deamino-arginine-vasopressin and Empty-Sella-Syndrome

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

The paper describes a patient with Asperger disorder, Neurogenic Diabetes Insipidus (NDI) and Primary Empty Sella (ES). His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. This is the first reported case of an autistic spectrum disorder associated with NDI or ES. The implications of the observed co-occurrence of these relatively rare disorders are discussed in relation to diagnosis and pathogenesis.

Topics: Adult; Autistic Disorder; Comorbidity; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Empty Sella Syndrome; Humans; Magnetic Resonance Imaging; Male; Pituitary Gland, Posterior; Syndrome; Water Intoxication

A 60-year-old woman was admitted to our hospital for surgical treatment of the left inguinal hernia. She had suffered from diabetes insipidus for ten years, and hormonal study revealed low plasma level of vasopressin. She has been taking nasally desmopressin acetate 5 micrograms twice a day and urinary output has been well controlled around 1200-1400 ml.day-1. CT-scan showed empty sella without any pituitary tumors. There were no evidences of increased intracranial pressure and neurological deficit. Following nasal instillation of desmopressin acetate 5 micrograms one hour before anesthesia, spinal anesthesia was performed with tetracaine 10 mg. Cephalad sensory block assessed by pinprick spread to T6 within 10 minutes. Systolic blood pressure gradually decreased from 120 to 90 mmHg, although no vasoconstrictors were needed. Arterial blood pressure was stable during the surgery. The operation lasted 80 minutes with 650 ml of fluid replacement, blood loss of 50 g and urinary output of 25 ml. She had no postspinal headache nor neurological deficit after surgery. Empty sella syndrome associated with diabetes insipidus is rare. Low spinal anesthesia can be performed safely whenever there is no evidence of increased intracranial pressure, although care should be taken for perioperative fluid and circulatory management.

Topics: Administration, Intranasal; Anesthesia, Spinal; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Empty Sella Syndrome; Female; Hernia, Inguinal; Humans; Intraoperative Care; Middle Aged; Monitoring, Intraoperative