgery, Gansu Provincial Hospital , Lanzhou, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveSevere or symptomatic hyponatremia during immune checkpoint inhibitor (ICI) therapy may reflect syndrome of inappropriate antidiuresis (SIADH), endocrine immune-related adverse events (irAEs), cancer-related factors, or mixed mechanisms. We mapped the evidence and reclassified diagnostically extractable cases to distinguish SIADH-like phenotypes from endocrine irAEs.

methodsPubMed, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched through May 24, 2026. Reports were assigned to A1 case-level, A2 population-level, or A3 diagnostic-framework layers. A1 summaries used patient/case denominators after a report-versus-patient audit. Diagnostic categories were reviewer-derived. Reporting completeness was described using six prespecified domains. We performed source-label and full-length-only sensitivity analyses.

resultsAll 194 reports sought for retrieval were assessed, and 146 were included: 127 A1 reports describing 144 patients/cases, 16 A2 reports, and 3 A3 reports. Strict classification identified 127/144 (88.2%) confirmed/probable adrenal-axis irAEs, 1/144 (0.7%) confirmed/probable SIADH, 3/144 (2.1%) SIADH-like phenotypes with incomplete endocrine exclusion, 2/144 (1.4%) thyroid-related cases, and 11/144 (7.6%) mixed, confounded, or non-endocrine mechanisms. Ten patients/cases carried an explicit source-level SIADH label; strict review classified six as adrenal-axis irAEs, one as SIADH, and three as SIADH-like with incomplete endocrine exclusion. After exclusion of 81 abstract/database-only A1 reports, 46 full-length reports described 59 patients: 52 adrenal-axis irAEs, 1 SIADH, and 6 mixed/confounded or non-endocrine cases.

conclusionPublished classifiable A1 cases were dominated by adrenal-axis irAEs. Strictly supported SIADH occurred but was rare in this selected evidence base, and the direction of findings persisted in the full-length-only analysis. These proportions are not incidence estimates. The proposed algorithm supports diagnostic sequencing and transparent reporting; it is not a stand-alone practice guideline.

Indexed as

ACTH deficiencyadrenal insufficiencyhyponatremiahypophysitisimmune checkpoint inhibitorsimmune-related adverse eventsSIADH

Identifiers

PMID42598993
PMCPMC13588285

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.