pituitrin and Brain-Diseases

The vasopressin system is complex and interacts with the central nervous, cardiovascular, renal, and hematological systems. Vasopressin plays an important role in the control of blood osmolarity and vascular tone, but is also involved in many other physiological events, which are mediated mainly via three types of vasopressin receptor: V1R, V2R, and V3R. V1R primarily mediate the vascular, and V2R the aquaretic, effects of vasopressin. Vasopressin may also interact with other receptors, like adrenergic and angiotensin-II receptors, or with distinct biological pathways, including those of nitric oxide and the K(ATP) channel. There are numerous clinical situations where vasopressin receptor modulators (agonists or antagonists) could be used. Currently, vasopressin and terlipressin are most commonly used to stimulate V1R in vasodilatory shock and cardiac arrest, while desmopressin, a synthetic analogue of vasopressin, acts on V2R; but new molecules are becoming available in the treatment of inappropriate antidiuretic hormone (ADH) secretion.

Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Brain Diseases; Cardiovascular Diseases; Clinical Trials as Topic; Drugs, Investigational; Hemorrhage; Humans; Inappropriate ADH Syndrome; Receptors, Vasopressin; Skin Diseases; Vasopressins

Etiopathogenesis, diagnostics and therapy of hyponatremias are summarized for clinicians. Hyponatremia is the most common electrolyte abnormality. Mild to moderate hyponatremia and severe hyponatremia are found in 15-30% and 1-4% of hospitalized patients, respectively. Pathophysiologically, hyponatremias are classified into two groups: hyponatremia due to non-osmotic hypersecretion of vasopressin (hypovolemic, hypervolemic, euvolemic) and hyponatremia of non-hypervasopressinemic origin (pseudohyponatremia, water intoxication, cerebral salt wasting syndrome). Patients with mild hyponatremia are almost always asymptomatic. Severe hyponatremia is usually associated with central nervous system symptoms and can be life-threatening. Diagnostic evaluation of patients with hyponatremia is directed toward identifying the extracellular fluid volume status, the neurological symptoms and signs, the severity and duration of hyponatremia, the rate at which hyponatremia developed. The first step to determine the probable cause of hyponatremia is the differentiation of the hypervasopressinemic and non-hypervasopressinemic hyponatremias with measurement of plasma osmolality, glucose, lipids and proteins. For further differential diagnosis of hyponatremia, the determination of urine osmolality, the clinical assessment of extracellular fluid volume status and the measurement of urine sodium concentration provide important information. The most important representative of euvolemic hyponatremias is SIADH. The diagnosis of SIADH is based on the exclusion of other hyponatremic conditions; low plasma osmolality (<275 mosmol/kg) and inappropriate urine concentration (urine osmolality >100 mosmol/kg) are of pathognomic value. Acute (<48 hrs) severe hyponatremia (<120 mmol/l) necessitates emergency care with rapid restoration of normal osmotic milieu (1 mmol/l/hr increase rate of serum sodium). Patients with chronic symptomatic hyponatremia have a high risk of osmotic demyelination syndrome in brain if rapid correction of the plasma sodium occurs (maximal rate of correction of serum sodium should be 0.5 mmol/l/hr or less). The conventional treatments for chronic asymptomatic hyponatremia (except hypovolemic patients) include water restriction and/or the use of demeclocycline or lithium or furosemide and salt supplementation. Vasopressin receptor antagonists have opened a new forthcoming therapeutic era. V2 receptor antagonists, such as lixivaptan, tolvaptan, satavaptan and the V2+

Topics: Antidiuretic Hormone Receptor Antagonists; Azepines; Benzamides; Benzazepines; Blood Volume; Brain Diseases; Central Nervous System; Chronic Disease; Demeclocycline; Demyelinating Diseases; Diagnosis, Differential; Diuretics; Extracellular Fluid; Furosemide; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lithium Compounds; Morpholines; Osmolar Concentration; Osmosis; Pyrroles; Severity of Illness Index; Sodium; Spiro Compounds; Time Factors; Tolvaptan; Vasopressins

Hyponatremia is an important and common electrolyte disorder in critically ill neurosurgical patients that has been reported in association with a number of different primary diagnoses. The correct diagnosis of the pathophysiological cause is vital because it dramatically alters the treatment approach.. We review the epidemiology and presentation of patients with hyponatremia, the pathophysiology of the disorder with respect to sodium and fluid balance, and the diagnostic procedures for determining the correct cause.. We then present the various treatment options, including discussion of one of the newest groups of agents, the arginine vasopressin receptor antagonists, currently under study for the treatment of hyponatremia in neurosurgical patients.. Hyponatremia is a serious comorbidity in neurosurgical patients that requires particular attention as its treatment varies by cause and its consequences can affect neurological outcome.

