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.

scholarly journals Acute and Chronic Posterior Pituitary Insufficiency Among Traumatic Brain Injury Patients at a Tertiary Care Center

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A623-A623
Author(s):  
Imtiyaz Ahmad Bhat ◽  
Moomin Hussain Bhat ◽  
Shariq Rashid Masoodi ◽  
Javid Ahmad Bhat ◽  
Zafar A Shah ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Diabetes Insipidus ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Posterior Pituitary ◽  
Urinary Osmolality ◽  
Pituitary Dysfunction

Abstract Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Disorders of salt and water balance are the most commonly recognized medical complications in the immediate post-TBI period and contribute to early morbidity and mortality. Objective: We aimed to evaluate the prevalence of acute (during hospital stay) and chronic posterior pituitary dysfunction in patients of head injury admitted at our tertiary care hospital. Study Design: Prospective, Observational study. Participants: 136 patients, attending tertiary care in North India with TBI with radiological evidence of head injury. Methodology: The severity of brain injury was assessed by the Glasgow Coma Scale (GCS), and Modified Rankin Scale (MRS) score at the time of admission. Lab measurements, apart from routine CBC and biochemical tests, included tests of serum and urinary osmolality, serum sodium, cortisol, and thyroid function test during the hospital stay. All patients were monitored closely during the hospital stay. Surviving patients were evaluated at 3, 6, and 12 months of follow-up. Urinary output and water deprivation tests were done to determine chronic posterior pituitary dysfunction. The results were compared against normative data obtained from 25 matched, healthy controls. Serum & urinary osmolality was measure by the freezing point method. Diabetes insipidus (DI) and Syndrome of inappropriate ADH secretion (SIADH) were diagnosed according to standard criteria. Results: Of 136 patients admitted, 61 (44.85%) had a mild head injury (GCS, ≤8), 47 (35.55%) had a moderate injury (GCS, 9-12), and 27 (19.85%) had a severe injury (GCS, 13-15). DI occurred in 10 patients (7.4%), while SIADH was observed in 4 patients in the immediate TBI period. Risk factors for diabetes insipidus were GCS of ≤ 8 at admission, midline shift, and surgical intervention. DI was an independent risk factor for death. There was a negative correlation between the presence of DI and GCS score (r, -0.367). Most of the patients with DI (8 out of 10) died during the hospital stay. One patient persisted to have partial diabetes insipidus and another one SIADH at three months post-TBI; both patients had recovered at six months of follow-up. No new case of DI or SIADH occurred on the follow up to 12 months. Conclusion: The incidence of acute DI in severe head injury (GCS ≤ 8) could be an indicator of the severity of TBI, and associated with increased mortality as most of our patients died during the hospital stay.

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.

Panhypopituitarism

2019 ◽  
pp. 234-238
Author(s):  
Diane Donegan ◽  
Irina Bancos
Keyword(s):  
Growth Hormone ◽  
Luteinizing Hormone ◽  
Anterior Pituitary ◽  
Follicle Stimulating Hormone ◽  
Premature Death ◽  
Cardiovascular Complications ◽  
Pituitary Hormones ◽  
Posterior Pituitary ◽  
Oral Ectoderm ◽  
Neural Ectoderm

Hypopituitarism is defined as a deficiency in 1 or more pituitary hormones. The pituitary gland is composed of the anterior pituitary, which originates from an invagination of the oral ectoderm and forms the Rathke pouch, and the posterior pituitary, which is derived from the neural ectoderm of the diencephalon. The anterior pituitary is composed of 5 types of hormone-producing cells: Somatotrophs produce growth hormone; gonadotrophs, follicle-stimulating hormone and luteinizing hormone; thyrotrophs, thyrotropin; 4 lactotrophs, prolactin; and corticotrophs, corticotropin. Identification of hypopituitarism is important because of its association with premature death due to respiratory and cardiovascular complications.

scholarly journals Anterior Pituitary Aplasia in an Infant with Ring Chromosome 18p Deletion

