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1.
No Shinkei Geka ; 48(8): 711-716, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32830136

RESUMO

Pituitary metastases(PM)are rare and show a poor prognosis. However, recent advances in diagnostic imaging could increase the chances of PM being diagnosed without a history of cancer. Furthermore, it was unclear whether adjuvant therapy could increase the survival of patients with PM or not. To clarify the clinical course of patients with PM, we report seven cases of PM with a literature review. Most patients showed symptomatic adenohypophyseal dysfunction(AD)and diabetes insipidus(DI)as initial symptoms. All patients underwent radiotherapy for PM and showed good local tumor control. However, except for one patient with improved DI, neither AD nor DI improved with radiotherapy. As for the prognosis, three patients with PM without a history of cancer survived longer than those with a history of cancer(20.3 vs. 11.7 months, respectively). In summary, early diagnosis and appropriate hormone replacement therapies are important in PM. Improvement of the general condition enables adjuvant therapy to prolong patient survival.


Assuntos
Diabetes Insípido , Neoplasias Hipofisárias , Humanos , Prognóstico
2.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-548771

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
Antidiuréticos/administração & dosagem , Infecções por Coronavirus/terapia , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido Neurogênico/terapia , Hidratação/métodos , Hipernatremia/terapia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Pneumonia Viral/terapia , Lesões Encefálicas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desidratação/terapia , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Insípido Neurogênico/complicações , Gerenciamento Clínico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Soluções Hipotônicas/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Solução Salina/uso terapêutico , Choque/etiologia , Choque/terapia
3.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32380474

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
Antidiuréticos/administração & dosagem , Infecções por Coronavirus/terapia , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido Neurogênico/terapia , Hidratação/métodos , Hipernatremia/terapia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Pneumonia Viral/terapia , Lesões Encefálicas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desidratação/terapia , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Insípido Neurogênico/complicações , Gerenciamento Clínico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Soluções Hipotônicas/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Solução Salina/uso terapêutico , Choque/etiologia , Choque/terapia
6.
Pan Afr Med J ; 33: 293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692902

RESUMO

Erdheim-Chester disease (ECD) is a very rare and aggressive form of non-Langerhans histiocytosis with unclear pathogenesis. Because of the heterogeneity of clinical presentation, diagnosis is often challenging and delayed. Currently, Interferon alpha is the first line treatment that is associated with a better survival. The prognosis is relatively poor, especially in case of neurological and cardiovascular involvement. Herein, we report the case of a 64-year-old Tunisian female patient presenting an aggressive form of ECD revealed by diabetes insipidus and cerebellar ataxia with a diagnosis delay of 4 years. The assessment of disease extent had also shown associated asymptomatic cardiac and bone involvement. Pegylated Interferon alpha was started at high dose allowing disease stabilization. This case illustrates that physicians should be aware of the heterogeneous manifestations of ECD in order to insure an early diagnosis and treatment. Long-term and regular follow-up is crucial because of the risk of disease progression.


Assuntos
Ataxia Cerebelar/etiologia , Diabetes Insípido/etiologia , Doença de Erdheim-Chester/diagnóstico , Diagnóstico Tardio , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/tratamento farmacológico , Feminino , Humanos , Interferon-alfa/administração & dosagem , Pessoa de Meia-Idade , Polietilenoglicóis/química , Prognóstico , Tunísia
7.
Rev Endocr Metab Disord ; 20(3): 283-294, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31656992

RESUMO

Arginine Vasopressin (AVP) and copeptin derive from the same precursor molecule. Due to the equimolar secretion, copeptin responds as rapidly as AVP to osmotic, hemodynamic and unspecific stress-related stimuli and both peptides show a very strong correlation. The physiological functions of AVP are homeostasis of fluid balance, vascular tonus and regulation of the endocrine stress response. In contrast, the exact function of copeptin remains unknown. Since copeptin, in contrast to AVP, can easily be measured with a sandwich immunoassay, its main function so far that it indirectly indicates the amount of AVP in the circulation. Copeptin has emerged as a useful measure in different diseases. On one hand, through its characteristics as a marker of stress, it provides a unique measure of the individual stress burden. As such, it is a prognostic marker in different acute diseases such as ischemic stroke or myocardial infarction. On the other side, it has emerged as a promising marker in the diagnosis of AVP-dependent fluid disorders. Copeptin reliably differentiates various entities of the polyuria polydipsia syndrome; baseline levels >20 pmol/L without prior fluid deprivation identify patients with nephrogenic diabetes insipidus, whereas levels measured upon osmotic stimulation with hypertonic saline or upon non-osmotic stimulation with arginine differentiate primary polydipsia from central diabetes insipidus. In patients with hyponatremia, low levels of copeptin together with low urine osmolality identify patients with primary polydipsia, but copeptin levels overlap in all other causes of hyponatremia, limiting its diagnostic use in hyponatremia. Copeptin has also been put forward as predictive marker for autosomal dominant polycystic kidney disease and for diabetes mellitus, but more studies are needed to confirm these findings.