Topics: Antidiuretic Hormone Receptor Antagonists; Brain Diseases; Comorbidity; Humans; Hyponatremia; Natriuretic Peptides; Prevalence; Receptors, Vasopressin; Sodium; Vasopressins; Water-Electrolyte Balance

Osmotic demyelination of the brain (ODS) is a dreaded complication that typically occurs several days after aggressive therapy for chronic hyponatraemia, but is eminently avoidable. In this teaching exercise, Professor McCance, an imaginary consultant, is asked to explain how he would have treated a 28-year-old female who had hyperkalaemia, hypoglycaemia, hypotension and hyponatraemia (118 mM) to prevent the development of ODS. He begins with a review of the physiology, including his own landmark work on chronic hyponatraemia associated with a contracted extracellular fluid volume. Adding quantitative analysis, the cause of the excessive rise in plasma sodium concentration is revealed, and a better plan for therapy is proposed.

Topics: Addison Disease; Adult; Brain Diseases; Demyelinating Diseases; Female; Humans; Hyperkalemia; Hypoglycemia; Hyponatremia; Hypotension; Renal Agents; Syndrome; Vasopressins; Water-Electrolyte Imbalance

Topics: Brain Diseases; Diabetes Insipidus; Electrolytes; Humans; Hypernatremia; Hyponatremia; Postoperative Complications; Vasopressins; Water; Water Intoxication; Water-Electrolyte Imbalance

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex; Adrenal Glands; Adrenocorticotropic Hormone; Anorexia Nervosa; Blood Glucose; Brain Diseases; Catecholamines; Child; Circadian Rhythm; Cyproterone; Dexamethasone; Growth Hormone; Humans; Hydrocortisone; Hypoglycemia; Hypothalamus; Infant; Insulin; Metyrapone; Nephrotic Syndrome; Obesity; Pituitary Gland; Prednisone; Vasopressins

Topics: Acromegaly; Adrenal Glands; Blood Glucose; Brain Diseases; Calcium; Dwarfism; Gigantism; Glucose Tolerance Test; Growth Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothalamus; Insulin; Lysine; Phosphates; Pituitary Diseases; Pneumoencephalography; Prolactin; Radioimmunoassay; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins; Water Deprivation

Topics: Brain Diseases; Bronchial Neoplasms; Deficiency Diseases; Diuresis; Ethanol; Hyponatremia; Kidney Concentrating Ability; Natriuresis; Respiratory Tract Diseases; Vasopressins

Topics: Brain Diseases; Female; Humans; Hypernatremia; Hypokalemia; Hyponatremia; Male; Metabolic Diseases; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Brain Diseases; Cerebrovascular Circulation; Drug Combinations; Electrocardiography; Epinephrine; Female; Hemostasis; Hemostatics; Humans; Male; Middle Aged; Ornithine; Tyrosine; Vasoconstrictor Agents; Vasopressins

Topics: 17-Hydroxycorticosteroids; Acromegaly; Adenoma, Chromophobe; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Brain Diseases; Central Nervous System Diseases; Clinical Trials as Topic; Craniocerebral Trauma; Diabetes Insipidus; Female; Humans; Hypothalamo-Hypophyseal System; Intracranial Pressure; Male; Metyrapone; Pituitary Diseases; Pituitary Function Tests; Pituitary Neoplasms; Pseudotumor Cerebri; Vasopressins

Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. A 36-year-old man with SAH was admitted to our ICU. His urine volume increased excessively 3 days after ICU admission, and it reached a peak (39,250 ml x day(-1)) on the 6th day in ICU. Since infusion volume was controlled with regard to daily urinary output, hyponatremia was not noticeable and excessive urine volume stood out conspicuously. Though vasopressin and desmopressin were administered, the symptoms of natriuresis and hyponatremia were aggravated, associated with hyper secretion of natriuretic peptides (ANP 160 pg x dl(-1), BNP 172 pg x dl(-1)). Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.

