scholarly journals Pituitary Lymphoma Presenting as Diabetes Insipidus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A600-A600
Author(s):  
Bilal Bashir ◽  
Deepa Liza Jacob ◽  
Moulinath Banerjee
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Anterior Pituitary ◽  
Primary Cns Lymphoma ◽  
Cns Lymphoma ◽  
Posterior Pituitary ◽  
High Attenuation ◽  
Secondary Hypothyroidism ◽  
New Findings ◽  
Ct Head

Abstract Introduction: Primary CNS lymphomas are rare accounting for 1-3% of CNS neoplasms. They lack specific clinical or radiological features and are diagnosed histologically. We describe a case of Primary CNS lymphoma involving pituitary gland presenting with confusion and diabetes insipidus. Case: 74-year-old presented with anorexia, weight loss, visual hallucinations and acute confusion. Initial evaluation revealed hypernatremia (148 mmol/L), an old cerebral infarct and new extensive thrombus in aorta and lower limb deep vein thrombosis. During hospital stay, he sustained a fall and a CT head showed a new high attenuation change around the temporal horn and left temporal lobe. MRI head was done to characterize the lesion but because of confusion and irritability, this was inconclusive. Patient continued to have hypernatremia with serum sodium ranging from 148 - 154 mmol/L (135-145 mmol/L) that failed to improve after rehydration. He continued to have negative fluid balance and urine output >2.5 litres a day with dilute urine and urine osmolarity of 134 mosm/L. Due to confusion, we were unable to conduct a water deprivation test. Anterior pituitary profile was consistent with secondary hypothyroidism (TSH was 0.09 (0.02-6.00), Free T4 8.2 (8.0-18.0) and (Free T3 was 2.8 (3.0- 4.8)), and secondary hypogonadism (Testosterone 0.9 nmol/L (6.1-27.1), FSH 1.0 IU/L and LH was <0.2 IU/L). Hypothalamic- adrenal axis was intact as cortisol showed adequate increment after corticotropin stimulation (Cortisol at 0 min 386 nmol/L, 30 minutes 584 nmol/L and 60 minutes 640 nmol/L). Further CT Head with contrast was carried out in view of new findings of hypopituitarism that showed smooth hyperattenuating pituitary gland that was consistent with diabetes insipidus and intense contrast enhancement seen in the periventricular regions and the caudate and dentate nuclei bilaterally. Based on clinical and radiological picture, diagnosis of CNS lymphoma and diabetes insipidus was made and commenced on desmopressin nasal spray. We were unable to perform brain biopsy or quantify the response to desmopressin due to rapid deterioration of patient who died 9 weeks after his initial presentation. An autopsy was carried out and histopathology of pituitary yielded normal anterior pituitary but posterior pituitary was completely infiltrated by Non-Hodgkin’s Lymphoma of Diffuse large B cell type that was also infiltrating parts of the cerebellum, temporal cortex and the basal ganglia hence proving diagnosis of Primary CNS lymphoma. Conclusion: Sudden onset of DI with pathological appearance of posterior pituitary and equivocal/non diagnostic CNS imaging should raise the suspicion of CNS lymphoma. Although diagnosis is histopathological, early detection with high index of suspicion and treatment and lead to better outcomes.

Serotonergic Neurons and Neuroendocrine Function

Physiology ◽  
1993 ◽  
Vol 8 (5) ◽  
pp. 202-207
Author(s):  
LD Van de Kar ◽  
MS Brownfield
Keyword(s):  
Pituitary Gland ◽  
Anterior Pituitary ◽  
Adrenocorticotropic Hormone ◽  
Renin Secretion ◽  
Nerve Terminals ◽  
Posterior Pituitary ◽  
Serotonergic Neurons ◽  
Neuroendocrine Function ◽  
Posterior Pituitary Gland

The release of serotonin (5-HT) from nerve terminals in the hypothalamus increases secretion of adrenocorticotropic hormone and prolactin from the anterior pituitary, vasopressin and oxytocin from the posterior pituitary gland, and renin secretion from the kidneys. Activation of 5-HT1 and/or 5-HT2 receptors stimulates the secretion of these hormones.

scholarly journals Primary CNS lymphoma with bilateral symmetric hypothalamic lesions presenting with panhypopituitarism and diabetes insipidus

Pituitary ◽  
2009 ◽  
Vol 14 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Brian Thomas Layden ◽  
Steve Dubner ◽  
Daniel J. Toft ◽  
Peter Kopp ◽  
Sean Grimm ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Primary Cns Lymphoma ◽  
Cns Lymphoma ◽  
Hypothalamic Lesions

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.

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.

