Panhypopituitarism in a patient with a hypothalamic and pineal germ cell tumor.

Summary: Central diabetes insipidus (DI) is characterized by decreased release of antidiuretic hormone, resulting in a variable degree of polyuria. The etiologies are variable, with the vast majority of cases either being idiopathic or resulting from primary or secondary tumors. Such tumors include craniopharyngioma, Langerhans cell histiocytosis, or a variety of inflammatory, vascular, or granulomatous diseases. It is exceptionally rare for pituitary adenomas to present with DI. We describe a young patient who first presented with symptoms consistent with DI. He was tested for DI and found to have panhypopituitarism due to a metastatic pineal germ cell tumor causing thickening of his pituitary stalk. Learning points: New onset central diabetes insipidus requires dedicated pituitary MRI for determination of etiology. Germ cell tumors in the pineal and suprasellar regions most commonly cause central diabetes insipidus. Determining the etiology of new-onset central diabetes insipidus can radically affect treatment.

Use and Accuracy of Inpatient CGM During the COVID-19 Pandemic: An Observational Study of General Medicine and ICU Patients.

BACKGROUND: Continuous glucose monitoring (CGM) is widely used in the outpatient setting for people with diabetes and has been limited to investigational use only for the inpatient population. In April 2020, the US FDA exercised enforcement discretion for the temporary use of inpatient CGM during the pandemic, thus hospitals were presented the opportunity to implement this technology. METHODS: We sought to investigate the accuracy of CGM in hospitalized patients on general care floors and the intensive care unit (ICU) in attempts to decrease healthcare professional exposure to COVID-19 and ultimately improve glycemic management of patients affected by COVID-19. Point of care (POC) and laboratory (Lab) glucose values were matched with simultaneous CGM glucose values and measures of accuracy were performed to evaluate the safety and usability of CGM in this population. Our data are presented drawing a distinction between POC and Lab as reference glucose sources. RESULTS: In 808 paired samples obtained from 28 patients (10 ICU, 18 general floor), overall mean absolute relative difference (MARD) for all patients using either POC or Lab as reference was 13.2%. When using POC as the reference glucose MARD was 13.9% and using Lab glucose as reference 10.9%. Using both POC and Lab reference glucose pairs the overall MARD for critical care patients was 12.1% and for general floor patients 14%. CONCLUSION: We determined, with proper protocols and safeguards in place, use of CGM in the hospitalized patient is a reasonable alternative to standard of care to achieve the goal of reducing healthcare professional exposure. Further study is necessary to validate safety, accuracy, and efficacy of this technology. Investigation and analysis are necessary for the development of protocols to utilize CGM trend arrows, alerts, and alarms.