Topics: Adult; Animals; Atrial Natriuretic Factor; Brain Diseases; Contraindications; Humans; Hyponatremia; Hypovolemia; Male; Natriuresis; Rats; Subarachnoid Hemorrhage; Syndrome; Urination Disorders; Vasopressins

The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients.. We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described.. Natriuresis (urine Na+ concentrations 131 to >250 mmol/l) and polyuria (5.5+/-1.5 ml/kg/h) with increased Na+ turnover (maximum Na+ loss: median 1.50 mmol Na+/kg/h, range 0.47 to >3.50) vanished within 2 weeks in 6/9 patients (increase in serum Na+ from 127+/-2 mmol/l to 136+/-1). K+ excretion was also high (maximum K+ loss: median 0.18 mmol K+/kg/h, range 0.09-0.53). ANP/BNP as suspected causes of salt wasting were elevated only in 1/6 and 2/7 patients, respectively. Plasma renin activities and aldosterone levels were either suppressed or in the low normal range.. Natriuresis and polyuria are the main diagnostic criteria for CSW. The fluid balance in CSW is negative, in contrast to a positive fluid balance in SIADH. The length of the disease is self-limited and generally ceases within 2 weeks, while Na+, K+, and fluid turnover should be monitored carefully. Only a minority of our children showed elevated ANP/BNP levels. A dose/effect relationship for natriuretic peptide levels and increased Na+ turnover could not be established.

Topics: Adolescent; Atrial Natriuretic Factor; Brain Diseases; Child; Child, Preschool; Female; Humans; Infant; Male; Natriuretic Peptide, Brain; Radioimmunoassay; Salts; Time Factors; Vasopressins

Topics: Brain Diseases; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Survival Rate; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Topics: Brain Diseases; Cardiopulmonary Resuscitation; Drug Therapy, Combination; Epinephrine; Heart Arrest; Humans; Sympathomimetics; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

The anteroventral region of the third ventricle (AV3V) is critical in mediating osmotic sensitivity. AV3V lesions increase plasma osmolality and block osmotic-induced vasopressin (VP) and oxytocin (OT) secretion. The aim was to evaluate the effects of AV3V lesions on neurosecretion under control/water replete conditions and after 48 h dehydration. The focus was on central peptidergic changes with measurement of OT and VP content in the hypothalamic paraventricular (PVN) and supraoptic (OT) regions and the posterior pituitary. AV3V-lesioned rats exhibited an elevated plasma osmolality and higher OT content in SON and PVN. There was an increase in VP content in PVN, but no change in SON. As predicted, the plasma peptide response to dehydration was absent in lesioned animals. However, dehydration produced depletion in posterior pituitary VP in lesioned animals with no change in OT. No changes in nuclear VP and OT levels were seen after dehydration. These results demonstrate that AV3V lesions alter the VP and OT neurosecretory system, seen as a blockade of osmotic-induced release and an increase in basal nuclear peptide content. The data indicate that interruption of the osmotic sensory system affects the central neurosecretory axis, resulting in a backup in content and likely changes in synthesis and processing.

Topics: Animals; Brain Diseases; Dehydration; Hypothalamo-Hypophyseal System; Male; Microdissection; Osmolar Concentration; Osmotic Pressure; Oxytocin; Paraventricular Hypothalamic Nucleus; Pituitary-Adrenal System; Radioimmunoassay; Rats; Rats, Wistar; Supraoptic Nucleus; Third Ventricle; Vasopressins; Water; Water-Electrolyte Balance

Central nervous system feedback loops centered on hypothalamic neurons control atrial natriuretic peptide (ANP). We evaluated the ANP response to arterial hypotension, isotonic blood volume expansion, and increase in plasma osmolality in 14 patients with multiple system atrophy (MSA). Seven of the patients were characterized by a lack of vasopressin response to hypotension (MSA type B), suggesting chronic sinoaortic denervation, and seven by a preserved response (MSA type A). Orthostatic hypotension decreased ANP in controls and type A patients, whereas ANP in type B was not affected. Isotonic saline infusion increased ANP and diuresis in controls and type A patients, whereas it did not affect ANP in type B. Osmotic load increased plasma osmolality and vasopressin in controls and MSA patients and ANP in controls and type A but not in type B patients. In MSA patients with altered afferent control of vasopressin, ANP secretion is not stimulated by blood volume expansion, osmotic load, or blood pressure, suggesting that afferent excitatory control plays a role in the release of ANP.

