scholarly journals Late diagnosis of isolated central diabetes insipidus secondary to congenital toxoplasmosis—case report

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
Tahir Omer ◽  
Mustafa Khan ◽  
Thomas Western
Keyword(s):  
Diabetes Insipidus ◽  
Correct Diagnosis ◽  
Congenital Toxoplasmosis ◽  
Serum Cortisol ◽  
Central Diabetes Insipidus ◽  
Serum Cortisol Level ◽  
Thyroid Function Tests ◽  
Choroid Plexuses ◽  
Anterior Pituitary Function ◽  
Intranasal Desmopressin

ABSTRACT Congenital toxoplasmosis is an uncommon infection. Hypothalamic/pituitary involvement leading to isolated central diabetes insipidus is extremely rare. Making a correct diagnosis of this condition, albeit challenging, is crucial for adequate management. We present a 54-year-old female who developed central diabetes insipidus as a complication of congenital toxoplasmosis. She had polydipsia and hypernatraemia on presentation and responded to intranasal desmopressin with normalization of above-mentioned findings. Magnetic resonance imaging and cranial X-ray’s showed pronounced intracranial calcifications in both choroid plexuses. Thyroid function tests, serum cortisol level and anterior pituitary function were all normal. To the best of our knowledge, this is the first reported case of isolated diabetes insipidus due to congenital toxoplasmosis in literature diagnosed late in adulthood and gives an insight into the challenges of diagnosing central diabetes insipidus and the hypothalamic/pituitary involvement in cases of congenital toxoplasmosis.

Congenital toxoplasmosis complicated with central diabetes insipidus in the first week of life

2006 ◽  
Vol 148 (2) ◽  
pp. 283 ◽  
Author(s):  
Akihisa Nitta ◽  
Hiroshi Suzumura ◽  
Kenichi Kano ◽  
Osamu Arisaka
Keyword(s):  
Diabetes Insipidus ◽  
Congenital Toxoplasmosis ◽  
Central Diabetes Insipidus

Congenital toxoplasmosis complicated by central diabetes insipidus in an infant with down syndrome

1996 ◽  
Vol 18 (1) ◽  
pp. 75-77 ◽  
Author(s):  
Rumi Yamakawa ◽  
Yushiro Yamashita ◽  
Akihiko Yano ◽  
Jun Morita ◽  
Hirohisa Kato
Keyword(s):  
Down Syndrome ◽  
Diabetes Insipidus ◽  
Congenital Toxoplasmosis ◽  
Central Diabetes Insipidus

scholarly journals Adrenocorticotrophin-dependent hypercortisolism: Imaging versus laboratory diagnosis

2012 ◽  
Vol 140 (7-8) ◽  
pp. 500-504
Author(s):  
Milina Tancic-Gajic ◽  
Svetlana Vujovic ◽  
Miomira Ivovic ◽  
Milos Stojanovic ◽  
Ljiljana Marina ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Serum Cortisol ◽  
Laboratory Diagnosis ◽  
Serum Cortisol Level ◽  
Inferior Petrosal Sinus ◽  
Mortality Case ◽  
Suppression Test ◽  
Dexamethasone Suppression

Introduction. Cushing?s syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. Case Outline. A 38-year-old woman with a typical appearance of Cushing?s syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol after 1 mg dexamethasone suppression test. 24-hour urinaryfree cortisol level was elevated. Differential diagnostic testing indicated adrenocorticotrophin (ACTH)- dependent lesion of the pituitary origin. Pituitary abnormalities were not observed during repeated MRI scanning. Inferior petrosal sinus sampling (IPSS) was performed: 1) Baseline ratio ACTH inferior petrosal sinus/peripheral was <2; 2) Corticotropin-releasing hormone (CRH) stimulated ratio ACTH inferior petrosal sinus/peripheral was <3; 3) Baseline intersinus ratio of ACTH was <1.4; 4) Increase in inferior petrosal sinus and peripheral ACTH of more than 50 percent above basal level after CRH; 5) Baseline ratio ACTH vena jugularis interna/peripheral was >1.7. Transsphenoidal exploration and removal of the pituitary tumor was performed inducing iatrogenic hypopituitarism. Postoperative morning serum cortisol level was less than 50 nmol/l on adequate replacement therapy with hydrocortisone, levothyroxine and estro-progestagen. Conclusion. No single test provides absolute distinction, but the combined results of several tests generally provide a correct diagnosis of Cushing?s syndrome.