HORMONAL HYPERTENSION RESULTING FROM PITUITARY IMBALANCE

1965 ◽  
Vol 43 (2) ◽  
pp. 269-278 ◽  
Author(s):  
John Hunter ◽  
R. E. Haist
Keyword(s):  
Blood Pressure ◽  
Pituitary Gland ◽  
Anterior Pituitary ◽  
Posterior Part ◽  
Pituitary Hormones ◽  
Posterior Pituitary ◽  
Blood Pressure Elevation ◽  
Arterial Blood ◽  
Target Organs ◽  
Intact Rats

The removal of the posterior part of the pituitary gland in the rat leads to an elevation in blood pressure. The production of an anterior–posterior pituitary imbalance in hypophysectomized animals by the administration of certain hormones of target glands influenced by the anterior pituitary (thyroxine, testosterone, cortisone (TTC)) also produces an increase in mean arterial blood pressure. In the intact animal, too, the administration of the hormones of the target organs (TTC) will lead to an elevation of blood pressure, and 1 week after the cessation of this treatment the blood pressure is as high or higher than at the end of the administration period. Administration of anterior pituitary hormones TSH, LH, and ACTH both in hypophysectomized and in intact rats also produced elevations in blood pressure. In two female dogs, administration of pituitary target-organ hormones (TTC) consistently produced an elevation of blood pressure associated with a direct effect of the injected hormones, followed by a depression of blood pressure below previous resting values after hormone withdrawal, presumably because of an associated inhibition of anterior pituitary effects. When certain hormones of the posterior pituitary gland are administered along with TTC, in both hypophysectomized and intact rats, the blood pressure elevation is not as great as with TTC alone, though, by themselves, the posterior pituitary factors caused some elevation in blood pressure. It is concluded that an imbalance between the influences of the anterior and posterior parts of the pituitary gland can lead to a significant elevation in blood pressure. It seems likely that, depending on the dose, the effects observed after the injection of the agent is discontinued may be due to persistence of the action of the agent or, in some instances, to inhibition of the activity of part of the pituitary gland.

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.

THE ANTIDIURETIC EFFECT OF INTRAVENOUS AND INTRACAROTID INFUSION OF CALCIUM CHLORIDE IN HYDRATED RATS

1965 ◽  
Vol 32 (2) ◽  
pp. 161-165 ◽  
Author(s):  
N. A. THORN ◽  
M. W. SMITH ◽  
E. SKADHAUGE
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Calcium Chloride ◽  
Calcium Ions ◽  
Intravenous Infusion ◽  
Essential Role ◽  
Hypotonic Solution ◽  
Posterior Pituitary ◽  
Antidiuretic Effect ◽  
Posterior Pituitary Gland

SUMMARY Calcium chloride was infused intravenously as a slightly hypotonic solution into hydrated rats anaesthetized with ethanol and Inactin. Doses of 12–24 mg. Ca2+/kg. caused a transitory antidiuretic effect during which time antidiuretic material was excreted in the urine. Intracarotid infusion of calcium chloride towards the head produced a more pronounced effect than intravenous infusion of the same amount. The same doses of calcium chloride failed to have an antidiuretic effect in rats with diabetes insipidus. These findings are discussed in relation to the hypothesis of Douglas & Poisner that calcium ions play an essential role in the release of vasopressin from the posterior pituitary gland.

The Regional Oxygen Saturation of Pituitary Adenomas Is Lower than That of the Pituitary Gland: Microspectrophotometric Study with Potential Clinical Implications

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 880-886 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Ales F. Aliashkevich ◽  
Volkmar Hans ◽  
Dorothee Haun ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Oxygen Saturation ◽  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Anterior Pituitary ◽  
Posterior Pituitary ◽  
Pituitary Tissue ◽  
Adenoma Tissue ◽  
Posterior Pituitary Lobe ◽  
Pituitary Macroadenomas

Abstract OBJECTIVE To study the regional oxygen saturation (rSO2) of pituitary adenomas, in comparison with that of the pituitary gland. METHODS Microspectrophotometric (MSP) measurements of rSO2 in adenomas and pituitary tissue were performed for a series of patients undergoing first-time transsphenoidal pituitary adenoma surgery, in a standardized anesthesia setting. The areas of measured tissue were sampled for histopathological and immunohistochemical (CD34 and CD45) assessments. The results of MSP measurements were compared with the results of the histopathological and immunohistochemical assessments. RESULTS Thirty-six MSP measurements and tissue samples were obtained among 22 patients with pituitary macroadenomas, including 14 from adenoma tissue, 17 from the anterior pituitary lobe, and 5 from the posterior pituitary lobe. The rSO2 of adenoma tissue (mean ± standard deviation, 43.3 ± 23.2%) was statistically significantly (P = 0.001) lower than the values for the anterior pituitary lobe (mean ± standard deviation, 71.8 ± 18.3%) and posterior pituitary lobe (mean ± standard deviation, 74.9 ± 4.8%). The difference between the rSO2 values for the anterior pituitary lobe and posterior pituitary lobe was not significant. There were no statistically significant differences in microvessel density (as assessed with CD34 staining) or lymphocyte density (as assessed with CD45 staining) among the three tissue types. CONCLUSION As assessed with MSP measurements, the rSO2 of adenoma tissue was significantly lower than that of the pituitary gland, indicating differences in their blood supply and/or metabolism in pituitary macroadenomas. Further studies are needed to determine whether MSP measurements can reliably facilitate intraoperative delineation of adenoma and pituitary tissue, in the effort to achieve complete tumor removal with minimal injury to pituitary tissue.

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