Topics: Atrial Natriuretic Factor; Blood Pressure; Blood Volume; Brain Diseases; Diuresis; Female; Humans; Hypertension; Isotonic Solutions; Male; Middle Aged; Nerve Degeneration; Osmolar Concentration; Posture; Saline Solution, Hypertonic; Sodium Chloride; Vasopressins

Children and menstruant women are far more likely than men to develop metabolic brain damage from hyponatremia. We evaluated brain adaptation and mortality from hyponatremia in male and female rats of three different age groups. With acute hyponatremia, the mortality was 84% in prepubertal rats vs. 15% in adults and 0% in elderly rats. With chronic hyponatremia, mortality was 13% in adult males vs. 62% in females. Testosterone pretreatment significantly decreased mortality (from 62 to 9% in adult females, and from 100% to zero in prepubertal rats), but estrogen significantly increased mortality (from 13 to 44% in adult males). With acute hyponatremia in adult rats, brain sodium was significantly decreased (-17%), but in prepubertal rats it was actually increased (+ 37%). Cerebral perfusion during chronic hyponatremia was significantly impaired in adult females vs. males or controls (P < 0.01). Neither vasopressin administration nor chronic hyponatremia induced with desmopressin resulted in any mortality or decrement of cerebral perfusion. Thus age, gender, and the cerebral effects of vasopressin are major determinants of mortality in experimental metabolic encephalopathy.

Topics: Adaptation, Physiological; Aging; Animals; Brain; Brain Diseases; Chronic Disease; Estrogens; Female; Hormones; Hyponatremia; Male; Rats; Sex Characteristics; Sexual Maturation; Survival Analysis; Testosterone; Vasopressins

Hypernatremia was detected in a dog that was evaluated because of seizures. During hospitalization, the dog was fully conscious and remained hypernatremic when drinking voluntarily and when water was added to the food. Urine volume increased and urine osmolality decreased during an infusion of hypertonic saline (2.5% NaCl) solution, despite development of progressive hyperosmolality. There was no correlation between plasma antidiuretic hormone concentration and osmolality during the infusion study. The dog released antidiuretic hormone normally after nonosmotic stimulation (ie, apomorphine administration). These findings allowed a diagnosis of hypodipsic hypernatremia caused by destruction of hypothalamic osmoreceptors. At necropsy, there was hydrocephalus, atrophy of the septum pellucidum, and neuraxonal dystrophy of the cuneate nuclei. The underlying neurologic disease responsible for the CNS lesions could not be determined, but hydrocephalus may have led to pressure atrophy in the region of the hypothalamus that contains osmoreceptors.

Topics: Animals; Brain Diseases; Dog Diseases; Dogs; Drinking; Fluid Therapy; Hypernatremia; Hypothalamus; Male; Osmolar Concentration; Seizures; Vasopressins; Water-Electrolyte Imbalance

Vasopressin in cerebrospinal fluid has been measured in 27 fullterm newborns with hypoxic-ischemic encephalopathy. These newborns were divided into three groups according to the degree of neurological involvement, and they have been compared with a control group of 10 newborns. Determinations of vasopressin in cerebrospinal fluid and plasma were done by RIA. The cerebrospinal fluid vasopressin in asphyxiated newborns was higher than in the control group (p < 0.001); the mean concentration in the group of newborns classified as moderate or severe hypoxic-ischemic encephalopathy was higher than in the control group (18.7 pg/ml vs 4.66 pg/ml), and also higher than in the group classified as mild (14.2 pg/ml). Cerebrospinal fluid vasopressin values have a direct relationship to the plasmatic values at 12 hours of life (r = 0.76; p < 0.001). We concluded that vasopressin values in cerebrospinal fluid at 12 hours increase according to the clinical severity of the neonatal hypoxic-ischemic encephalopathy and that they have a strong relationship with plasmatic vasopressin.