scholarly journals Congenital toxoplasmosis presenting as central diabetes insipidus in an infant: a case report

2014 ◽  
Vol 7 (1) ◽  
Author(s):  
Sarar Mohamed ◽  
Abdaldafae Osman ◽  
Nasir A Al Jurayyan ◽  
Abdulrahman Al Nemri ◽  
Mustafa AM Salih
Keyword(s):  
Case Report ◽  
Diabetes Insipidus ◽  
Congenital Toxoplasmosis ◽  
Central Diabetes Insipidus

Central diabetes insipidus caused by a pituitary stalk germinoma resembling infundibuloneurohypophysitis

2020 ◽  
Vol 13 (9) ◽  
pp. e234724
Author(s):  
Daniela Dias ◽  
Helena Vilar ◽  
João Passos ◽  
Valeriano Leite
Keyword(s):  
Diabetes Insipidus ◽  
Brain Mri ◽  
Correct Diagnosis ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Initial Assessment ◽  
Complete Disappearance ◽  
Close Monitoring ◽  
Initial Symptoms ◽  
Pituitary Lesion

We report the case of a pituitary stalk germinoma initially misdiagnosed and treated as infundibuloneurohypophysitis (INH). A 27-year-old man presented with a 1-year history of polydipsia, polyuria, nycturia consistent with central diabetes insipidus and a hyperintense pituitary stalk lesion on MRI. A possible INH diagnosis was considered, after excluding other pathologies. Lesion biopsy was discarded at that time on the ground of a small target and the high risk of added morbidity. Oral desmopressin led to initial symptoms resolution but, in the following months, an anterior panhypopituitarism developed, in spite of appropriate treatment and, by that time, the brain MRI also revealed lesion growth, which prompted a biopsy recommendation. The pathology analysis revealed a germinoma. After chemotherapy and radiotherapy, there was complete disappearance of the pituitary lesion, but the panhypopituitarism persisted. In conclusion, this case highlights the importance and difficulty of precise diagnosis in the initial assessment of pituitary stalk lesions and the need for close monitoring of treatment response. Diagnostic reassessment and biopsy in atypical cases is the only path to achieve the correct diagnosis and treatment.

scholarly journals Central Diabetes Insipidus: A Previously Unreported Side Effect of Temozolomide

2013 ◽  
Vol 98 (10) ◽  
pp. 3926-3931 ◽  
Author(s):  
Alexander T. Faje ◽  
Lisa Nachtigall ◽  
Deborah Wexler ◽  
Karen K. Miller ◽  
Anne Klibanski ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Side Effect ◽  
Central Diabetes Insipidus ◽  
Bright Spot ◽  
Patient Database ◽  
Anterior Pituitary Function ◽  
The Central Nervous System ◽  
Effect Of Treatment ◽  
Case Presentations ◽  
Index Cases