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Edward J. Bellfield ◽  
Jacqueline Chan ◽  
Sarah Durrin ◽  
Valerie Lindgren ◽  
Zohra Shad ◽  
...  
Keyword(s):  
Anterior Pituitary ◽  
Genetic Material ◽  
Ring Chromosome ◽  
Deletion Syndrome ◽  
First Year ◽  
Posterior Pituitary ◽  
Radiologic Findings ◽  
Midline Defects ◽  
First Year Of Life

We present the first reported case of an infant with 18p deletion syndrome with anterior pituitary aplasia secondary to a ring chromosome. Endocrine workup soon after birth was reassuring; however, repeat testing months later confirmed central hypopituitarism. While MRI reading initially indicated no midline defects, subsequent review of the images confirmed anterior pituitary aplasia with ectopic posterior pituitary. This case demonstrates how deletion of genetic material, even if resulting in a chromosomal ring, still results in a severe syndromic phenotype. Furthermore, it demonstrates the necessity of close follow-up in the first year of life for children with 18p deletion syndrome and emphasizes the need to verify radiology impressions if there is any doubt as to the radiologic findings.

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.

scholarly journals A Longitudinal Study of Vasopressin Cell Antibodies, Posterior Pituitary Function, and Magnetic Resonance Imaging Evaluations in Subclinical Autoimmune Central Diabetes Insipidus

1999 ◽  
Vol 84 (9) ◽  
pp. 3047-3051 ◽  
Author(s):  
A. De Bellis ◽  
A. Colao ◽  
F. Di Salle ◽  
V. I. Muccitelli ◽  
S. Iorio ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Autoimmune Diseases ◽  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Pituitary Function ◽  
Study Entry ◽  
Posterior Pituitary ◽  
Resonance Imaging

Cytoplasmic autoantibodies to vasopressin-cells (AVPcAb) have been detected not only in patients with overt central diabetes insipidus (CDI), but also in patients with endocrine autoimmune diseases without CDI. This suggests that complete CDI can be preceded by a preclinical stage. Among 878 patients with endocrine autoimmune diseases without CDI, 9 patients found to be AVPcAb positive and 139 AVPcAb-negative controls were enrolled in this open prospective study. They were evaluated for AVPcAb and posterior pituitary function at least yearly for about 4 yr (range, 37–48 months); during this span, magnetic resonance imaging (MRI) of posterior pituitary and stalk was performed only in the AVPcAb-positive patients. Five of the 9 AVPcAb-positive patients had normal posterior pituitary function at study entry. They were AVPcAb positive throughout the follow-up period. At later stages of the study, 3 of them developed partial CDI, and 1 developed complete CDI. The remaining 4 patients showed impaired response to the water deprivation test at study entry and were diagnosed as having partial CDI. Two of them agreed to receive desmopressin replacement for 1 yr. After this treatment, the patients became negative for AVPcAb and displayed normal posterior pituitary function until the end of the follow-up. Conversely, the 2 untreated patients with partial CDI remained AVPcAb positive. One of them developed overt CDI. None of the controls became AVPcAb positive or developed CDI. The normal hyperintense MRI signal of the posterior pituitary, present at study entry, persisted subsequently in all 9 AVPcAb-positive patients, including those developing overt CDI, only disappearing in the late phase of complete CDI. In asymptomatic subjects, the monitoring of AVPcAb, but not MRI, seems to be useful to predict a progression toward partial/overt CDI. Early desmopressin therapy in patients with partial CDI could interrupt or delay the autoimmune damage and the progression toward clinically overt CDI.

scholarly journals Permanent Central Diabetes Insipidus with Complete Regression of Pituitary Stalk Enlargement After 4 Years of Follow-up

2011 ◽  
Vol 1 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Gönül Öcal ◽  
Zeynep Şıklar ◽  
Merih Berberoğlu ◽  
Pelin Bilir ◽  
Özlem Engiz ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Complete Regression

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.

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

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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