Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study

2015 ◽  
Vol 100 (6) ◽  
pp. 2268-2274 ◽  
Author(s):  
Katharina Timper ◽  
Wiebke Fenske ◽  
Felix Kühn ◽  
Nica Frech ◽  
Birsen Arici ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Water Deprivation ◽  
Surrogate Marker ◽  
Clinical Information ◽  
Final Diagnosis ◽  
Saline Infusion ◽  
Infusion Test ◽  
Funding Sources ◽  
History Of ◽  
Single Baseline

Context: The polyuria-polydipsia syndrome comprises primary polydipsia (PP) and central and nephrogenic diabetes insipidus (DI). Correctly discriminating these entities is mandatory, given that inadequate treatment causes serious complications. The diagnostic “gold standard” is the water deprivation test with assessment of arginine vasopressin (AVP) activity. However, test interpretation and AVP measurement are challenging. Objective: The objective was to evaluate the accuracy of copeptin, a stable peptide stoichiometrically cosecreted with AVP, in the differential diagnosis of polyuria-polydipsia syndrome. Design, Setting, and Patients: This was a prospective multicenter observational cohort study from four Swiss or German tertiary referral centers of adults >18 years old with the history of polyuria and polydipsia. Measurements: A standardized combined water deprivation/3% saline infusion test was performed and terminated when serum sodium exceeded 147 mmol/L. Circulating copeptin and AVP levels were measured regularly throughout the test. Final diagnosis was based on the water deprivation/saline infusion test results, clinical information, and the treatment response. Results: Fifty-five patients were enrolled (11 with complete central DI, 16 with partial central DI, 18 with PP, and 10 with nephrogenic DI). Without prior thirsting, a single baseline copeptin level >21.4 pmol/L differentiated nephrogenic DI from other etiologies with a 100% sensitivity and specificity, rendering a water deprivation testing unnecessary in such cases. A stimulated copeptin >4.9 pmol/L (at sodium levels >147 mmol/L) differentiated between patients with PP and patients with partial central DI with a 94.0% specificity and a 94.4% sensitivity. A stimulated AVP >1.8 pg/mL differentiated between the same categories with a 93.0% specificity and a 83.0% sensitivity. Limitation: This study was limited by incorporation bias from including AVP levels as a diagnostic criterion. Conclusion: Copeptin is a promising new tool in the differential diagnosis of the polyuria-polydipsia syndrome, and a valid surrogate marker for AVP. Primary Funding Sources: Swiss National Science Foundation, University of Basel.

Abstract TP41: Prevalence and Factors Associated with Early Ischemic Changes on Non-contrast CT Obtained Less Than 90 Minutes After Symptom Onset

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jared Noroozi ◽  
David S Liebeskind ◽  
Jeffrey L Saver ◽  
Sidney Starkman ◽  
Juan Pablo Villablanca ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Ischemia ◽  
Symptom Onset ◽  
Clinical Information ◽  
Final Diagnosis ◽  
Factors Associated ◽  
History Of ◽  
Artery Disease ◽  
Initial Imaging ◽  
Contrast Ct

