Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 886
Filtrar
1.
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
2.
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
3.
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
4.
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
5.
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
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 40(5): 699-704, 2018 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-30404705

RESUMO

Traumatic brain injury(TBI)is a major cause of hypothalamopituitary dysfunction. TBI-related hypothalamopituitary dysfunction is more common in the acute phase. Disturbance of pituitary/gonadal axis and growth hormone axis,as well as posterior pituitary dysfunction including central diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion,are the most frequently seen. During the chronic phase of TBI,anterior hypopituitarism is the major concern,which affects the quality of life. Risk factors for hypothalamopituitary dysfunction following TBI include low Glasgow score,high body mass index,hypoxia,older age,longer intensive care unit stay and longer coma status,radiological evidence of acute brain injury,and increased intracranial pressure. Children and adolescents are in a crucial period of growth and development,and therefore TBI-related pituitary dysfunction during this period can substantially affect the cognition and behaviors. There is currently no reliable biochemical marker predicting hypothalamopituitary dysfunctions. Therefore,it is of great importance to evaluate the pituitary function and take appropriate hormone replacement for moderate-severe TBI patients or mild TBI patients with apparent symptoms,especially for patients with water-electrolyte disturbance and adrenal deficiency. Growth hormone and gonadal hormone replacement therapies are crucial for children and adolescents.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Doenças Hipotalâmicas/etiologia , Doenças da Hipófise/etiologia , Adolescente , Criança , Diabetes Insípido/complicações , Humanos , Hipopituitarismo/etiologia , Hipófise/fisiopatologia , Qualidade de Vida
8.
BMJ Case Rep ; 20182018 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-30337283

RESUMO

A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. Orbital MRI showed thinned extrinsic ocular musculature, intraconal fat infiltration, retro-ocular compression and thickening of maxillary and sphenoid sinus walls. She had been suffering from diabetes insipidus for the last 7 years. During our diagnosis process, she presented signs of cardiac tamponade. Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. Pericardiocentesis temporarily controlled tamponade and corticoid therapy temporarily abated exophthalmos. Pericardiectomy definitively resolved tamponade. Histological examination of pericardial tissue was conclusive of Erdheim-Chester disease. Exophthalmos responded to pegylated interferon-alpha-2a. Facial bone pain disappeared after zoledronic acid and interferon treatment. During interferon therapy, the patient suffered from a severe generalised desquamative exanthema that slowly resolved after discontinuing interferon. Diabetes insipidus remains controlled with desmopressin.


Assuntos
Tamponamento Cardíaco/etiologia , Diabetes Insípido/complicações , Doença de Erdheim-Chester/complicações , Exoftalmia/diagnóstico por imagem , Dor Facial/etiologia , Idoso , Tamponamento Cardíaco/cirurgia , Diabetes Insípido/tratamento farmacológico , Diagnóstico Diferencial , Ecocardiografia/métodos , Doença de Erdheim-Chester/patologia , Exoftalmia/tratamento farmacológico , Exoftalmia/etiologia , Dor Facial/diagnóstico , Dor Facial/tratamento farmacológico , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Derrame Pericárdico/diagnóstico por imagem , Pericardiocentese/métodos , Doenças Raras , Resultado do Tratamento
9.
J Int Med Res ; 46(11): 4829-4836, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30270804

RESUMO

The prevalence of juvenile-onset gout has been increasing. Hereditary factors and secondary diseases should be considered in these patients. Adipsic diabetes insipidus (ADI) is characterized by arginine vasopressin (AVP) deficiency, which results in hypotonic polyuria, and dysfunction of thirst osmoreceptors, which results in failure to generate a thirst sensation in response to hypernatremia. We herein report a case of a boy with gouty arthritis, refractory hyperuricemia, prominent hypernatremia, a high creatinine concentration, and a history of surgery for a hypothalamic hamartoma. The patient was diagnosed with central diabetes insipidus after endocrine evaluation. Because he never had symptoms of thirst, the final diagnosis was corrected to ADI. This is the first report of gout due to chronic ADI in an adolescent. Volume contraction due to ADI might be one cause of hyperuricemia and renal impairment in such patients. Moreover, AVP deficiency might directly lead to low urate clearance due to the lack of vasopressin receptor 1 stimulation. Lack of polydipsia and polyuria may delay the diagnosis of ADI and lead to severe complications of a chronic hyperosmolar status. Sufficient and effective establishment of normovolemia is critical for these patients.


