Use of Copeptin Levels to Predict the Resolution of Transient Postoperative SIADH

2020 ◽  
Vol 93 (4) ◽  
pp. 258-262
Author(s):  
Brandon Jones ◽  
Margarita Corredor ◽  
Aida Lteif ◽  
Siobhan  Pittock ◽  
Joshua Bornhorst ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Arachnoid Cyst ◽  
Hormone Secretion ◽  
Case Description ◽  
Older Children ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Pituitary Dysfunction ◽  
Endoscopic Fenestration

<b><i>Background:</i></b> Copeptin levels reflect vasopressin activity and help classify osmoregulatory disorders. There is limited pediatric experience using copeptin to diagnose and manage diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and bi- or tri-phasic postsurgical osmoregulatory disorders. In this report, we describe serial copeptin levels in an infant who developed transient SIADH after neurosurgery. <b><i>Case Description:</i></b> A 4-month-old infant with no prior pituitary dysfunction underwent endoscopic fenestration of a large arachnoid cyst (3.5 × 4.7 × 3.8 cm). He developed SIADH on postoperative day 4 with seizures, hyponatremia (sodium 121 mmol/L), and concentrated urine (535 mOsm/kg). His initial copeptin level was inappropriately high in the context of his hyponatremia. Copeptin levels decreased as his SIADH resolved. Serial copeptin levels correlated to the infant’s increased ability to dilute urine. <b><i>Conclusion:</i></b> Copeptin levels in this infant are consistent with levels described in adults and older children. Obtaining copeptin levels may improve providers’ ability to quickly diagnose and manage SIADH amongst other heterogeneous causes of hyponatremia. Lastly, trending copeptin levels improved providers’ ability to monitor SIADH progression, and may allow preemptive fluid titration for children with bi- or tri-phasic shifts in osmoregulation after neurological procedures.

scholarly journals Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Subsequent Central Diabetes Insipidus: A Rare Presentation of Pituitary Apoplexy

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
S. B. Smedegaard ◽  
J. O. Jørgensen ◽  
N. Rittig
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Pituitary Apoplexy ◽  
Hormone Secretion ◽  
Central Diabetes Insipidus ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Pituitary Dysfunction

Pituitary apoplexy (PA) is a rare endocrine emergency that occasionally presents with sodium disturbances. Here we present a rare case with a previously healthy 41-year-old female who presented with acute onset headache and nausea without visual impairment or overt pituitary dysfunction. Plasma sodium concentrations declined abruptly during the first two days of admission to a nadir of 111 mmol/l. Urine and blood chemistry were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Magnetic resonance imaging revealed recent bleeding into a pituitary cystic process. Hyponatremia was successfully corrected with fluid restriction and both visual function and anterior pituitary function remained intact. Subsequently, the patient developed central diabetes insipidus (CDI), which responded well to desmopressin substitution. To our knowledge, this is the first case of PA presenting predominantly with posterior pituitary dysfunction that transitioned from SIADH to permanent CDI.

TREATMENT OF ACUTE POST-OPERATIVE INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION WITH DIPHENYLHYDANTOIN

1974 ◽  
Vol 76 (3) ◽  
pp. 625-628 ◽  
Author(s):  
Alex M. Landolt
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Intravenous Administration ◽  
Hormone Secretion ◽  
Urine Concentration ◽  
Water Excretion ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion

ABSTRACT Post-operative inappropriate antidiuretic hormone (ADH) secretion was observed 6 times in a group of 26 patients without diabetes insipidus before surgery for craniopharyngioma. Fourteen patients with existing diabetes insipidus did not show this disturbance. Intravenous administration of diphenylhydantoin (250 mg q. 8 h) controlled the hyponatraemia during the interphase of abnormal urine concentration and established an increased transitory water excretion in an 8 year old child operated upon for craniopharyngioma.

Suprasellar arachnoid cyst resulting in the syndrome of inappropriate antidiuretic hormone secretion

2010 ◽  
Vol 6 (5) ◽  
pp. 486-488 ◽  
Author(s):  
Alexandra D. Beier ◽  
Samuel H. Cheshier ◽  
Aabir Chakraborty ◽  
Peter Dirks
Keyword(s):  
Antidiuretic Hormone ◽  
Arachnoid Cyst ◽  
Pediatric Population ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Hypothalamic Pituitary Axis ◽  
Suprasellar Arachnoid Cyst ◽  
Cyst Fenestration

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is occasionally seen after hypothalamic injury or dysfunction, although it typically occurs in association with other endocrine disturbances. It is has never been described as a presenting feature of a suprasellar arachnoid cyst (SAC) in the pediatric population. The authors describe the case of an enlarging SAC resulting in SIADH as the only presenting feature, with an otherwise normal hypothalamic-pituitary axis. An SAC was diagnosed in utero in this 5-month-old girl who had a normal functioning hypothalamic-pituitary axis on presentation. Because of cyst enlargement and hydrocephalus, the patient was scheduled for surgery; however, preoperative labs revealed SIADH. After stabilizing the serum sodium concentration with fluid restriction and the administration of 3% sodium chloride, the patient underwent endoscopic cyst fenestration. Postoperatively, she had complete resolution of the SIADH. Syndrome of inappropriate antidiuretic hormone secretion as the presenting symptom of an SAC has not been previously described. In the aforementioned patient, the proposed mechanism for SIADH was enlargement of the suprasellar arachnoid cyst causing compression of the supraoptic and paraventricular nuclei and thus overstimulating the secretion of arginine vasopressin, which resulted in SIADH. The association of SIADH with an SAC is reportable, as is the resolution of the SIADH via cyst fenestration. The authors suggest that SIADH is an uncommon presenting feature of SACs and that syndrome resolution is possible with cyst decompression.

Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH

2017 ◽  
Vol 30 (6) ◽  
pp. 693-696 ◽  
Author(s):  
Nandini Bhat ◽  
Erjola Balliu ◽  
Jennifer Osipoff ◽  
Andrew Lane ◽  
Thomas Wilson
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Animal Studies ◽  
Hormone Secretion ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Severe Hyponatremia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Wisdom Teeth

AbstractHyponatremia can be a complication of opioid therapy, which has been postulated to occur secondary to inappropriate antidiuretic hormone secretion (syndrome of inappropriate antidiuretic hormone secretion [SIADH]). We report severe hyponatremia following wisdom teeth extraction with opioid analgesia in a 19-year-old female with diabetes insipidus (DI) and acquired panhypopituitarism that challenges this theory. As this patient has DI, we believe opioid treatment caused severe hyponatremia by the following mechanisms: (1) Opioids have a direct antidiuretic effect independent of changes in ADH, as demonstrated in Brattleboro rats with central DI. (2) Hydrocodone may have stimulated this patient’s thirst center contributing to hyponatremia, as demonstrated in animal studies. Opioid use can cause hyponatremia in patients independent of ADH. It is important for clinicians to be aware of this so that patients can be appropriately counseled.

Sign in / Sign up

Export Citation Format

Share Document