Background: Usually early infarct signs on imaging take a few hours to develop in ischemic stroke. There may be a subset of patients manifesting early infarct signs on imaging hyperacutely. Objective: To determine the prevalence and factors associated with very early infarct signs on ASPECTS among patients with cerebral ischemia who were imaged <90 minutes after symptom onset. Methods: Subjects participating in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) phase 3 clinical trial with a final diagnosis of cerebral ischemia (TIA or Stroke) and initial imaging performed <90 minutes from last known well time (LKWT) were included. ASPECTS was graded by a neuroradiologist (JPV) blinded to all clinical information. Individual subjects were characterized as having no early ischemic changes (ASPECTS 10) vs. early ischemic changes (ASPECTS 0-9). We describe the prevalence of early ischemic signs in this prospectively enrolled cohort, clinical factors associated with early ischemic changes as well as outcomes. Results: There were 566 cases imaged a mean of 71 (SD 11) minutes after LKWT. Mean age was 69 (SD 13), 43% women, 93% ischemic stroke, 7% TIA, median emergency department NIHSS 8 (IQR 3-16), median ASPECTS score of 10 (IQR 7-10, range 1-10). There were 200 cases with early ischemic findings (35%). Early ischemic changes were not related to age, blood pressure, history of hypertension, diabetes, dyslipidemia, coronary artery disease, or time to imaging (71 vs. 71 mins). Early ischemic changes were more commonly noted in women (50% vs. 39%, p=0.015) and associated higher presenting NIHSS (14 [IQR 7-20] vs 5 [IQR 2-11], p<0.001). The presence of any hyperacute ischemia change was associate with worse 90-day outcome (modified Rankin score 3 [IQR 1-5] vs 1 [IQR 0-3, p<0.001). Conclusions: Early ischemic changes were noted on about 1/3 rd of imaging obtained <90 minutes after symptom onset. The presence of hyperacute ischemic changes is associated with more severe stroke and poor clinical outcomes.

scholarly journals Cystic pancreatic lesions: MR imaging findings and management

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Giovanni Morana ◽  
Pierluigi Ciet ◽  
Silvia Venturini
Keyword(s):  
Differential Diagnosis ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Main Pancreatic Duct ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Morphological Findings ◽  
History Of ◽  
Cystic Pancreatic Lesions ◽  
Radiological Examinations

AbstractCystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

Nineteen-year-old female with unilateral ankle pain. What is your diagnosis?

1997 ◽  
Vol 87 (2) ◽  
pp. 74-79
Author(s):  
E Sobel ◽  
MA Kosinski ◽  
TJ Lehman
Keyword(s):  
Differential Diagnosis ◽  
Case History ◽  
Final Diagnosis ◽  
Ankle Pain ◽  
Laboratory Values ◽  
Left Ankle ◽  
Full Explanation ◽  
History Of

The case history of a 19-year-old female with left ankle pain of 18 months' duration is presented. The reader is encouraged to make his or her own diagnosis after reviewing the history, laboratory values, and imaging. The final diagnosis with a full explanation and differential diagnosis will follow.

scholarly journals Ollier disease: the first report in Syria

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Yaseen Dhemesh ◽  
Talha Tawekji ◽  
Mohammad-Nasan Abdul-Baki ◽  
Ghazal Abi-Zamr ◽  
Sawssan Ali
Keyword(s):  
Differential Diagnosis ◽  
Malignant Transformation ◽  
Bone Tumor ◽  
Final Diagnosis ◽  
Benign Bone Tumor ◽  
Pathological Fractures ◽  
Pathological Characteristics ◽  
History Of ◽  
Ollier Disease ◽  
Skeletal Disorder

Abstract Ollier disease is a rare nonhereditary skeletal disorder, characterized by multiple enchondromas, which are noncancerous growth of cartilage. In this report, we present a case of Ollier disease in a 10-year-old Syrian boy. The patient presented with multiple boney masses on hands; he had a history of pathological fractures when he was 5, which caused crippling. We analyzed the clinical, radiographical and pathological characteristics of our patient, which helped us to reach the final diagnosis. Ollier disease is a benign bone tumor, but it has a risk of malignant transformation into chondrosarcoma. The aim of this report is to document the presence of Ollier disease in Syria to help other Syrian physicians considering this disease in the differential diagnosis if they face similar presentations.