Topics: Asphyxia Neonatorum; Brain Diseases; Brain Ischemia; Gestational Age; Humans; Hypoxia; Infant, Newborn; Vasopressins

Topics: Animals; Antipsychotic Agents; Brain; Brain Diseases; Dyskinesia, Drug-Induced; Female; Humans; Male; Melatonin; Mental Disorders; Paraventricular Hypothalamic Nucleus; Risk Factors; Vasopressins

Seventeen unselected, consecutive patients with intracranial disease and accompanying hyponatraemia were studied. All would previously have been diagnosed as having the syndrome of inappropriate antidiuretic hormone (ADH) secretion on the basis of spot plasma/urinary electrolyte testing with the application to them of existing standard laboratory criteria. Timed urinary collections and matching plasma samples were available in all but three cases for the derivation of creatinine, osmotic and free-water clearances, tubular reabsorbed water, and fractional water and sodium excretions. In a number of patients the plasma renin, aldosterone and ADH levels were also assayed. On the basis of the overall findings, 13 patients were diagnosed as in fact having a salt-wasting state whilst in only four patients was the diagnosis of inappropriate ADH secretion (SIADH) substantiated. It is suggested that obtaining simple derived parameters of sodium and water homeostasis can add significantly in differentiating between these quite opposite syndromes.

Topics: Aged; Aldosterone; Brain Diseases; Female; Homeostasis; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Postoperative Complications; Renin; Vasopressins; Water-Electrolyte Balance

For intracranial diseases, plasma atrial natriuretic peptide (ANP), antidiuretic hormone (ADH) and aldosterone were determined and their effects on the development of hyponatremia with central origin were studied. The subjects were 71 cases of intracranial diseases which were admitted to our hospital during a period of 1 year from March, 1989 to March, 1990. The diseases were broken down to subarachnoid hemorrhage 26 cases, hypertensive intracerebral hemorrhage 19 cases, head injury 12 cases, cerebral infarction 11 cases and 3 other cases. Serum-urine electrolytes, plasma ANP and ADH were determined in the acute stage on Day 1 to 4, in the hyponatremia stage on Day 5 to 14 and in the chronic stage on Day 15 downward. Hyponatremia was defined as the serum sodium level of 130 mEq/l or less. Cases evidently having other causes such as heart failure and renal insufficiency were excluded. In the normal control group of persons who were admitted to our hospital for a close checkup (n = 20), plasma ANP was 26.5 +/- 11.6 pg/ml (10-50); levels of 50 pg/ml or more were regarded as abnormally high. 1) Hyponatremia was found in 18 cases (25.4%), subarachnoid hemorrhage in 7 cases, hypertensive intracerebral hemorrhage in 4 cases, head injury in 5 cases and others in 2 cases. 2) The time of onset of hyponatremia was on the 8.3 hospital day. The duration was 7.2 days. The minimum serum sodium level was 124.6 mEq/l. 3) There was no significant change in the plasma aldosterone level at each stage.2+ Predicting development of hyponatremia from plasma ADH and ANP levels in the acute stage is difficult. Inadequate secretion of ANP rather than ADH appeared to be an important factor for the development of hyponatremia, but the plasma ANP level was not always abnormally high, so involvement of other sodium diuretic factors should also be kept in mind.

Topics: Adult; Aged; Aged, 80 and over; Aldosterone; Atrial Natriuretic Factor; Brain Diseases; Female; Humans; Hyponatremia; Male; Middle Aged; Vasopressins

Herein we will describe a case of chronic hypernatremic-hyperosmolar syndrome with cerebral localization of systemic sarcoidosis. Several determinations of plasma arginine vasopressin (p-AVP) at various plasma sodium levels were carried out in this patient. During the study p-AVP values varied between 2.6 and 9.5 pg/ml. A high percentage of them was related to plasma osmolality, pointing out that p-AVP secretion was osmotically mediated. This behavior is in contrast with the tendency of hypernatremic patients previously reported in the literature, in whom p-AVP values were inappropriately low for the corresponding degree of plasma osmolality, suggesting that vasopressin secretion was not influenced by osmotic stimulation. Furthermore, our case, unlike those previously described, showed high values of urinary osmolality. In conclusion, our patient represents, in essence, the 'middle' of the spectrum of the hypodipsic-hypernatremic syndrome, because she is to be inserted between the majority of patients who have little or no osmotically mediated AVP release and the case of a child, recently described, who had completely normal AVP secretion.