Assuntos
Diabetes Insípido/complicações , Gota/complicações , Hiperuricemia/complicações , Nefropatias/complicações , Adolescente , Diabetes Insípido/diagnóstico por imagem , Gota/diagnóstico por imagem , Humanos , Hiperuricemia/diagnóstico por imagem , Articulações/anormalidades , Articulações/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Masculino
10.
Rinsho Shinkeigaku ; 58(11): 668-672, 2018 Nov 28.
Artigo em Japonês | MEDLINE | ID: mdl-30369523

RESUMO

A 56-year-old man noted sudden onset of headache, fever, right pupil-spared oculomotor nerve palsy and consciousness disturbance. Swelling of pituitary with T1 high intensity on brain MRI suggested the diagnosis of pituitary apoplexy. Considering significant decrease of pituitary anterior lobe hormone and central diabetes insipidus, high dose of hydrocortisone was administered. Eight days after onset, consciousness level and headache improved. On day 30, brain MRI revealed the reduction of mass size, and on day 46, photophobia and double vision disappeared. Following the rapid response to steroid and disappearance of pituitary lesion, pituitary apoplexy was probably caused by panhypophisitis. Thin-slice brain MRI confirmed the compression of oculomotor nerve at inlet zone of cavernous sinus, suggesting the mechanism of oculomotor palsy was perfusion impairment of feeding artery.


Assuntos
Hipofisite Autoimune/complicações , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Nervo Oculomotor/diagnóstico por imagem , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/etiologia , Hipofisite Autoimune/tratamento farmacológico , Diabetes Insípido/complicações , Diabetes Insípido/tratamento farmacológico , Humanos , Hidrocortisona/administração & dosagem , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/tratamento farmacológico , Apoplexia Hipofisária/tratamento farmacológico , Hormônios Adeno-Hipofisários/deficiência , Resultado do Tratamento
11.
N Engl J Med ; 379(5): 428-439, 2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30067922

RESUMO

BACKGROUND: The indirect water-deprivation test is the current reference standard for the diagnosis of diabetes insipidus. However, it is technically cumbersome to administer, and the results are often inaccurate. The current study compared the indirect water-deprivation test with direct detection of plasma copeptin, a precursor-derived surrogate of arginine vasopressin. METHODS: From 2013 to 2017, we recruited 156 patients with hypotonic polyuria at 11 medical centers to undergo both water-deprivation and hypertonic saline infusion tests. In the latter test, plasma copeptin was measured when the plasma sodium level had increased to at least 150 mmol per liter after infusion of hypertonic saline. The primary outcome was the overall diagnostic accuracy of each test as compared with the final reference diagnosis, which was determined on the basis of medical history, test results, and treatment response, with copeptin levels masked. RESULTS: A total of 144 patients underwent both tests. The final diagnosis was primary polydipsia in 82 patients (57%), central diabetes insipidus in 59 (41%), and nephrogenic diabetes insipidus in 3 (2%). Overall, among the 141 patients included in the analysis, the indirect water-deprivation test determined the correct diagnosis in 108 patients (diagnostic accuracy, 76.6%; 95% confidence interval [CI], 68.9 to 83.2), and the hypertonic saline infusion test (with a copeptin cutoff level of >4.9 pmol per liter) determined the correct diagnosis in 136 patients (96.5%; 95% CI, 92.1 to 98.6; P<0.001). The indirect water-deprivation test correctly distinguished primary polydipsia from partial central diabetes insipidus in 77 of 105 patients (73.3%; 95% CI, 63.9 to 81.2), and the hypertonic saline infusion test distinguished between the two conditions in 99 of 104 patients (95.2%; 95% CI, 89.4 to 98.1; adjusted P<0.001). One serious adverse event (desmopressin-induced hyponatremia that resulted in hospitalization) occurred during the water-deprivation test. CONCLUSIONS: The direct measurement of hypertonic saline-stimulated plasma copeptin had greater diagnostic accuracy than the water-deprivation test in patients with hypotonic polyuria. (Funded by the Swiss National Foundation and others; ClinicalTrials.gov number, NCT01940614 .).


