THE CLINICAL USE OF CHLORPROPAMIDE IN DIABETES INSIPIDUS

ABSTRACT Chlorpropamide has been shown to be an effective oral therapy in diabetes insipidus of hypothalamic-pituitary origin. In some cases with anterior pituitary dysfunction, although chlorpropamide was antidiuretic, hypoglycaemia was a barrier to continued therapy. Tests indicated that chlorpropamide does not produce this effect by a reduction in glomerular filtration rate nor by increasing vasopressin secretion, nor by acting like the thiazide diuretics in diabetes insipidus but is more likely to act by increasing the sensitivity of the renal tubule to low and otherwise ineffective concentrations of vasopressin.

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Clinical use of estimating glomerular filtration rate equ-ations during pregnancy

Health ◽

10.4236/health.2011.31006 ◽

2011 ◽

Vol 03 (01) ◽

pp. 32-36

Author(s):

Luiz Paulo José Marques ◽

Regina Rocco ◽

Maria Helena Victor ◽

Benedita Calheiros de Novaes ◽

Ana Luiza Batista de Carvalho ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Clinical Use

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Concentration of urine in the absence of ADH with minimal or no decrease in GFR

AJP Renal Physiology ◽

10.1152/ajprenal.1980.239.1.f84 ◽

1980 ◽

Vol 239 (1) ◽

pp. F84-F91 ◽

Cited By ~ 1

Author(s):

B. R. Edwards ◽

M. Gellai ◽

H. Valtin

Keyword(s):

Glomerular Filtration Rate ◽

Diabetes Insipidus ◽

Filtration Rate ◽

Aortic Constriction ◽

Filtration Fraction ◽

Urinary Osmolality ◽

Systematic Relationship ◽

Mean Values ◽

Potential Mediator ◽

Concentration Of Urine

It is known that large (more than 50%) reductions in glomerular filtration rate (GFR) can lead to formation of hyperosmotic urine in the absence to depend critically upon reduced delivery of luid to the loops of Henle. In the present study, we tried to determine whether a much lesser decrease in GFR could also result in hyperosmotic urine when ADH is absent. The following mean values (control vs. 3 h of partial aortic constriction) were obtained in 21 conscious diabetes insipidus rats: GRF, 909 +/- 35 (SE) vs. 835 +/- 49 microliter . min-1 . 100 g body wt-1 (8% decrease; P less than 0.02); urinary osmolality (Uosmol), 125 ”/- 6 vs. 309 +/- 14 mosmol/kg H2O (P less than 0.001; peak Uosmol 350 +/- 22). Analysis of individual responses revealed that Uosmol increased as much when there was no measurable decrease in GFR as when such decrease occurred. Neither GFR nor filtration fraction bore any systematic relationship to Uosmol or to each other. We conclude that in the absence of ADH Uosmol can increase with minimal or no change in GFR. Changes in filtration fraction--a potential mediator of reduced delivery to the loops--could not explain the increased Uosmol, even in those instances in which GFR remained unchanged.

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Diabetes Insipidus and Anterior Pituitary Dysfunction after Staphylococcal Meningitis and Multiple Brain Abscesses

The Journal of Infectious Diseases ◽

10.1093/infdis/146.1.102 ◽

1982 ◽

Vol 146 (1) ◽

pp. 102-102 ◽

Cited By ~ 7

Author(s):

J. M. Gatell ◽

E. Esmatjes ◽

C. Serra ◽

M. Aymerich ◽

J. G. SanMiguel

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pituitary Dysfunction ◽

Brain Abscesses

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Anterior Pituitary Dysfunction in Children with Idiopathic Central Diabetes Insipidus

Clinical Pediatric Endocrinology ◽

10.1297/cpe.4.supple6_109 ◽

1995 ◽

Vol 4 (Supple6) ◽

pp. 109-114

Author(s):

Yoko Nomura ◽

Kazumichi Onigata ◽

Ryo Ogawa ◽

Tomohisa Nagashima ◽

Hiroshi Miyake ◽

...

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Central Diabetes Insipidus ◽

Pituitary Dysfunction

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Idiopathic diabetes insipidus (DI) with transient or permanent anterior pituitary dysfunction

Pediatric Research ◽

10.1203/00006450-198112000-00031 ◽

1981 ◽

Vol 15 (12) ◽

pp. 1540-1540

Author(s):

R Pomarede ◽

P Czernichow ◽

R Rappaport

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pituitary Dysfunction

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Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging “Mismatch Pattern”

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa540 ◽

2020 ◽

Vol 105 (11) ◽

Author(s):

Deborah Bianco ◽

Flavia Napoli ◽

Giovanni Morana ◽

Angela Pistorio ◽

Anna Elsa Maria Allegri ◽

...

Keyword(s):

Pituitary Gland ◽

Diabetes Insipidus ◽

Contrast Enhancement ◽

Anterior Pituitary ◽

Magnetic Resonance Images ◽

Central Diabetes Insipidus ◽

Pituitary Hormone ◽

Gland Size ◽

Pituitary Dysfunction

Abstract Context The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. Objective To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. Methods We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. Results Seventeen of 29 patients (58.6%) with idiopathic CDI displayed “mismatch pattern,” consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while “mismatch” appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). Conclusions The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up.

