scholarly journals Anterior and Posterior Pituitary Function Testing with Simultaneous Insulin Tolerance Test and a Novel Copeptin Assay

2007 ◽  
Vol 92 (7) ◽  
pp. 2640-2643 ◽  
Author(s):  
Mira Katan ◽  
Nils G. Morgenthaler ◽  
Kashinath C. S. Dixit ◽  
Jonas Rutishauser ◽  
Georg E. Brabant ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Insulin Injection ◽  
Tolerance Test ◽  
Pituitary Function ◽  
Posterior Pituitary ◽  
Maximum Increase ◽  
Maximal Increase ◽  
Patients With Diabetes ◽  
Pituitary Function Test

Abstract Context: Posterior pituitary function in patients with suspected diabetes insipidus is usually assessed by a water deprivation test. Alternatively, a nonosmotic stimulus such as hypoglycemia may be used to stimulate vasopressin [arginine vasopressin (AVP)] secretion. Plasma AVP measurement may aid in the diagnosis and, especially, differential diagnosis of diabetes insipidus and polydipsia. However, AVP measurement is cumbersome. Copeptin, the stable C-terminal glycopeptide of the AVP prohormone, is stoichiometrically secreted from the posterior pituitary. Objective: The aim was to study the value of copeptin levels in the diagnosis of diabetes insipidus during insulin-induced hypoglycemia. Patients and Methods: A total of 38 patients were studied during insulin-induced hypoglycemia as part of a combined pituitary function test for possible anterior pituitary disease. There were 29 patients who had normal posterior pituitary function, and nine had central diabetes insipidus. Blood sampling was done before and 30, 45, and 90 min after iv insulin injection. Copeptin was measured with a new sandwich immunoassay. Results: Patients with intact posterior pituitary function had basal copeptin levels of 3.7 ± 1.5 pm, with a maximal increase to 11.1 ± 4.6 pm 45 min after insulin injection. Copeptin levels in patients with diabetes insipidus were 2.4 ± 0.5 pm before insulin injection, with a maximum increase to 3.7 ± 0.7 pm. Both basal and stimulated copeptin levels were lower in patients with diabetes insipidus as compared with patients with intact posterior pituitary function. A stimulated copeptin level 45 min after insulin injection of less than 4.75 pm had an optimal diagnostic accuracy to detect diabetes insipidus. Conclusion: Copeptin measurement may be used to assess posterior together with anterior pituitary function during insulin-induced hypoglycemia.

Pituitary assessment strategy

2011 ◽  
pp. 127-136
Author(s):  
W. M. Drake ◽  
P. J. Trainer
Keyword(s):  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Patient Management ◽  
Pituitary Function ◽  
Rational Approach ◽  
Posterior Pituitary ◽  
Physiological Basis ◽  
Assessment Strategy ◽  
Anterior Pituitary Function ◽  
Treatment Of Diabetes

The optimum methods of testing anterior and posterior pituitary function and the interpretation of the results are subjects of continuing debate. The syndromes associated with and consequences of hypo- and hyperpituitarism, and the diagnosis and treatment of diabetes insipidus are all discussed elsewhere in this book. The intention of this chapter is to describe the physiological basis and evidence in favour of the various available tests of anterior pituitary function, discuss the limitations of using artificial assessments on which to base patient management decisions and, ultimately, endeavour to produce a rational approach to the investigation of suspected hypopituitarism.

Meningoencephalitis Complicated by Pituitary Insufficiency and a Spontaneously Resolving Suprasellar Mass

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 567-569 ◽  
Author(s):  
Katherine Jew ◽  
Veronica Piziak ◽  
Paul F. Gilliland ◽  
Douglas L. Hurley
Keyword(s):  
Antibiotic Therapy ◽  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Pituitary Function ◽  
Pituitary Insufficiency ◽  
Posterior Pituitary ◽  
Bacterial Origin ◽  
Anterior Pituitary Function

Abstract A 53-year-old woman presented with acute meningoencephalitis associated with anterior and posterior pituitary insufficiency. A computed axial tomogram (CT) of the head revealed a suprasellar mass. The meningoencephalitis, presumably of bacterial origin, resolved after antibiotic therapy and, on a repeat CT, the suprasellar mass had disappeared. Five months after the initial illness, the patient's diabetes insipidus had resolved, anterior pituitary function had improved, and there was no sign of the suprasellar mass. The presence of a suprasellar mass in conjunction with acute meningoencephalitis and anterior and posterior pituitary insufficiency should raise the suspicion that the mass is not neoplastic and may be infectious or inflammatory in origin.

scholarly journals Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis

2017 ◽  
Vol 177 (2) ◽  
pp. 127-135 ◽  
Author(s):  
Isabella Lupi ◽  
Mirco Cosottini ◽  
Patrizio Caturegli ◽  
Luca Manetti ◽  
Claudio Urbani ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Glucocorticoid Therapy ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Autoimmune Hypophysitis ◽  
Negative Prognostic Factor ◽  
Anterior Pituitary Function ◽  
Design And Methods

Introduction Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable. Objective To identify clinical and radiological findings associated with response to glucocorticoids. Design and methods 12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12–96 months). Results MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (n = 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (n = 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% P = 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; P = 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (P = 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (P = 0.008) but diabetes insipidus persisted in all. Conclusions Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids.

Evaluation of Anterior Pituitary Function in Patients with Posttraumatic Diabetes Insipidus

1980 ◽  
Vol 51 (6) ◽  
pp. 1279-1282 ◽  
Author(s):  
TOMMASO BARRECA ◽  
CARLO PERRIA ◽  
ANTONELLO SANNIA ◽  
GIANNI MAGNANI ◽  
ERMANNO ROLANDI
Keyword(s):  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Pituitary Function ◽  
Anterior Pituitary Function

Diabetes insipidus from sarcoidosis confined to the posterior pituitary

1997 ◽  
pp. 514-519 ◽  
Author(s):  
KC Loh ◽  
A Green ◽  
PA Fitzgerald ◽  
N Weidner ◽  
JB Tyrrell ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Pituitary Hormones ◽  
Pulmonary Sarcoidosis ◽  
Complete Regression ◽  
Posterior Pituitary ◽  
Pituitary Mass ◽  
Laboratory Investigations ◽  
New Onset

A young white man with new-onset central diabetes insipidus was discovered to have a posterior pituitary mass on magnetic resonance imaging. No other radiological abnormalities were noted in the anterior pituitary, infundibulum or hypothalamus. No other endocrinopathies were present: laboratory investigations showed normal basal concentrations of anterior pituitary hormones, including prolactin. The patient was suspected to have sarcoidosis affecting the posterior pituitary, because of the discovery of pulmonary sarcoidosis during his diagnostic evaluation. His symptoms of polydipsia and polyuria responded promptly to intranasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP). The patient demonstrated complete regression of the posterior pituitary mass after a course of corticosteroid therapy. However, his diabetes insipidus persisted and he continues to need DDAVP treatment, currently at 12 months of follow-up. The resolution of the neurohypophysial mass was compatible with the diagnosis of pituitary sarcoidosis and this precluded the need for a transsphenoidal biopsy or surgery.

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