Assuntos
Diabetes Insípido/diagnóstico , Glicopeptídeos/sangue , Polidipsia/diagnóstico , Poliúria/etiologia , Solução Salina Hipertônica/administração & dosagem , Privação de Água/fisiologia , Adulto , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/efeitos adversos , Diabetes Insípido/sangue , Diabetes Insípido/complicações , Diabetes Insípido/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Hiponatremia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Polidipsia/sangue , Polidipsia/complicações , Curva ROC , Sensibilidade e Especificidade , Urina/química
13.
Clin Neurol Neurosurg ; 167: 141-146, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29494890

RESUMO

OBJECTIVES: It is well-known that Rathke's cleft cysts (RCCs) infrequently cause headache, endocrinological dysfunction, and visual disturbance, and in rare cases, cause diabetes insipidus (DI). Although surgical evacuation of the cyst content can result in high rates of symptomatic improvement, not only the treatment efficacy but also the pathophysiology of DI with RCC are undetermined. The aim of this study is to elucidate the underlying mechanisms and outcomes of DI associated with RCCs. PATIENTS AND METHODS: We retrospectively studied 109 patients with RCCs treated at Kanazawa University Hospital between 2000 and 2016. Their age, sex, symptoms, endocrinological status, DI, visual disturbance, neuroradiological findings, pathological appearances, and pre-/post-operative hormone levels and status of anti-diuretic hormone replacements were assessed. RESULTS: Among 109 cases of RCCs, five cases (4.6%, 2 males and 3 females) manifested with DI as initial presentation were included. These five cases could be divided into two types: the acute type and the chronic type, based on the onset and duration of symptoms. Three acute onset cases presented with not only strong thirst but also sudden headaches without pituitary dysfunction, whereas the two chronic onset cases presented with chronic headaches and hypopituitarism. Pathological examination in the acute type revealed inflammatory cell infiltration into only the posterior lobe of the pituitary and disruption of the cyst wall adjacent to the posterior lobe, which might suggest RCC rupture. In contrast, the chronic type showed inflammatory cell infiltration into both the anterior and posterior lobes of the pituitary and thickened fibrosis beneath the cyst wall. Postoperatively, two cases of the acute type could be controlled with a smaller amount of 1-deamino-8-D-arginine vasopressin (DDAVP) than that required preoperatively, whereas no change was observed in the cases of the chronic type. CONCLUSION: The cases of DI onset caused by RCCs could be divided into the acute type and the chronic type. In the chronic type, surgical treatment could not affect the status of DI. However, in acute type, urgent surgical intervention partially relieved DI.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Diabetes Insípido/cirurgia , Hipopituitarismo/cirurgia , Neoplasias Hipofisárias/cirurgia , Adulto , Idoso , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/patologia , Criança , Diabetes Insípido/complicações , Feminino , Humanos , Hipopituitarismo/complicações , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/complicações , Doenças da Hipófise/cirurgia , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Resultado do Tratamento
14.
Minerva Endocrinol ; 43(4): 458-464, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29463074