Assuntos
Arginina Vasopressina/metabolismo , Diabetes Insípido/metabolismo , Glicopeptídeos/metabolismo , Vasopressinas/metabolismo , Feminino , Humanos , Masculino
8.
BMC Endocr Disord ; 19(1): 114, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664980

RESUMO

BACKGROUND: Pituitary metastasis is a rare condition with a poor prognosis. Very few patients with pituitary metastasis are symptomatic. It is often associated with presence of co-existing metastases to other organs. Isolated pituitary metastasis as the first presentation of primary malignancy is uncommon. CASE PRESENTATION: A 72-year-old woman presented with a 2-month history of polyuria, increasing thirst and unexplained weight loss. Esophagogastroduodenoscopy (EGD) was scheduled as part of the investigation. She was kept nil per os for 10 h prior to EGD, after which she developed alteration of consciousness. Further investigation revealed hypernatremia with sodium level of 161 mmol/L and low urine osmolality of 62 mOsm/kg. Her urine output was 300 mL per hour. Diabetes insipidus (DI) was diagnosed based on evidence of polyuria, hypernatremia, and low urine osmolality. Her urine output decreased and urine osmolality increased to 570 mOsm/kg in response to subcutaneous desmopressin acetate, confirming central DI. Pituitary magnetic resonance imaging showed a heterogeneous gadolinium enhancing lesion at the sellar and suprasellar regions, measuring 2.4 × 2.6 × 3.9 cm compressing both the hypothalamus bilaterally and the inferior aspect of optic chiasm as well as displacing the residual pituitary gland anteriorly. The posterior pituitary bright spot was absent. These MRI findings suggested pituitary macroadenoma. There were also multiple small gadolinium-enhancing lesions up to 0.7 cm in size with adjacent vasogenic brain edema at the subcortical and subpial regions of the left frontal and parietal areas, raising the concern of brain metastases. Pituitary hormonal evaluation was consistent with panhypopituitarism. Histopathological and immunohistochemical studies of the pituitary tissue revealed an adenocarcinoma, originating from the lung. Computed tomography of the chest and abdomen was subsequently performed, showing a 2.2-cm soft tissue mass at the proximal part of right bronchus. There was no evidence of distant metastases elsewhere. The final diagnosis was adenocarcinoma of the lung with pituitary metastasis manifesting as panhypopituitarism and central DI. Palliative care along with hormonal replacement therapy was offered to the patient. She died 4 months after diagnosis. CONCLUSION: Diagnosis of pituitary metastasis is challenging, especially in patients with previously undiagnosed primary cancer. It should be considered in the elderly patients presenting with new-onset central DI with or without anterior pituitary dysfunction.


Assuntos
Adenocarcinoma de Pulmão/patologia , Diabetes Insípido/patologia , Hipopituitarismo/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma de Pulmão/complicações , Idoso , Diabetes Insípido/complicações , Feminino , Humanos , Hipopituitarismo/complicações , Neoplasias Pulmonares/complicações , Prognóstico
9.
Neurosurg Clin N Am ; 30(4): 515-524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471059

RESUMO

Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations.