Topics: Arginine Vasopressin; Brain Diseases; Chronic Disease; Female; Humans; Hypernatremia; Middle Aged; Osmolar Concentration; Sarcoidosis; Syndrome; Thirst; Vasopressins

Patients with intracranial disease are at risk of developing clinical deterioration due to a hyponatremic syndrome associated with an inappropriate degree of natriuresis, the "syndrome of inappropriate secretion of anti-diuretic hormone (ADH)" or SIADH. To investigate the hypothesis that atrial natriuretic peptide (ANP) is related to the natriuresis in SIADH, serum samples were obtained from 8 neurosurgical patients with intracranial disease seen consecutively who fulfilled the traditional clinical and laboratory criteria for SIADH. In one patient with a hemorrhagic cerebral infarction an elevation of serum ADH (5.7 pg/ml; normal = 1 to 5 pg/ml) in association with a normal level of serum ANP (49.8 pg/ml; normal = 10 to 60 pg/ml) was seen. Six patients (2 with intracerebral hemorrhage and 1 with hemorrhagic cerebral infarction, 1 with aneurysmal subarachnoid hemorrhage, 1 with glioblastoma multiforme, and 1 with Creutz-feldt-Jakob disease) had elevated serum ANP levels (197.0, 112.0, 92.0, 432.0, 97.5, and 138.0 pg/ml, respectively) associated with either normal or low ADH levels (1.3, 2.5, 1.2, 0.7, 2.3, and 0.5 pg/ml, respectively). Another patient with an intracerebral hemorrhage had a normal serum ANP level (37.0 pg/ml) and undetectable ADH level (less than 0.5 pg/ml). In the 7 patients in whom either ADH or ANP alone was elevated, a reciprocal relationship was observed between serum ADH and ANP levels, which could be expressed in logarithmic form (correlation coefficient, r = 0.727). In the 6 patients in whom serum ANP level alone was elevated, a near linear relationship was observed between serum ANP levels and urine sodium excretion (r = 0.851).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Natriuretic Factor; Brain Diseases; Humans; Hyponatremia; Sodium; Vasopressins

In neurosurgical patients with hyponatraemia (plasma sodium less than 130 mmol/l) and natriuresis, increased antidiuretic hormone (ADH) secretion may be appropriate rather than inappropriate. Ten such patients were studied prospectively to assess circulating ADH concentration and body fluid volumes. Compared with a control group, the mean plasma ADH level was significantly elevated (0.9 pmol/l (s.e.m. = 0.2) versus 0.2 pmol/l (s.e.m. = 0.1], the total body water was normal (101% (s.e.m. = 3) versus 100% (s.e.m. = 6], while the blood volume was significantly reduced (89% (s.e.m. = 3) versus 104% (s.e.m. = 5]. The elevated ADH level was therefore appropriate to a reduced blood volume. This suggests that, in neurosurgical patients with hyponatraemia, fluid restriction could be dangerous. Serial observations in this small group of patients showed that salt replacement and normal fluid intake resulted in a fall in the elevated ADH levels.

Topics: Acute Disease; Adult; Blood Volume; Body Water; Brain Diseases; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Natriuresis; Plasma Volume; Prospective Studies; Vasopressins

We examined the relation between plasma atrial natriuretic peptide (ANP) and the changes of the regulating hormones ADH and renin aldosterone in 20 neurosurgical intensive care patients. All patients suffered from elevated intracranial pressure due to severe head trauma or severe subarachnoidal hemorrhage of the anterior circulation. Under controlled mechanical hyperventilation (CMV) with PEEP, 15 patients without evidence of central dysregulation showed no change in plasma ANP, ADH and aldosterone. In five patients with severe central dysregulation of either electrolytes or blood pressure, increases of plasma ANP of various degrees could be observed together with a decline in serum aldosterone.

Topics: Aldosterone; Atrial Natriuretic Factor; Brain Diseases; Craniocerebral Trauma; Critical Care; Humans; Intracranial Pressure; Reference Values; Renin; Subarachnoid Hemorrhage; Vasopressins; Water-Electrolyte Balance

Topics: Brain Diseases; Calcinosis; Child, Preschool; Diabetes Insipidus; Humans; Kidney Diseases; Male; Vasopressins

