scholarly journals The natural history of post-traumatic neurohypophysial dysfunction

2005 ◽  
Vol 152 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Amar Agha ◽  
Mark Sherlock ◽  
Jack Phillips ◽  
William Tormey ◽  
Christopher J Thompson
Keyword(s):  
Natural History ◽  
Acute Phase ◽  
Peak Plasma ◽  
Hormone Secretion ◽  
Plasma Osmolality ◽  
Additional Patient ◽  
Posterior Pituitary ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
History Of ◽  
Post Traumatic

Background and objectives: Posterior pituitary function remains poorly investigated after traumatic brain injury (TBI). We report the results of a study designed to prospectively define the natural history of post-traumatic diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) using standard reliable methodology. Design and methods: 50 consecutive patients with severe or moderate TBI (initial Glasgow Coma Scale (GCS) score 3/15–13/15) were prospectively studied on three occasions: at the acute phase and at 6 months and at 12 months following TBI. In the acute phase, DI was diagnosed either by the presence of hypernatraemia in association with hypotonic polyuria or by the water-deprivation test (WDT) and, at 6 and 12 months by the WDT in all patients. Normative data on response to the WDT were obtained from healthy matched volunteers. Functional outcome was assessed using the Glasgow Outcome Scale (GOS). Results: 13 patients (26%) had DI in the acute post-TBI phase, of whom nine patients recovered by 6 months and one additional patient recovered by 12 months. Of the remaining three patients with permanent DI, two had partial vasopressin deficiency. Acute-phase peak plasma osmolality correlated negatively with the initial GCS scores (r = −0.39, P = 0.005) and with the GOS scores (r = −0.45, P = 0.001). Seven patients had SIADH in the acute phase of TBI but none did at 6 or 12 months. No new cases of DI or SIADH were noted after the acute phase. Conclusion: This prospective study shows that posterior pituitary dysfunction is common following TBI. Most cases recover completely but there is an appreciable frequency of long-term DI which can be subtle and should be recognized and managed appropriately.

The natural history of post-traumatic hypopituitarism: Implications for assessment and treatment

2005 ◽  
Vol 118 (12) ◽  
pp. 1416.e1-1416.e7 ◽  
Author(s):  
Amar Agha ◽  
Jack Phillips ◽  
Patrick O’Kelly ◽  
William Tormey ◽  
Christopher J. Thompson
Keyword(s):  
Natural History ◽  
Assessment And Treatment ◽  
History Of ◽  
Post Traumatic

The Natural History of Post-Traumatic Reflex Sympathetic Dystrophy

1998 ◽  
Vol 23 (1) ◽  
pp. 20-23 ◽  
Author(s):  
A. ZYLUK
Keyword(s):  
Natural History ◽  
Grip Strength ◽  
Reflex Sympathetic Dystrophy ◽  
Prospective Trial ◽  
Signs And Symptoms ◽  
Final Assessment ◽  
Functionally Impaired ◽  
History Of ◽  
Post Traumatic

The paper presents the results of a prospective trial to examine the natural history of early reflex sympathetic dystrophy (RSD). Thirty patients with post-traumatic RSD of the hand were observed without treatment. They were reassessed 1, 2 and 6 months after diagnosis with a final assessment at 10 to 18 months (average 13 months). Twenty-seven patients completed the study. Three were withdrawn during the study because of persistence of signs and symptoms of RSD and were given further treatment. Of the 27 patients who completed the study, only one showed sufficient features of the condition to warrant the diagnosis of mild RSD. In the remaining 26, most features of RSD had resolved spontaneously. Pain and swelling disappeared more quickly than other features of RSD. Although the signs and symptoms of RSD had largely gone at 13 months, the hands were still functionally impaired because of weaker grip strength.

scholarly journals Chagasic meningoencephalitis in the immunodeficient

1998 ◽  
Vol 56 (1) ◽  
pp. 93-97 ◽  
Author(s):  
LAZO JAVIER ◽  
ANTONIO CARLOS OLIVEIRA MENESES ◽  
ADEMIR ROCHA ◽  
MARCELO SIMÃO FERREIRA ◽  
JAIME OLAVO MARQUEZ ◽  
...  
Keyword(s):  
Natural History ◽  
Trypanosoma Cruzi ◽  
Chagas Disease ◽  
Acute Phase ◽  
Brain Pathology ◽  
History Of ◽  
The Brain

