Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

2019 ◽  
Vol 110 (6) ◽  
pp. 525-534 ◽  
Author(s):  
Alessandro Maria Berton ◽  
Filippo Gatti ◽  
Federica Penner ◽  
Emanuele Varaldo ◽  
Nunzia Prencipe ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Surrogate Marker ◽  
Pituitary Surgery ◽  
Central Diabetes Insipidus ◽  
Optimal Timing ◽  
Vasopressin Release ◽  
Biochemical Alterations ◽  
Post Surgery ◽  
Patients At Risk ◽  
Pituitary Lesion

Introduction: Central diabetes insipidus (CDI) is a frequent complication of pituitary surgery, but its diagnosis lacks standardized criteria. Copeptin, a surrogate marker of arginine vasopressin release, is triggered by psycho-physical stresses such as pituitary surgery. Low postoperative copeptin could predict CDI onset. The aims of this study were the validation of copeptin as a predictor of post-neurosurgical CDI and the identification of the optimal timing for its determination. Methods: Sixty-six consecutive patients operated for a hypothalamic-pituitary lesion were evaluated. Copeptin was determined preoperatively and at 1, 6, 12, 24 and 48 h post-extubation. Fifty-eight patients were reassessed after 3–6 months post-surgery to confirm transient (3 cases) or permanent CDI (5 cases) diagnosis. Results: A marked copeptin peak was identified at 1 h after extubation, when a value below or equal to 12.8 pmol/L had a good accuracy in identifying CDI cases (AUC 0.866, 95% CI 0.751–0.941). Moreover, a copeptin peak above 4.2 pmol/L excluded permanent forms (AUC 1, 95% CI 0.629–1). Regression analysis identified copeptin as the only significant predictor of CDI (OR 0.86, 95% CI 0.75–0.98, p = 0.02). A copeptin T1/T0 ratio below or equal to 1.47 identified patients at risk of isolated biochemical alterations even in the absence of an overt CDI. Conclusions: A prompt increase of copeptin is expected at 1 h after extubation. The absence of this peak is a reliable predictor of post-neurosurgical CDI.

scholarly journals Methotrexate-associated lymphoproliferative disorder with hypopituitarism and central diabetes insipidus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Misaki Aoshima ◽  
Koji Nagayama ◽  
Kei Takeshita ◽  
Hiroshi Ajima ◽  
Sakurako Orikasa ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Subcutaneous Tissue ◽  
Brain Magnetic Resonance Imaging ◽  
Immunosuppressive Drugs ◽  
Anterior Mediastinum ◽  
Central Diabetes Insipidus ◽  
Oculomotor Nerve Palsy ◽  
List Type ◽  
Pituitary Dysfunction ◽  
Pituitary Lesion

Summary Patients treated with immunosuppressive drugs, especially methotrexate (MTX), rarely develop lymphoproliferative disorders (LPDs), known as MTX-related LPD (MTX–LPD). The primary site of MTX–LPD is often extranodal. This is the first reported case of MTX–LPD in the pituitary. A 65-year-old woman was admitted to our hospital with symptoms of oculomotor nerve palsy and multiple subcutaneous nodules. She had been treated with MTX for 11 years for rheumatoid arthritis. Computed tomography showed multiple masses in the orbit, sinuses, lung fields, anterior mediastinum, kidney, and subcutaneous tissue. Brain magnetic resonance imaging revealed a sellar mass. She was diagnosed with hypopituitarism and central diabetes insipidus based on endocrine examination. Although pituitary biopsy could not be performed, we concluded that the pituitary lesion was from MTX–LPD, similar to the lesions in the sinuses, anterior mediastinum, and subcutaneous tissue, which showed polymorphic LPD on biopsy. MTX was discontinued, and methylprednisolone was administered to improve the neurologic symptoms. After several weeks, there was marked improvement of all lesions, including the pituitary lesion, but the pituitary function did not improve. When pituitary lesions are caused by MTX–LPD, the possibility of anterior hypopituitarism and central diabetes insipidus needs to be considered. Further studies are needed to investigate the effectiveness of early diagnosis and treatment of MTX–LPD in restoring pituitary dysfunction. Learning points Pituitary lesions from MTX–LPD may cause hypopituitarism and central diabetes insipidus. Pituitary metastasis of malignant lymphoma and primary pituitary lymphoma, which have the same tissue types with MTX–LPD, have poor prognosis, but the lesions of MTX–LPD can regress only after MTX discontinuation. In cases of pituitary lesions alone, a diagnosis of MTX–LPD may be difficult, unless pituitary biopsy is performed. This possibility should be considered in patients treated with immunosuppressive drugs. Pituitary hypofunction and diabetes insipidus may persist, even after regression of the lesions on imaging due to MTX discontinuation.

scholarly journals Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Hyung Kim ◽  
Yong Hwy Kim ◽  
Young Soo Je ◽  
Kyoung Ryul Lee ◽  
Hwan Sub Lim ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Serum Sodium ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Diagnostic Value ◽  
Normal Serum ◽  
Central Diabetes Insipidus ◽  
Copeptin Level ◽  
Percentage Difference ◽  
Normal Serum Sodium

AbstractCopeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference =  − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.