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Pituitary Sarcoidosis in a Pediatric Patient Successfully Treated With Adalimumab and Methotrexate

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211012191 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110121

Author(s):

D. Sofia Villacis-Nunez ◽

Amit Thakral

Keyword(s):

Pituitary Gland ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pediatric Population ◽

Severe Headache ◽

Pediatric Case ◽

Central Hypothyroidism ◽

Pituitary Dysfunction ◽

Direct Infiltration ◽

High Index Of Suspicion

Neurosarcoidosis is a rare phenomenon in the pediatric population, with only a few cases reported in the literature worldwide. While hypothalamo-pituitary involvement is known to occur, direct infiltration of the pituitary gland and isolated anterior pituitary dysfunction without diabetes insipidus is seldom observed. A high index of suspicion is required for diagnosis of neurosarcoidosis, and treatment can be challenging due to lack of standardized guidelines. We present the case of a 17-year-old female with known sarcoidosis of the lacrimal glands, who developed severe headache and neurologic symptoms secondary to granulomatous infiltration of the pituitary gland and infundibulum due to neurosarcoidosis. She was successfully treated with corticosteroids, methotrexate, and adalimumab, with complete radiologic resolution. This is the first documented pediatric case of neurosarcoidosis with radiologic granulomatous infiltration of the pituitary gland, manifesting as partial anterior hypopituitarism, in the form of central hypothyroidism, without diabetes insipidus.

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A Micropuncture Study of Proximal Tubular Function after Acute Hydrochlorothiazide Administration to Brattleboro Rats with Diabetes Insipidus

Clinical Science ◽

10.1042/cs0570427 ◽

1979 ◽

Vol 57 (5) ◽

pp. 427-434 ◽

Cited By ~ 22

Author(s):

S. J. Walter ◽

J. F. Laycock ◽

D. G. Shirley

Keyword(s):

Glomerular Filtration Rate ◽

Diabetes Insipidus ◽

Glomerular Filtration ◽

Filtration Rate ◽

Inhibitory Effect ◽

Tubular Reabsorption ◽

Brattleboro Rats ◽

Fluid Reabsorption ◽

Proximal Tubular ◽

Proximal Tubular Reabsorption

1. Renal function in anaesthetized Brattleboro rats with hereditary hypothalamic diabetes insipidus was studied with micropuncture techniques before, and 1–3 h after, a single injection of hydrochlorothiazide. 2. In rats given hydrochlorothiazide and kept in sodium and water balance, total glomerular filtration rate and superficial nephron filtration rate were similar to values in control animals, whereas fractional fluid reabsorption in the proximal tubule (as evidenced by tubular fluid/plasma inulin concentration ratios) was slightly, but significantly, reduced. This suggests that hydrochlorothiazide may have a small direct inhibitory effect on proximal tubular reabsorption. 3. When rats were given hydrochlorothiazide and the resultant extra urinary sodium losses were not replaced, there was a marked antidiuresis. In these animals total glomerular filtration rate was reduced by 23% and superficial nephron filtration rate by 27% when compared with values in control rats. Fractional proximal tubular fluid reabsorption increased significantly whereas absolute proximal fluid reabsorption was unaffected. 4. It is concluded that the reduction in body sodium which follows acute hydrochlorothiazide administration over-rides any inhibitory effect of the drug on proximal tubular reabsorption, and leads instead to an increase in fractional fluid reabsorption at this site. This effect, combined with the fall in glomerular filtration rate, results in a greatly reduced delivery of fluid to the more distal nephron segments, and is probably largely responsible for the observed antidiuresis.

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The Role of Sodium Depletion in Hydrochlorothiazide-Induced Antidiuresis in Brattleboro Rats with Diabetes Insipidus

Clinical Science ◽

10.1042/cs0540209 ◽

1978 ◽

Vol 54 (3) ◽

pp. 209-215

Author(s):

D. G. Shirley ◽

S. J. Walter ◽

J. F. Laycock

Keyword(s):

Glomerular Filtration Rate ◽

Diabetes Insipidus ◽

Glomerular Filtration ◽

Plasma Flow ◽

Filtration Rate ◽

Renal Plasma Flow ◽

Sodium Concentration ◽

Effective Renal Plasma Flow ◽

Plasma Sodium ◽

Sodium Depletion

1. The mechanism of the antidiuretic effect of hydrochlorothiazide in diabetes insipidus was studied in anaesthetized Brattleboro rats with the hereditary hypothalamic form of the disease. 2. The antidiuresis caused by acute administration of hydrochlorothiazide followed an increase in sodium excretion and was associated with a significant fall in the plasma sodium concentration. There were concomitant falls in effective renal plasma flow and glomerular filtration rate. 3. When sodium depletion was prevented by adjusting the infusion of sodium chloride, the falls in plasma sodium concentration, effective renal plasma flow and glomerular filtration rate were abolished. Under these circumstances there was an increase in urine volume, which suggests that hydrochlorothiazide may inhibit fractional fluid reabsorption in the proximal convoluted tubule. 4. The results indicate that the antidiuresis caused by hydrochlorothiazide in diabetes insipidus results, at least in part, from falls in effective renal plasma flow and glomerular filtration rate. These in turn seem to be entirely secondary to the drug-induced sodium depletion.

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