deamino-arginine-vasopressin and Hypothyroidism

Acquired von Willebrand's syndrome type I is the supposed main underlying cause of bleeding tendency in hypothyroid patients. The purpose of this systematic review was to summarize the published evidence on the association between hypothyroidism and acquired von Willebrand's syndrome. All published clinical epidemiological and interventional studies, case reports and in vitro studies that investigated the association between hypothyroidism and acquired von Willebrand's syndrome were identified by a computer-assisted search of the MEDLINE and EMBASE electronic databases. A quality assessment was performed for clinical epidemiological studies. A total of 41 papers were included. A total of 22 epidemiological in vivo studies, two in vitro studies and 47 case reports were finally analyzed. No high quality in vivo study was identified. Almost all bleeding episodes described in the case reports were mucocutaneous. von Willebrand factor (VWF) antigen value was available for 23 patients: median value 28 U/dL (range: 4-45); VWF activity was available for 24 patients: median value 28.5 U/dL (range: <3-55); factor VIII activity was available for 16 patients: median value 47 U/dL (range: 9-74). Acquired von Willebrand's syndrome may be the main factor responsible for bleeding diathesis in overt hypothyroid patients. Even if bleeding episodes are mainly mild and mucocutaneous, blood transfusion, drug administration or surgical procedure may be required.

Topics: Adolescent; Adult; Aged; Bleeding Time; Child; Deamino Arginine Vasopressin; Disease Susceptibility; Female; Hemorrhage; Hemostatics; Humans; Hypothyroidism; Male; Middle Aged; Thyroxine; von Willebrand Diseases; von Willebrand Factor

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

The term von Willebrand disease includes many bleeding disorders caused by abnormalities of vWF. Frequent or severe bleeding may be indicative of vWD or other bleeding conditions. Primary care practitioners need to be familiar with vWD and evaluate possibly affected individuals with appropriate laboratory studies. Patients with vWD should be educated about their disorder and preventive measures to limit its effect. Medications are available that can treat or prevent bleeding complications for most patients with vWD. Intervention with blood products is occasionally necessary.

Topics: Adolescent; Child; Child, Preschool; Chromosomes, Human, Pair 12; Deamino Arginine Vasopressin; Gene Deletion; Heart Defects, Congenital; Humans; Hypothyroidism; Incidence; Platelet Count; von Willebrand Diseases; von Willebrand Factor

Pituitary stalk sectioning is only essential in cases of craniopharyngioma originating from the stalk or metastatic tumor to the stalk. Some patients can discontinue postoperative antidiuretic hormone (ADH) supplementation with special conditions.. Sixty-three patients with craniopharyngiomas who were treated by surgery with pituitary stalk sectioning were included in this study. Great care was taken to preserve the fine arteries running along the lateral walls of the third ventricle. Removal rates, change of endocrinologic status, and magnetic resonance imaging (MRI) findings were investigated.. Total removal was achieved in 52 of 54 patients in initial surgery (96.3%), and in 5 of 9 patients in retreatment (55.6%). ADH supplementation was required in all patients from the day of surgery, but was discontinued in 29 of 54 patients among the initial surgery group (53.7%) and in 2 of 9 patients among the retreatment group (22.2%). Preservation of thyroid hormone secretion was observed in 24 of 31 patients who could discontinue ADH (77.4%), but only in 12 of 32 patients who could not discontinue ADH (37.5%). Recovery from diabetes insipidus (DI) was significantly associated with preservation of thyroid function (P < 0.01). Postoperative MRI showed that part of the hypothalamus was enhanced in patients with recovery from DI.. Total removal was achieved in 91% of all cases. Half of the patients could discontinue ADH supplementation, which was associated with preservation of thyroid function. The findings of hypothalamic enhancement on postoperative MRI may be associated with recovery from DI.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidiuretic Agents; Child; Child, Preschool; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Glucocorticoids; Hormone Replacement Therapy; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Prognosis; Recovery of Function; Thyroid Hormones; Young Adult

Gunshot injuries (GSI) of the cranial area have an extremely high mortality rate. Herein, we present a girl who has been living with a bullet in the posterior sellar region. A 6-year-old girl was admitted with complaints of headache, polyuria and polydypsia, which started after a GSI. At the time of admission the patient's anthropometric, physical and neurological examinations were normal. Urine output was 5.5 L/m2/24h. A water deprivation test suggested central diabetes insipidus, which responded to treatment. Evaluation of other pituitary hormones revealed central hypothyroidism and growth hormone deficiency. Pituitary hormone deficiency must be kept in mind in patients injured by a gunshot to the sellar/parasellar region.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Human Growth Hormone; Humans; Hypopituitarism; Hypothyroidism; Pituitary Hormones; Thyroxine; Wounds, Gunshot

Hypothyroidism can be complicated by bleeding symptoms such as easy bruising, menorrhagia and sometimes even a severe bleeding tendency with fatal outcome. Usually there is a prolonged bleeding time, or a low plasma concentration of coagulation factor VIII (FVIII) or von Willebrand factor (vWF). The aim of the present study was to investigate the acute haemostatic effect of desmopressin in hypothyroid patients. Another aim was to study the long-term effect of thyroxine replacement on the plasma concentrations of coagulation factors and to ascertain the duration of thyroxine treatment needed to restore haemostatic function.. The effects of desmopressin, given intravenously over 10 minutes at a dosage of 0.3 micrograms/kg, and thyroxine treatment on haemostatic function were studied prospectively in 10 patients with hypothyroidism.. Before treatment only five of the patients manifested bleeding symptoms; one had prolonged bleeding time, and one had low plasma concentrations of vWF:Ag. Desmopressin virtually immediately reduced bleeding time, enhanced platelet adhesiveness, and significantly increased plasma concentrations of FVIII and vWF. The plasma concentrations of FVIII and vWF showed a significant increase after 4 months, whereas 7 months treatment with thyroxine was needed to reduce bleeding time significantly.. Our results suggest that in hypothyroid patients desmopressin may be of value for the acute treatment of bleeding or as cover for surgery.

Topics: Adult; Aged; Bleeding Time; Deamino Arginine Vasopressin; Factor VIII; Female; Hemostasis; Humans; Hypothyroidism; Male; Middle Aged; Platelet Adhesiveness; Platelet Count; Prospective Studies; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine; von Willebrand Factor

Because of menorrhagia, a 13-year-old girl was found to have type I von Willebrand disease and then chronic autoimmune thyroiditis with hypothyroidism. All clinical and laboratory evidence of von Willebrand disease resolved transiently after infusion of desmopressin, and permanently with L-thyroxine therapy. We recommend investigation for hypothyroidism in patients with newly diagnosed acquired von Willebrand disease.

Topics: Adolescent; Deamino Arginine Vasopressin; Diseases in Twins; Drug Therapy, Combination; Female; Humans; Hypothyroidism; Infusions, Intravenous; Thyroiditis, Autoimmune; Thyroxine; von Willebrand Diseases

Topics: Celiac Disease; Congenital Hypothyroidism; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hyponatremia; Hypothyroidism; Infant; Male; Seizures

Topics: Deamino Arginine Vasopressin; Hyperthyroidism; Hypopituitarism; Hypothyroidism; Iodine Isotopes; Iodine Radioisotopes; Oxytocin; Pharmacology; Physiology; Pituitary Gland; Thyroid Function Tests; Vasopressins