pituitrin and Aneurysm

Hypopituitarism and hyponatremia, especially when severe, are infrequent findings particularly when the cause of hypopituitarism at presentation is unknown and untreated. Interestingly, hyponatremia is usually seen in elderly patients with hypopituitarism due to various causes. We present a case with unrecognized and untreated hypopituitarism due to a large aneurysm of the internal carotid artery in the sellar region causing the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Topics: Aneurysm; Carotid Artery, Internal; Female; Humans; Hyponatremia; Hypopituitarism; Inappropriate ADH Syndrome; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Middle Aged; Radiography; Vasopressins

Topics: Aneurysm; Angiography; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Humans; Vasopressins

In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.

Topics: Aneurysm; Angiography; Duodenal Diseases; Embolization, Therapeutic; Enteritis; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Peptic Ulcer; Peutz-Jeghers Syndrome; Postoperative Complications; Salmonella Infections; Vasopressins

Topics: Anesthesia, Intravenous; Aneurysm; Angiography; Angiotensin II; Animals; Arteriovenous Fistula; Blood Pressure Determination; Dye Dilution Technique; Hypertension; Ischemia; Kidney; Norepinephrine; Phentolamine; Punctures; Rabbits; Spectrophotometry; Thrombosis; Trimethaphan; Urinary Catheterization; Vasopressins