Two cases of hyponatremia with intracranial lesions are reported with emphasis on diagnostic value of measurement of antidiuretic hormone (ADH) and atrial natriuretic polypeptide (ANP). Case 1. A 77-year-old female was transferred to our hospital for further care of vegetative state after subarachnoid bleeding on May 23, 1986. She was operated by neck clipping of rt-IC bifurcation aneurysm and lt-internal carotid-posterior communicating aneurysm at another hospital. On admission, computed tomography showed diffuse low density at bilateral thalamus and centrum semiovale. Biochemical analysis revealed hyponatremia (120 mEq/t) with increased natriuresis. Endocrinological date revealed normal plasma ADH and high plasma ANP levels. Patient was treated with infusion of 1% NaCl. Case 2. A 65-year-old male was admitted to our department because of gradual impairment of consciousness and generalized convulsion. Computed tomography showed small low density area at rt-thalamus and lt-cerebellar hemisphere. Biochemical date revealed severe hyponatremia (91 mEq/t) with normal plasma level of ADH and high plasma ANP. He was treated with infusion of 3% NaCl and hyponatremia was improved. The hyponatremia is frequently associated with intracranial disorders such as brain tumor, subarachnoid hemorrhage and head injury. Originally, hyponatremia with natriuresis was thought to be caused by salt wasting. This syndrome was defined as the inability to prevent salt loss in the urine due to undefined natriuretic factor in the brain. However, since 1957, because of introduction of concept of SIADH, it has generally become accepted that patients with natriuresis had SIADH. (ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Atrial Natriuretic Factor; Brain; Brain Diseases; Female; Humans; Hyponatremia; Male; Natriuresis; Vasopressins

Topics: Blood Transfusion; Brain Diseases; Critical Care; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Lypressin; Sepsis; Somatostatin; Terlipressin; Vasopressins

Topics: Brain; Brain Diseases; Calcinosis; Child, Preschool; Drinking Behavior; Humans; Hypernatremia; Male; Sodium; Thirst; Tomography, X-Ray Computed; Vasopressins; Water-Electrolyte Balance

Nine children with Schwartz-Bartter-syndrome are described. Seven suffered from severe diseases of the CNS, 2 developed the syndrome during treatment with vincristine, the damaging action of which on the CNS is known. The main symptoms of the syndrome are: hyponatremia with consecutive hypotonia of the extracellular space caused by excessive urinary sodium loss. The plasma volume is not diminished. Therapeutically administered NaCl appears in the urine which is hyperosmolar in spite of the hypoosmolarity of the plasma. The increased secretion of ADH which Schwartz et al. postulated to be the cause of the syndrome has been confirmed in recent years. The organism attempts to excrete the increased fluid volume which is retained by ADH, probably by means of a natriuretic hormone, so-called third factor. Enhanced activity of such a factor was assessed in one of our cases.

Topics: Brain Diseases; Brain Injuries; Cerebrospinal Fluid Shunts; Child; Cysts; Female; Humans; Inappropriate ADH Syndrome; Infant; Male; Tuberculosis, Meningeal; Vasopressins; Vincristine

Topics: Brain Diseases; Calcinosis; Cerebral Cortex; Child, Preschool; Diabetes Insipidus; Humans; Kidney; Male; Tomography, X-Ray Computed; Vasopressins

Cerebrospinal fluid and plasma vasopressin were measured in patients with cerebral disorders associated with varying levels of elevated intracranial pressure. The mean cerebrospinal fluid vasopressin concentration was significantly increased in patients with pseudotumor cerebri (2.0 +/- 0.2 [SEM] pg/ml), intracranial tumor (2.3 +/- 0.4 pg/ml), and intracranial hemorrhage (1.9 +/- 0.3 pg/ml) compared with control patients (1.2 +/- 0.1 pg/ml). A significant relationship was found between intracranial pressure and the cerebrospinal fluid vasopressin concentration within all groups of patients and in the whole sample as well (r = 0.79; p less than 0.001). In the groups of patients with intracranial tumor, hydrocephalus, and intracranial hemorrhage, some individuals showed plasma vasopressin concentrations inappropriate to the corresponding plasma osmolality, but no relationship was found between intracranial pressure and plasma vasopressin concentration. It is suggested that increased intracranial pressure is a stimulus to centrally released vasopressin. The clinical importance of increased cerebrospinal fluid vasopressin concentrations is still not known.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Cerebral Hemorrhage; Female; Humans; Hydrocephalus; Intracranial Pressure; Male; Middle Aged; Osmolar Concentration; Pseudotumor Cerebri; Vasopressins

A mathematical model of the adrenal postpituitary system has been used in cases of brain disease in which endocrine disturbances play an aggravating role. A computer simulation has suggested a type of therapy adding vasopressin to corticoids; this association seems to elicit better results than corticoids alone. Posttraumatic disorders of the cerebral hydration, on one hand, and inoperable or recurrent tumors, on the other hand, take advantage of such a systemic, formalized approach.