Based on their own experience and on the literature, the authors compare the brain pathology due to HIV+ associated Trypanosoma cruzi reactived infection to that described for the natural history of the Chagas' disease (CD). The peculiar focal necrotizing chagasic meningoencephalitis (MECNF) which appears only in immunedeficient chagasics, especially when the deficiency is due HIV is a safe criterion for reactivation of CD. MECNF morphologic findings are unlike to those found either for some cases of acute phase CD or for chronic nervous form of CD.

scholarly journals Therapeutic opportunities to prevent post-traumatic arthritis: Lessons from the natural history of arthritis after articular fracture

2015 ◽  
Vol 33 (9) ◽  
pp. 1266-1277 ◽  
Author(s):  
Steven A. Olson ◽  
Bridgette D. Furman ◽  
Virginia B. Kraus ◽  
Janet L. Huebner ◽  
Farshid Guilak
Keyword(s):  
Natural History ◽  
Articular Fracture ◽  
History Of ◽  
Post Traumatic ◽  
Traumatic Arthritis

Antidepressant-Induced Adverse Reactions in a Patient with Hemorrhagic Stroke

2005 ◽  
Vol 39 (10) ◽  
pp. 1755-1757 ◽  
Author(s):  
Zoran Bogdanovic ◽  
Jhansi R Nalamati ◽  
John K Kilcullen ◽  
Sunil Dhuper
Keyword(s):  
Adverse Drug Reactions ◽  
Adverse Reactions ◽  
Hemorrhagic Stroke ◽  
Hormone Secretion ◽  
Drug Reactions ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Number Of Patients ◽  
Close Supervision ◽  
Post Stroke Depression ◽  
History Of

Objective: To report a case of antidepressant-induced adverse drug reactions in a patient with hemorrhagic stroke. Case Summary: A 56-year-old man developed life-threatening adverse reactions after fluoxetine was added to his previously prescribed regimen of buspirone and olanzapine. One week after starting fluoxetine 60 mg/day, the patient developed syndrome of inappropriate antidiuretic hormone secretion and serotonin syndrome concurrently. The patient had experienced a hemorrhagic stroke before the adverse drug reactions occurred. DISCUSSION: A patient with a history of hemorrhagic stroke developed serious adverse drug reactions when fluoxetine was added to his drug therapy. When the combination therapy was stopped, all adverse effects gradually disappeared and laboratory abnormalities were corrected. The likelihood that the adverse reactions were caused by fluoxetine is probable according to the Naranjo probability scale. In addition, a history of stroke may be a risk factor for the development of such reactions. CONCLUSIONS: Today, patients with depression after experiencing a stroke are treated more effectively, but antidepressant-induced adverse drug reactions may be serious. A growing number of patients are treated for post-stroke depression; they require close supervision and careful dosing of antidepressants to prevent full-blown adverse reactions from occurring.

Routine postoperative fluid restriction to prevent syndrome of inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary adenoma

2021 ◽  
pp. 1-8
Author(s):  
M. Harrison Snyder ◽  
David T. Asuzu ◽  
Dawn E. Shaver ◽  
Mary Lee Vance ◽  
John A. Jane
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Pituitary Surgery ◽  
Fluid Restriction ◽  
Readmission Rates ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
History Of ◽  
Transsphenoidal Resection

OBJECTIVE Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma. METHODS In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons. RESULTS In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0–0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9–1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1–9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0–5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3–26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1–0.9], p = 0.04). CONCLUSIONS Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

scholarly journals Sertraline induced hyponatremia

2017 ◽  
Vol 10 (4) ◽  
pp. 1 ◽  
Author(s):  
H Dhananjay Bhat ◽  
Harish Thanusubramanian ◽  
Balaji O
Keyword(s):  
Sodium Chloride ◽  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Hormone Secretion ◽  
Newly Diagnosed ◽  
Carcinoma Of The Breast ◽  
Severe Hyponatremia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
History Of

A 53 year old female patient with a history of carcinoma of the breast in remission and dilated cardiomyopathy on treatment was newly diagnosed with depression. She was started on Sertraline 50mg once a day. 2 days later she developed severe hyponatremia (serum sodium 114mEq/l). Her condition further deteriorated and on the 6th day her medication was stopped and replaced with mirtazapine. Osmolality studies she was diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion). She was treated with IV sodium chloride for her hyponatremia. At discharge serum sodium levels improved (127mEq/l)  and subsequent follow up 4 weeks later showed normal sodium values (138mEq/L)Keywords: Sodium chloride, Syndrome of inappropriate antidiuretic hormone, Serum sodium, Serum osmolarity.

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