RESUMO
The occurrence of polyuria-polydipsia syndrome with hypotonic urine requires careful diagnostic strategy. This study aims to evaluate diagnostic modalities for central diabetes insipidus. We conducted a retrospective study of 41 cases with central diabetes insipidus (CDI). Data were collected at the Department of Endocrinology, University Hospital La Rabta, Tunis, from 1990 to 2013. We identified the circumstances for detecting CDI, the abnormalities in anterior pituitary assessment and pituitary imaging. CDI occurred in the postoperative period in 20 patients. The average urine 24-hour volume was significantly higher in patients with CDI outside a surgical setting. Water deprivation test was successful in all patients who benefited from it. Outside of neurosurgery, infiltration causes were found in 6 patients and tumor causes were found in 6 patients. CDI was associated with empty sella turcica in 1 case and idiopathic sella turcica in 3 patients. Hypothalamic-pituitary magnetic resonance imaging and anterior pituitary balance sheet are systematic outside pituitary surgery setting and obvious primary polydipsia.
Assuntos
Diabetes Insípido Neurogênico/diagnóstico , Polidipsia/etiologia , Poliúria/etiologia , Adolescente , Adulto , Criança , Diabetes Insípido Neurogênico/etiologia , Diabetes Insípido Neurogênico/fisiopatologia , Humanos , Hipotálamo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Estudos Retrospectivos , Tunísia , Adulto JovemRESUMO
Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Diabetes Insípido Neurogênico/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Antidiuréticos/uso terapêutico , Vasos Coronários , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Neurogênico/tratamento farmacológico , Diabetes Insípido Neurogênico/etiologia , Humanos , Hipotálamo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Hipófise/diagnóstico por imagem , Poliúria/diagnóstico , Poliúria/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , CintilografiaRESUMO
Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Assuntos
Adulto , Humanos , Masculino , Antidiuréticos/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Neurogênico/diagnóstico , Hipotálamo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Hipófise/diagnóstico por imagem , Poliúria/diagnóstico , Complicações Pós-Operatórias/diagnósticoAssuntos
Craniofaringioma/cirurgia , Diabetes Insípido Neurogênico/diagnóstico , Diabetes Insípido Neurogênico/etiologia , Hipotálamo/fisiopatologia , Obesidade/diagnóstico , Obesidade/etiologia , Neoplasias Hipofisárias/cirurgia , Adolescente , Diabetes Insípido Neurogênico/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Humanos , Hiperfagia/etiologia , Hiperfagia/fisiopatologia , Masculino , Obesidade/complicações , ReoperaçãoRESUMO
In Taiwan, Solanum indicum L. has been used in folk medicine for the treatment of inflammation, toothache, ascites, edema, and wound infection. The plant is rich in solanine, an alkaloidal glycoside. We report a 43-year-old man who developed polyuria and polydipsia after taking seven doses of concentrated solution of Solanum indicum L. over two weeks. A water deprivation test and a low serum antidiuretic hormone level helped to confirm a diagnosis of central diabetes insipidus. We suggest that excessive doses of Solanum indicum L. may cause central diabetes insipidus.