Assuntos
Adenoma/complicações , Adenoma/cirurgia , Hipernatremia/etiologia , Hiponatremia/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Diabetes Insípido/etiologia , Homeostase , Humanos , Hipernatremia/prevenção & controle , Hiponatremia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Sódio/metabolismo
10.
Rev Endocr Metab Disord ; 20(3): 295-302, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31471845

RESUMO

Parathyroid hormone (PTH) exerts both anabolic and catabolic actions on bone,depending on the duration and periodicity of exposure. Hypoparathyroidism is defined by inadequate production of PTH in the presence oflow serum calcium. In hypoparathyroidism it has been reported an increase in corticaland trabecular bone mass, but it is still unknown if these quantitative variations maybe accompanied by qualitative ones and increased bone strength. Despite the extensive data available on the effects of hypoparathyroidism on bone, itseffect on the hard end point in this area which is the risk of fractures still remainsunresolved and highly debated. As a matter of fact no previous review has focused onthis relevant clinical topic. This review will deal with the various aspects of bone metabolism (turn-over,density, quality) in hypoparathyroidism, focusing on the few data available on therisk of fracture and in particular of morphometric vertebral fractures, the emerging way to assess actual skeletal fragility particularly in secondary forms of osteoporosis.


Assuntos
Hipoparatireoidismo/complicações , Fraturas da Coluna Vertebral/etiologia , Animais , Arginina Vasopressina/metabolismo , Diabetes Insípido/complicações , Glicopeptídeos/metabolismo , Humanos , Hipoparatireoidismo/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia
12.
World Neurosurg ; 132: e841-e851, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31398519

RESUMO

OBJECTIVE: To analyze the preservation of hypothalamic function using the endoscopic endonasal approach (EEA) in a single-center clinical series of patients with hypothalamus-invaded craniopharyngioma (CP) and compare this series with reported cases by the open transcranial approach (TCA). METHODS: A retrospective review of hypothalamus-invaded CP surgical cases treated with EEA was performed. Hypothalamic damage was evaluated in terms of the body mass index (BMI), endocrine status, and quality of life before and after surgery. A review of the available literature reporting the use of EEA and TCA over the last decade was performed for comparison. RESULTS: In total, 63 cases amenable to EEA were investigated. The elevation in BMI was substantial and an increase in BMI greater than 9% was observed in 22 patients (34.92%). Most patients exhibited a BMI gain >9% within 3 months postoperatively. A total of 16 of the 19 patients who had normal anterior pituitary function preoperatively worsened after surgery. Of the 27 cases reporting preoperative partial hypopituitarism, 16 cases worsened postoperatively and 11 cases remained unchanged. All 9 cases with preoperative panhypopituitarism remained unchanged postoperatively. A total of 40 new cases developed diabetes insipidus, and 3 of the 10 patients with preoperative diabetes insipidus exhibited resolved at the latest follow-up. The quality of life showed no significant difference. CONCLUSIONS: EEA can achieve greater gross total resection than TCA when performed by an experienced surgeon. Combined with the reduced postoperative hypothalamic damage in our patients with only hypothalamus-invaded CP, especially the shortened time horizons of hypothalamic obesity development and reduced percentage of patients with obesity, the EEA technique should be a preferred alternative over TCA.


Assuntos
Craniofaringioma/cirurgia , Hipotálamo/cirurgia , Neuroendoscopia/métodos , Obesidade/epidemiologia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Índice de Massa Corporal , Craniofaringioma/complicações , Craniofaringioma/patologia , Diabetes Insípido/etiologia , Humanos , Hipopituitarismo/etiologia , Hipotálamo/metabolismo , Hipotálamo/patologia , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Invasividade Neoplásica , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Período Pré-Operatório , Qualidade de Vida , Estudos Retrospectivos , Ganho de Peso
13.
Endocrinol Metab Clin North Am ; 48(3): 583-603, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31345525

RESUMO

Diagnosis of lymphocytic hypophysitis occurring in the peripartum period is based on clinical and neuroradiological data and does not require a biopsy. Its course is generally spontaneously favorable in terms of mass effect but may require the administration of corticosteroids or even transsphenoidal resection. The course of pituitary deficiencies is highly variable; some cases recover over time, whereas others persist indefinitely. Sheehan syndrome is very rare in developed countries. Because agalactia and amenorrhea are often neglected, the diagnosis is generally delayed. Diabetes insipidus occurring in late pregnancy is caused by the increased placental production of vasopressinase and disappears after delivery.