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 AFTER ABDOMINAL SURGERY: A CASE REPORT

2021 ◽  
Author(s):  
Aarti Maharaj ◽  
Kundan Jana ◽  
Kalyana Janga ◽  
Sheldon Greenberg ◽  
Elie Fein
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Diabetes Insipidus ◽  
Pituitary Surgery ◽  
Central Diabetes Insipidus ◽  
Intraoperative Blood Loss ◽  
Prolonged Surgery

Post-operative polyuria due to Diabetes Insipidus is a commonly reported complication of pituitary surgery. However, central DI post abdominal surgery is rare and may be related to pre-existing DI or prolonged surgery with intraoperative blood loss. A thorough workup needs to be done to exclude central DI in such patients.

scholarly journals Management of Diabetes Insipidus following Surgery for Pituitary and Suprasellar Tumors

2021 ◽  
Author(s):  
Mussa Almalki ◽  
Maswood M. Ahmad ◽  
Imad Brema ◽  
Mohammed Almehthel ◽  
Khaled M. AlDahmani ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Pituitary Surgery ◽  
Central Diabetes Insipidus ◽  
Therapeutic Interventions ◽  
Response To Treatment ◽  
Csf Leak ◽  
Close Monitoring ◽  
Large Tumor ◽  
Increased Risk ◽  
Rathke's Cleft

Central diabetes insipidus (CDI) is a common complication of pituitary surgery. However, it is most frequently transient. It is defined by the excretion of an abnormally large volume of dilute urine with increasing serum osmolality. The reported incidence of CDI after pituitary surgery is variable; ranging from 0-90 %. Large tumor size, gross total resection, and intraoperative cerebrospinal fluid (CSF) leak usually have an increased risk of CDI as also seen with craniopharyngioma and Rathke’s cleft cysts. It can be associated with high morbidities and mortality if not promptly recognized and treated on time. It is essential to rule out other causes of postoperative polyuria to avoid unnecessary pharmacotherapy and iatrogenic hyponatremia. Once the diagnosis of CDI is established, close monitoring is required to evaluate the response to treatment and to determine whether the CDI is transient or permanent. This review outlines the evaluation and management of patients with CDI after pituitary and suprasellar tumors surgery to help recognize the diagnosis, consider the differential diagnosis, initiate therapeutic interventions, guide monitoring, and long-term management. Keywords: Central diabetes insipidus (CDI), polydipsia, polyuria, pituitary adenoma, preoperative risk factor, and pituitary surgery, arginine vasopressin, desmopressin, and treatment.

scholarly journals Transient idiopathic central diabetes insipidus: is severe sepsis a possible cause?

2017 ◽  
Vol 11 (1) ◽  
pp. 78 ◽  
Author(s):  
Ilaria Lazzari ◽  
Alessandro Graziani ◽  
Federica Mirici ◽  
Giuseppe Francesco Stefanini
Keyword(s):  
Severe Sepsis ◽  
Case Report ◽  
Diabetes Insipidus ◽  
Kidney Failure ◽  
Central Diabetes Insipidus ◽  
Acute Kidney Failure ◽  
Neuron Activity ◽  
Vasopressin Release ◽  
Vasopressin Neuron ◽  
Possible Cause

Idiopathic central diabetes insipidus (CDI) is a disorder characterized by hypotonic polyuria and polydipsia, without any identified etiology. Here we report a case of a 57-year-old woman, with idiopathic CDI, admitted to our department with severe sepsis and acute kidney failure. After clinical and radiological investigations, she was diagnosed with idiopathic CDI. In this case report the findings suggest that severe sepsis could be the trigger for this disease. In addition, we hypothesise that apelin, a diuretic neuropeptide, plays a role in such a process. Apelin levels are known to increase during severe sepsis, which in turn counteracts vasopressin actions through inhibition of vasopressin neuron activity and vasopressin release.

scholarly journals Options for individualizing therapy for postoperative central diabetes insipidus

2017 ◽  
Vol 14 (3) ◽  
pp. 54-57
Author(s):  
Larisa K. Dzeranova ◽  
Darya S. Mikaylova ◽  
Ekaterina A. Pigarova ◽  
Natalia G. Mokrysheva ◽  
Lyudmila Y. Rozhinskaya ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Diabetes Insipidus ◽  
Life Quality ◽  
Pituitary Surgery ◽  
Drug Dosage ◽  
Central Diabetes Insipidus ◽  
Common Life ◽  
Life Threatening

Postoperative diabetes insipidus is a common life-threatening morbidity after pituitary surgery. More frequent neurosurgeon interventions make drugs adjustment very important for higher life quality in the case of postoperative complications. We present the case of personalized adjustment of drug dosage to treat postoperative diabetes insipidus in patient undergoing reccurent transnasal adenomectomy.

scholarly journals Concurrent central diabetes insipidus and cerebral salt wasting disease in a post-operative case of craniopharyngioma: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patel Zeeshan Jameel ◽  
Sham Lohiya ◽  
Keta Vagha ◽  
Tauheed Ahmed ◽  
Divya Pujari ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Electrolyte Disorders ◽  
Wasting Disease ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Diuretic Hormone ◽  
Diagnosis And Management ◽  
Post Surgery ◽  
Inappropriate Secretion

Abstract Background Water and electrolyte disorders commonly encountered in children post-surgery involving hypothalamus and posterior pituitary, are central diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone and cerebral salt wasting disease. Delayed diagnosis and inadequate management of such cases may lead to worsened neurological outcomes with a high mortality rate. Case presentation Here we report the case of a 7-year-old girl who underwent surgical resection of a craniopharyngioma, following which she initially developed central diabetes insipidus. However, later on in the course of her illness she developed symptomatic hyponatremia with natriuresis which was diagnosed to be due to cerebral salt wasting disease. This combination of central diabetes insipidus and cerebral salt wasting syndrome is a rare occurrence and poses a diagnostic challenge. Diagnosis and management can be even more difficult when these conditions precede or coexist with each other. Conclusion In such cases development of hyponatremia should always prompt consideration of unusual causes like cerebral salt wasting disease in addition to the classically described syndrome of inappropriate secretion of anti-diuretic hormone. Hence, a thorough knowledge of these disorders along with intensive monitoring of fluid and sodium status is critical for timely diagnosis and management of these patients.

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