Abstract 3051: Blood Pressure Thresholds to Predict the Cause of Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Sevan R Komshian ◽  
Jonathan T Kleinman ◽  
Ryan W Snider ◽  
Irina Eyngorn ◽  
Didem Aksoy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Chronic Phase ◽  
Clinical Information ◽  
Roc Curves ◽  
Final Diagnosis ◽  
Chronic Hypertension ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Contrast Angiography ◽  
History Of

Introduction: Chronic hypertension is a common cause of spontaneous intracerebral hemorrhage (ICH), but not all patients who are hypertensive on hospital presentation have an ICH caused by hypertension (htnICH). We sought to determine blood pressure (BP) thresholds that correlated with a presumed htnICH in a prospective cohort. Methods: The NIH-funded Diagnostic Utility of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study prospectively enrolled consecutive ICH patients to determine the utility of routine MRI in the diagnosis and management of these patients. Contrast angiography was pursued in a predefined patient subset. At 3 months, ICH cause was determined by the treating stroke physician after review of all clinical information, including MRI in the acute and chronic phase, pathology, and clinic follow-up, as available. Statistical analyses were done using SPSS: χ2; 2 tailed t-tests; and Mann-Whitney U tests were used as appropriate. Receiver operator characteristic (ROC) curves were created and results expressed as area under curve (AUC). Results: We included 136 patients in this report (age: 63±17yrs; ICH volume: 22±27cc; NIHSS: 9±8; GCS: 13±3). Of these, 70% had a history of hypertension, 40% had an admission SBP> 180mmHg, and 22% an admission SBP >200mmHg. Sixty patients (44%) had htnICH as their final diagnosis. A history of hypertension was associated with htnICH (χ2=11.8, p<0.001), but 48% (46/95) of patients with a history of hypertension did not have a htnICH. Patients with a htnICH had: higher SBP (189 vs 157mmHg, p<0.0001); higher MAP (131 vs 110mmHg, p<0.0001), higher NIHSS (12 vs 6.5, p<0.0001); smaller ICH volumes (16.6 vs 26.0cc, p=0.03); and non-lobar hematomas (χ2=62.3, p180mmHg was 74% specific and 58% sensitive for a subsequent diagnosis of htnICH, a SBP> 200mmHg was 90% specific and 37% sensitive, and a MAP >132mmHg was 90% specific and 45% sensitive. Using ROC analysis, MAP predicted hypertensive etiology with an AUC of 0.75 (p<0.0001, 95% CI: 0.67-0.83). Patients with htnICH and MAP 132mmHg based on age, NIHSS, gender, ICH volume, or ICH location (lobar vs non-lobar). Conversely, patients with non-htnICH and MAP >132mmHg on admission tended to have larger ICH volumes (44 vs 24cc, p=0.07) and higher NIHSS (10 vs 6, p=0.21), but did not differ by location from those with a MAP<132mmHg. Non-lobar location alone was 74% specific and 93% sensitive for htnICH, and a non-lobar ICH or a MAP>132mmHg was 64% specific and 95% sensitive for htnICH. Conclusions: In our cohort, a history of hypertension predicted htnICH no better than chance. An admission SBP >200mmHg or a MAP >132mmHg predicted htnICH in 90% of these patients, but missed two-thirds of cases. ICH location alone was a sensitive predictor of htnICH, but blood pressure thresholds were more specific.

scholarly journals Atypical presentations of orbital cellulitis in an 11-year-old boy

2020 ◽  
Vol 4 ◽  
pp. 40-43
Author(s):  
Nnenna Henrietta Oraegbunam ◽  
Ernest Ikechukwu Ezeh ◽  
Nkama Etiowo ◽  
Roseline Nkeiruka Ezeh
Keyword(s):  
Differential Diagnosis ◽  
Systemic Infection ◽  
Final Diagnosis ◽  
Acute Onset ◽  
Orbital Cellulitis ◽  
Easy Access ◽  
Purulent Matter ◽  
Upper Respiratory Tract ◽  
Conjunctival Hyperemia ◽  
History Of