Abstract Context: Temozolomide (TMZ) is an alkylating agent primarily used to treat tumors of the central nervous system. We describe 2 patients with apparent TMZ-induced central diabetes insipidus. Using our institution's Research Patient Database Registry, we identified 3 additional potential cases of TMZ-induced diabetes insipidus among a group of 1545 patients treated with TMZ. Case Presentations: A 53-year-old male with an oligoastrocytoma and a 38-year-old male with an oligodendroglioma each developed symptoms of polydipsia and polyuria approximately 2 months after the initiation of TMZ. Laboratory analyses demonstrated hypernatremia and urinary concentrating defects, consistent with the presence of diabetes insipidus, and the patients were successfully treated with desmopressin acetate. Desmopressin acetate was withdrawn after the discontinuation of TMZ, and diabetes insipidus did not recur. Magnetic resonance imaging of the pituitary and hypothalamus was unremarkable apart from the absence of a posterior pituitary bright spot in both of the cases. Anterior pituitary function tests were normal in both cases. Using the Research Patient Database Registry database, we identified the 2 index cases and 3 additional potential cases of diabetes insipidus for an estimated prevalence of 0.3% (5 cases of diabetes insipidus per 1545 patients prescribed TMZ). Conclusions: Central diabetes insipidus is a rare but reversible side effect of treatment with TMZ.

scholarly journals OTHR-09. CENTRAL DIABETES INSIPIDUS: A RARE UNREPORTED SIDE EFFECT OF TEMOZOLOMIDE IN PEDIATRICS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii423-iii424
Author(s):  
Christopher Kuo ◽  
Kaaren Waters ◽  
Clement Cheung ◽  
Ashley Margol
Keyword(s):  
Diabetes Insipidus ◽  
Pediatric Patient ◽  
Side Effect ◽  
Case Reports ◽  
Central Diabetes Insipidus ◽  
Preliminary Evaluation ◽  
Laboratory Findings ◽  
First Case ◽  
Anterior Pituitary Function ◽  
Clinically Significant

Abstract Temozolomide is a chemotherapeutic agent commonly used in the treatment of central nervous system tumors. While there are case reports of temozolomide associated central diabetes insipidus (CDI) in adults, this has not been reported in children. We describe the first case of temozolomide associated CDI in a pediatric patient. The patient was a previously healthy 12yr old male diagnosed with anaplastic astroblastoma. He underwent gross total resection of the lesion and was subsequently treated with focal radiation therapy and concurrent temozolomide. On day 21 of therapy he developed thrombocytopenia, severe polyuria and polydipsia. Temozolomide was held and he underwent a preliminary evaluation for CDI. Initial laboratory findings were concerning for CDI, and he was admitted for further work-up and to assess the need for desmopressin. Additional laboratory tests demonstrated normal anterior pituitary function and his serum sodium normalized when allowed to drink to thirst, mitigating the need for desmopressin. Temozolomide was not restarted and the symptoms of polyuria and polydipsia resolved and did not recur. Upon review, the tumor did not involve the pituitary or hypothalamus. Additionally, these areas were not involved in the irradiation field. CDI is a rare but clinically significant side effect of temozolomide, reported in adults. Given this is the first report of CDI secondary to temozolomide in a pediatric patient, we speculate that this is likely under-recognized in children. Prompt recognition and treatment is necessary to prevent severe sequelae of hypernatremia.

scholarly journals case of porencephaly complicated by central diabetes insipidus in a dog

2021 ◽  
Vol 77 (01) ◽  
pp. 6489-2021
Author(s):  
ALI EVREN HAYDARDEDEOĞLU ◽  
EKREM ÇAĞATAY ÇOLAKOĞLU ◽  
HADI ALIHOSSEINI
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Veterinary Medicine ◽  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Mri Features ◽  
Rare Congenital Disorder ◽  
The Central Nervous System ◽  
Cerebral Cysts ◽  
Intranasal Desmopressin

Porencephaly is an extremely rare congenital disorder of the central nervous system characterized by focal cerebral cysts and cavities. Central diabetes insipidus is also a well-described condition in veterinary medicine. A 4-year-old Terrier dog was referred to the hospital with polyuria and polydipsia. Based on a diagnostic examination, porencephaly complicated by central diabetes insipidus was determined. Treatment consisted in administering intranasal desmopressin to the conjunctiva. The dog remains clinically healthy for 2 years. This case report reflects the MRI features of porencephaly and central diabetes insipidus associated with congenital porencephaly.

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