RESUMO

Diabetes insipidus, characterized by polyuria and polydipsia, is a rare disease during pregnancy. Nevertheless, its recognition is important to avoid complications due to dehydration and hypernatremia. Its manifestation during pregnancy ranges from exacerbation of pre-existing central or nephrogenic diabetes insipidus to transient pregnancy-induced diabetes insipidus due to the increased metabolism of the antidiuretic hormone vasopressin (AVP) by the placental vasopressinase. Diagnosis can be challenging, as urinary frequency is common during pregnancy and primary polydipsia also needs to be excluded. Also, the standard water deprivation test is not recommended during pregnancy due to the increased risk of complications. Treatment depends upon the final diagnosis, with desmopressin (DDAVP) being the medication of choice in AVP-deficient diabetes insipidus, whereas nephrogenic diabetes insipidus requires treatment of the underlying disease and supportive measures.


Assuntos
Diabetes Insípido/terapia , Complicações na Gravidez/terapia , Adulto , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/complicações , Diabetes Insípido/tratamento farmacológico , Diabetes Insípido/fisiopatologia , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/fisiopatologia
18.
Swiss Med Wkly ; 147: w14514, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29120013

RESUMO

Primary polydipsia (PP) has been defined as excessive intake of fluids. However, the pathogenesis of PP remains unexplored. Different theories include a dysfunction in the thirst mechanism, involvement of the hippocampus, stress-reducing behaviour and lesion occurrences in specific areas of the brain. Most studies have been performed in the psychiatric setting, indicating that PP coincides with schizophrenia, anxiety disorder and depression. However, an increasing number of case reports emphasise the incidence of PP in non-psychiatric patients. As often recommended by healthcare professions and in life-style programmes, the phenomenon of excessive fluid intake appears to be growing, especially in health-conscious and active people. PP is part of the polyuria-polydipsia syndrome, so the differential diagnosis diabetes insipidus (central or nephrogenic) must be excluded. The gold standard when differentiating between these disorders has been the water deprivation test. However, new options for distinguishing between these entities have been proposed e.g., measurement of copeptin, a reliable surrogate marker of the hormone arginine vasopressin (AVP). The major risk of excessive drinking is the development of hyponatraemia and the ensuing complications. In patients with PP, factors reducing the renal excretory capacity of the kidney such as acute illness, medications or low solute intake may accumulate in hyponatraemia. Treatment options for PP remain scarce. Different medication and behavioural therapy have been investigated, but never on a large scale and rarely in non-psychiatric patients. This review provides an overview of the pathophysiology, characteristics, complications, and outcomes of patients with PP in the medical and psychiatric patient.


Assuntos
Diagnóstico Diferencial , Polidipsia Psicogênica/complicações , Polidipsia Psicogênica/terapia , Arginina Vasopressina/sangue , Diabetes Insípido/complicações , Diabetes Insípido/diagnóstico , Humanos , Hiponatremia/complicações , Polidipsia Psicogênica/diagnóstico , Polidipsia Psicogênica/fisiopatologia , Esquizofrenia/complicações
19.
Intern Med ; 56(21): 2943-2948, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28943556

RESUMO

We herein describe two cases of refractory antineutrophil cytoplasmic antibody-associated vasculitis (AAV) complicated with diabetes insipidus (DI) possibly related to hypertrophic pachymeningitis (HP). One patient had microscopic polyangiitis and HP, which were refractory to cyclophosphamide, azathioprine, rituximab, mycophenolate mofetil (MMF), and mizoribine. Remission was finally achieved with the use of etanercept, but DI occurred 5 years later. The other patient had granulomatosis with polyangiitis, which that was refractory to cyclophosphamide, methotrexate, MMF, and rituximab. DI subsequently developed, but was successfully treated with etanercept. Dura mater hypertrophy was macroscopically observed in the latter case.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Diabetes Insípido/complicações , Etanercepte/uso terapêutico , Imunossupressores/uso terapêutico , Idoso , Feminino , Humanos , Meningite/complicações , Poliangiite Microscópica/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA