deamino-arginine-vasopressin and Adrenal-Insufficiency

Some diseases contribute to hypopituitarism without clinical manifestations and the glucocorticoid therapy may unveil central diabetes insipidus. The condition is rare and usually causes problems for clinical physicians.. A 59-year-old woman presented to our hospital due to facial numbness and persistent eyelid heaviness.. Physical examination and cerebrospinal fluid examination supported a diagnosis of Guillain-Barre[Combining Acute Accent] syndrome. Magnetic resonance imaging showed an empty sella. Hormone test indicated hypopituitarism.. The patient received intravenous immunoglobulin and glucocorticoid. Central diabetes insipidus appeared after 20 days. Subsequently, the patient was prescribed 1-desamino-8-D-arginine vasopressin and prednisone.. During 6 months' follow-up, the patient's urine output was gradually reduced to normal level.. This case indicated that hypopituitarism may be caused by an empty sella and be masked by adrenal insufficiency. Central diabetes insipidus may present after glucocorticoid therapy.

Topics: Adolescent; Adrenal Insufficiency; Adult; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Drug Therapy, Combination; Empty Sella Syndrome; Female; Glucocorticoids; Guillain-Barre Syndrome; Humans; Hypopituitarism; Immunoglobulins, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Prednisone; Treatment Outcome

Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.

Topics: Adrenal Insufficiency; Blood Cell Count; Cerebral Infarction; Child; Chronic Disease; Consciousness Disorders; Craniopharyngioma; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Female; Frontal Lobe; Humans; Hyponatremia; Hypophysectomy; Hypopituitarism; Hypothalamus; Hypothermia; Hypothyroidism; Pancreatitis; Pancytopenia; Pituitary Neoplasms; Postoperative Complications; Seizures; Sleep Stages

Central diabetes insipidus (CDI) is an infrequent complication of neurosarcoidosis (NS). Its presentation may be masked by adrenal insufficiency (AI) and uncovered by subsequent steroid replacement. A 45-year-old woman with a history of NS presented 2 weeks after abrupt cessation of prednisone with nausea, vomiting, decreased oral intake and confusion. She was diagnosed with secondary AI and intravenous hydrocortisone was promptly begun. Over the next few days, however, the patient developed severe thirst and polyuria exceeding 6 L of urine per day, accompanied by hypernatraemia and hypo-osmolar urine. She was presumed to have CDI due to NS, and intranasal desmopressin was administered. This eventually normalised her urine output and serum sodium. The patient was discharged improved on intranasal desmopressin and oral prednisone. AI may mask the manifestation of CDI because low serum cortisol impairs renal-free water clearance. Steroid replacement reverses this process and unmasks an underlying CDI.

Topics: Adrenal Insufficiency; Antidiuretic Agents; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Glucocorticoids; Humans; Hydrocortisone; Hypernatremia; Middle Aged; Polyuria; Prednisone; Sarcoidosis; Thirst

There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma-related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion.

Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adolescent; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Circadian Rhythm; Combined Modality Therapy; Deamino Arginine Vasopressin; Dexamethasone; Female; Follow-Up Studies; Glucocorticoids; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysectomy; Male; Metyrapone; Middle Aged; Neoplasm Recurrence, Local; Pituitary ACTH Hypersecretion; Pituitary Neoplasms; Postoperative Complications; Remission Induction; Retrospective Studies; Saliva; Secretory Rate; Young Adult

Topics: Adrenal Insufficiency; Antidiuretic Agents; Breast Neoplasms; Carcinoma, Ductal, Breast; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Dizziness; Fatal Outcome; Female; Humans; Hydrocortisone; Hypernatremia; Lymphatic Diseases; Middle Aged; Muscle Weakness; Tomography, X-Ray Computed

Topics: Administration, Intranasal; Adrenal Insufficiency; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Dermatitis, Exfoliative; Diabetes Insipidus, Neurogenic; Humans; Hydrocortisone; Hypopituitarism; Male; Prednisolone; Treatment Outcome