Assuntos
Doenças da Hipófise/terapia , Complicações na Gravidez/terapia , Diabetes Insípido/diagnóstico , Diabetes Insípido/epidemiologia , Diabetes Insípido/terapia , Feminino , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/epidemiologia , Hipopituitarismo/terapia , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia
14.
Pediatr Neurosurg ; 54(4): 288-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291634

RESUMO

Cerebral sinovenous thrombosis (CSVT) is a rare but not a negligible complication in pediatric brain tumor. An 11-year-old male with suprasellar germ cell tumor developed treatment-related vascular complications of CSVT and subdural hematoma. The underlying mechanism of CSVT was attributed to multiple risk factors, such as adipsic diabetes insipidus, obesity, central apnea, and chemotherapy-induced endothelial injury. In an attempt to minimize the possible risk of vascular complications, including late effect in pediatric brain tumors, we would like to stress the importance of individualized supportive therapy, i.e., hormone replacement, fluid management, thromboprophylaxis, and bi-level positive airway pressure therapy.


Assuntos
Diabetes Insípido/complicações , Germinoma/complicações , Hematoma Subdural/complicações , Neoplasias Hipofisárias/complicações , Trombose dos Seios Intracranianos/complicações , Anticoagulantes , Criança , Tratamento Farmacológico , Germinoma/diagnóstico , Hematoma Subdural/terapia , Humanos , Masculino , Obesidade/complicações , Trombose dos Seios Intracranianos/terapia
16.
World Neurosurg ; 131: e81-e87, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31306837

RESUMO

BACKGROUND: Pituitary stalk sectioning is only essential in cases of craniopharyngioma originating from the stalk or metastatic tumor to the stalk. Some patients can discontinue postoperative antidiuretic hormone (ADH) supplementation with special conditions. METHODS: Sixty-three patients with craniopharyngiomas who were treated by surgery with pituitary stalk sectioning were included in this study. Great care was taken to preserve the fine arteries running along the lateral walls of the third ventricle. Removal rates, change of endocrinologic status, and magnetic resonance imaging (MRI) findings were investigated. RESULTS: Total removal was achieved in 52 of 54 patients in initial surgery (96.3%), and in 5 of 9 patients in retreatment (55.6%). ADH supplementation was required in all patients from the day of surgery, but was discontinued in 29 of 54 patients among the initial surgery group (53.7%) and in 2 of 9 patients among the retreatment group (22.2%). Preservation of thyroid hormone secretion was observed in 24 of 31 patients who could discontinue ADH (77.4%), but only in 12 of 32 patients who could not discontinue ADH (37.5%). Recovery from diabetes insipidus (DI) was significantly associated with preservation of thyroid function (P < 0.01). Postoperative MRI showed that part of the hypothalamus was enhanced in patients with recovery from DI. CONCLUSIONS: Total removal was achieved in 91% of all cases. Half of the patients could discontinue ADH supplementation, which was associated with preservation of thyroid function. The findings of hypothalamic enhancement on postoperative MRI may be associated with recovery from DI.


Assuntos
Antidiuréticos/uso terapêutico , Craniofaringioma/cirurgia , Diabetes Insípido/tratamento farmacológico , Sistema Hipotálamo-Hipofisário/metabolismo , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Recuperação de Função Fisiológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/etiologia , Feminino , Glucocorticoides/deficiência , Glucocorticoides/uso terapêutico , Terapia de Reposição Hormonal , Humanos , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Sistema Hipotálamo-Hipofisário/diagnóstico por imagem , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Hipófise/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Hormônios Tireóideos/uso terapêutico , Adulto Jovem
17.
Eur J Endocrinol ; 181(2): 193-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31167167

RESUMO

Background: Diagnosis and treatment of dysnatremia is challenging and further complicated by the pitfalls of different sodium measurement methods. Routinely used sodium measurements are the indirect (plasma/serum) and direct (whole blood) ion-selective electrode (ISE) method, showing discrepant results especially in the setting of acute illness. Few clinicians are aware of the differences between the methods in clinically stable patients or healthy volunteers. Methods: Data of 140 patients and 91 healthy volunteers undergoing osmotic stimulation with hypertonic saline infusion were analyzed. Sodium levels were measured simultaneously by indirect and direct ISE method before and at different time points during osmotic stimulation up to a sodium threshold of ≥150 mmol/L. The primary outcome was the difference in sodium levels between the indirect and direct ISE method. Results: 878 sodium measurements were analyzed. Mean (s.d.) sodium levels ranged from 141 mmol/L (2.9) to 151 mmol/L (2.1) by the indirect ISE compared to 140 mmol/L (3) to 149 mmol/L (2.8) by the direct ISE method. The interclass correlation coefficient between the two methods was 0.844 (95% CI: 0.823-0.863). On average, measurements by the indirect ISE were 1.9 mmol/L (95% CI limits: -3.2 to 6.9) higher than those by the direct ISE method (P < 0.001). The tendency of the indirect ISE method resulting in higher levels increased with increasing sodium levels. Conclusion: Intra-individual sodium levels differ significantly between the indirect and direct ISE method also in the absence of acute illness. It is therefore crucial to adhere to the same method in critical situations to avoid false decisions due to measurement differences.