Spontaneous acute-onset proptosis accompanied with inflammatory signs in children is commonly caused by orbital cellulitis/abscess; however, the clinician should always be alert to the possibility of other causes such as neoplastic: Orbital rhabdomyosarcoma (RMS), traumatic, and iatrogenic factors. This is a case report of an 11-year-old boy presenting with an acute-onset non-axial proptosis of the left eye without a history of trauma, sinus disease, or systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital RMS. However, the final diagnosis was orbital cellulitis with abscess. The purpose of the study was to report a case of “cold” orbital abscess that clinically mimics orbital RMS. An 11-year-old boy presented with a 2 weeks history of painless, rapid-onset non-axial proptosis in the left eye. It was associated with periorbital edema, and mild conjunctival hyperemia. There was no preceding or associated history of fever, trauma, upper respiratory tract infection, sinusitis, or immunosuppression. An initial clinical diagnosis of RMS, with orbital cellulitis as a differential diagnosis, was made delaying commencement of antibiotic therapy. Following the drainage of greenish tinged purulent matter growing Staphylococcus aureus on culture, the diagnosis of orbital cellulitis with abscess was made. A broad-spectrum antibiotics and subsequent adjunct anti-inflammatory therapy yielded excellent clinical resolution. The case demonstrates the pitfalls/challenges in differentiating orbital space occupying lesions manifesting with inflammatory features on the basis of clinical findings alone. This is particularly relevant in a busy triage ophthalmic clinic in a low resource environment without easy access to any form of orbital imaging. In addition, the case highlights that green tinged purulent matter can be found in infections from a myriad of organisms aside from the popularly known Pseudomonas aeruginosa.

Post saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

2014 ◽  
Vol 122 (03) ◽  
Author(s):  
M Weigel ◽  
A Riester ◽  
G Hanslik ◽  
K Lang ◽  
S Endres ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test

F.N.A.C. AS DIAGNOSTIC TOOL OF PAROTID TUMORS AND ASSOCIATED PITFALLS IN CORRELATION WITH HISTOPATHOLOGY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Bhawana Pant ◽  
Sanjay Gaur ◽  
Prabhat Pant
Keyword(s):  
Preoperative Diagnosis ◽  
Histopathological Examination ◽  
Clinical Information ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Histopathological Diagnosis ◽  
Cytological Diagnosis ◽  
Tertiary Referral Centre ◽  
Clear Cut ◽  
Parotid Tumors

F.NA.C has been used for ages as a safe and economical tool for fast preoperative diagnosis of parotid tumors. It has certain pitfall which sometimes leads to misdiagnosis and consequently it may have affect on treatment of the tumors. Keeping in view of the diverse classification of parotid tumors’ information from cytology should be combined with radiology as well as clinical diagnosis. Aim: To discuss some cases where there was discrepancy between cytological diagnosis and histopathological result and also suggest measures to improve the efficacy of F.N.A.C. Material and methods: The study includes 50 cases of parotid tumours who presented to the  department of ENT at Government medical college Haldwani which is a tertiary referral centre during 2009 to 2016. Only adult patients were included and inflammatory swelling were excluded from the study. All patients evaluated  Contrast enhanced computerized tomography(CECT) and  Magnetic resonance imaging (MRI) followed by Fine needle aspiration cytology .Preoperative diagnosis was made upon the findings of the above investigations and different types of  parotid surgeries  were done. . Final diagnosis was made on  histopathological  examination. Result :The most common tumour  came out to be pleomorphic adenoma (23 cases-46%) followed by mucoepidermoid carcinoma(12cases-24%). In ten  cases there was no clear cut  association between cytological diagnosis and final histopathological diagnosis. Conclusion: FNAC is highly sensitive and specific technique for diagnosis of many salivary gland swellings. FNAC can be used preoperatively to avoid unnecessary surgery and biopsy. Details of clinical information and radiologic features may help the pathologist to arrive at the appropriate diagnosis and reduce false interpretation. Pitfalls may also occur with improper technique of FNAC which can be overcome by proper caution.

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