deamino-arginine-vasopressin and Hypophysitis

Rathke's cleft cyst (RCC) is a common incidental tumor in the hypothalamic-pituitary region. Some reports have shown that the clinical symptoms and endocrine functions of symptomatic RCCs are temporarily improved by glucocorticoid administration. However, it is still unknown whether glucocorticoid treatment is effective for symptomatic RCCs according to long-term observations. In this study, we describe the long-term clinical outcomes of two cases of glucocorticoid-treated biopsy-proven secondary hypophysitis caused by RCCs. We summarize the symptoms, imaging findings, and endocrine evaluations of two symptomatic RCC patients with concomitant hypophysitis before and after prednisolone treatment. In both evaluated cases, visual impairments and altered endocrine parameters were present due to chiasm and stalk compression; these outcomes improved after shrinkage of RCCs in response to prednisolone administration, and partial recovery of anterior pituitary hormone secretion was observed. However, in both cases, the deficits in anterior pituitary hormone secretion recurred, possibly due to persistent inflammatory infiltration in the RCCs and pituitary glands. After relapse of hypophysitis, anterior hormone secretion did not fully recover. In our cases of secondary hypophysitis caused by RCCs, prednisolone administration had an early effect of cyst shrinkage, followed by partial improvements in clinical symptoms and pituitary functions. However, long-term observation showed that prednisolone treatment did not contribute to complete improvement in anterior pituitary hormone dysfunction.

Topics: Antidiuretic Agents; Central Nervous System Cysts; Deamino Arginine Vasopressin; Female; Glucocorticoids; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysitis; Hypopituitarism; Middle Aged; Pituitary Neoplasms; Prednisolone

Topics: Antidiuretic Agents; COVID-19; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Female; Humans; Hypophysitis; Magnetic Resonance Imaging; Middle Aged; Pituitary Gland; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Treatment Outcome

Topics: Achlorhydria; Adult; Cyclophosphamide; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Hormones; Humans; Hypogonadism; Hyponatremia; Hypophysitis; Lupus Erythematosus, Systemic; Methylprednisolone; Treatment Outcome; Young Adult

The clinical features, course and outcome of hantavirus infection is highly variable. Symptoms of the central nervous system may occur, but often present atypically and diagnostically challenging. Even though the incidence of hantavirus infection is increasing worldwide, this case is the first to describe diabetes insipidus centralis as a complication of hantavirus infection in the Western world.. A 49-year old male presenting with severe headache, nausea and photophobia to our neurology department was diagnosed with acute haemorrhage in the pituitary gland by magnetic resonance imaging. In the following days, the patient developed severe oliguric acute kidney failure. Diagnostic workup revealed a hantavirus infection, so that the pituitary haemorrhage resulting in hypopituitarism was seen as a consequence of hantavirus-induced hypophysitis. Under hormone replacement and symptomatic therapy, the patient's condition and kidney function improved considerably, but significant polyuria persisted, which was initially attributed to recovery from kidney injury. However, water deprivation test revealed central diabetes insipidus, indicating involvement of the posterior pituitary gland. The amount of urine production normalized with desmopressin substitution.. Our case report highlights that neurological complications of hantavirus infection should be considered in patients with atypical clinical presentation.

Topics: Acute Kidney Injury; Antibodies, Viral; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Follow-Up Studies; Hantavirus Infections; Hormone Replacement Therapy; Humans; Hypophysitis; Hypopituitarism; Magnetic Resonance Imaging; Male; Middle Aged; Orthohantavirus; Phylogeny; Polymerase Chain Reaction; Polyuria; Treatment Outcome