Assuntos
Diabetes Insípido/sangue , Eletrodos Íon-Seletivos/normas , Polidipsia/sangue , Solução Salina Hipertônica/administração & dosagem , Sódio/sangue , Diabetes Insípido/diagnóstico , Humanos , Hipernatremia/sangue , Hipernatremia/induzido quimicamente , Hipernatremia/diagnóstico , Hiponatremia/sangue , Hiponatremia/diagnóstico , Polidipsia/diagnóstico , Estudos Prospectivos
19.
Intern Med J ; 49(6): 785-788, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31185522

RESUMO

A 41-year-old man was diagnosed with hypogonadotropic hypogonadism managed with gonadotropins after routine fertility review. Eight months later he presented with new polydipsia and polyuria, lethargy and easy bruising. A full blood count showed 28% circulating blasts. A bone marrow biopsy confirmed a diagnosis of acute myeloid leukaemia with inv(3)(q21.3q26.2) with additional monosomy 7. Central diabetes insipidus (DI) was diagnosed following a water deprivation test. Pituitary magnetic resonance imaging showed a slightly thickened pituitary stalk, stable Rathke's cyst, and new absence of the pituitary bright spot. The patient was commenced on desmopressin and induction chemotherapy, subsequently requiring a bone marrow transplant. Bone marrow examination at 100 days post-transplant revealed cytogenetic remission. All symptoms of DI resolved and magnetic resonance imaging showed return of the posterior bright spot and a pituitary stalk of normal thickness. Biochemical hypogonadotropic hypogonadism persisted but was uninterpretable in the context of systemic illness and recent chemotherapy. DI is a rare complication of haematological malignancies, and the prevalence and pathophysiology of DI in this context are poorly understood. Pathogenic mechanisms proposed include leukaemic infiltration of the pituitary, interference with antidiuretic hormone synthesis, and abnormal thrombopoiesis influencing hormone levels. Particular cytogenetic abnormalities such as inv(3)(q21.3q26.2) and monosomy 7 appear to be more commonly associated with DI and also appear to confer worse outcomes. Aetiologies in the literature remain elusive but as DI is a recognised association of haematological malignancies it should be considered in a patient presenting with polydipsia and polyuria.


Assuntos
Cromossomos Humanos Par 7/genética , Diabetes Insípido/etiologia , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/patologia , Adulto , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/tratamento farmacológico , Humanos , Leucemia Mieloide Aguda/genética , Imagem por Ressonância Magnética , Masculino , Monossomia , Hipófise/diagnóstico por imagem
20.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142487

RESUMO

We report a case of a patient with mild traumatic brain injury (TBI) who was diagnosed with permanent central diabetes insipidus (DI). A 21-year-old man was admitted to our outpatient clinic with polyuria and polydipsia 1 week after a mild head injury. He was well, except for these complaints. The initial laboratory workup was consistent with DI. There was no abnormality with other laboratory and hormone values. MRI showed lack of neurohypophyseal hyperintensity with no other abnormal findings. The patient responded well to desmopressin therapy. At the first year of the diagnosis, the patient still needed to use desmopressin treatment as we concluded that DI is permanent. DI is not uncommon after TBI, but it is often seen after severe TBI. We present here an extraordinary case of developing permanent DI after mild TBI with the absence of neurohypophyseal bright spot on MRI with no other abnormal findings.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Diabetes Insípido/etiologia , Acidentes por Quedas , Doença Crônica , Humanos , Imagem por Ressonância Magnética , Masculino , Polidipsia/etiologia , Poliúria/etiologia , Adulto Jovem
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