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aged; Arginine Vasopressin; Astrocytoma; Brain Diseases; Brain Neoplasms; Computers; Dehydration; Dexamethasone; Drug Therapy, Combination; Humans; Hydrocortisone; Models, Theoretical; Neoplasm Recurrence, Local; Thalamus; Vasopressins

The role played by prostaglandins in the secretion of ADH and modulation of its action was investigated by testing the effects of prostaglandin synthesis inhibition in patients with SIADH of cerebral or pulmonary origin. Three patients with SIADH of central origin and 3 with SIADH of peripheral origin were subjected to 4 successive water-loading tests. In the first and fourth tests, the patients absorbed water 20 ml/kg bodyweight; in the second test they absorbed alcohol 2.5 ml/kg followed by water 17.5 ml/kg. The third test was preceded by a 3-day inhibition of prostaglandin synthesis with indomethacin 200 mg/day and aspirin 1.5 g/day. In patients with SIADH of peripheral origin the percent water-load excreted after 4 hours was low (less than 35%) with the 4 tests, whereas it reached 80% (p less than 0.001) with the third test (prostaglandin inhibition) in those with SIADH of central origin. Alcohol did not significantly correct the antidiuretic effect in any of the patients in both groups. It is concluded that prostaglandins reduce ADH secretion in central SIADH but do not modify antidiuresis in peripheral SIADH, since ectopic secretion probably does not depend on prostaglandins. The prostaglandin inhibition test therefore seems to be more helpful than the alcohol test to differentiate between central and peripheral SIADH. Further studies, however, are required to confirm these findings.

Topics: Adult; Aged; Aspirin; Brain Diseases; Ethanol; Female; Humans; Inappropriate ADH Syndrome; Indomethacin; Lung Diseases; Male; Middle Aged; Prostaglandin Antagonists; Prostaglandins; Vasopressins; Water

Topics: Acute Disease; Adult; Alcoholism; Brain; Brain Diseases; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Substance Withdrawal Syndrome; Vasopressins; Water Intoxication

Topics: Adolescent; Brain Diseases; Diabetes Insipidus; Female; Humans; Hypoxia; Male; Middle Aged; Vasopressins

The hypothalamic magnocellular system of the rhesus monkey was studied with specific immunocytochemical techniques in animals that had undergone hypothalamic lesions. The results indicate that this system maintains a regenerative capacity even when its tracts are interrupted within the hypothalamus. New neurohemal units are reconstituted from newly formed vessels within the scar as well as from preexistent blood vessels, such as perforating and pial arterioles, and the vessels of the pars tuberalis of the pituitary gland, which normally do not contain neurosecretory terminals.

Topics: Animals; Brain Diseases; Cicatrix; Female; Fluorescent Antibody Technique; Haplorhini; Hypothalamus; Macaca mulatta; Neurophysins; Oxytocin; Regeneration; Vasopressins

Topics: Brain Diseases; Cerebral Ventricles; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Vasopressins

Topics: Adolescent; Adult; Aged; Brain Diseases; Diuresis; Female; Humans; Kidney; Male; Middle Aged; Osmolar Concentration; Vasopressins

We describe 11 premature infants with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The syndrome is far more common than the single case report in the literature would indicate. All the infants had either asphyxiation at birth, intracranial hemorrhage, or meningitis. Of the nine children available for follow-up observation, seven demonstrated serious neurological sequelae. The diagnosis of SIADH in the premature neonate may be difficult to establish due to the complexity of precipitating factors.

Topics: Brain Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pituitary Diseases; Syndrome; Vasopressins

Topics: Animals; Brain Diseases; Cats; Cytoplasmic Granules; Intracranial Pressure; Microscopy, Electron; Pituitary Gland, Posterior; Subarachnoid Hemorrhage; Vasopressins

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is described in a 67-year-old man with cerebellar and cerebral atrophy. This is the first reported case of this association.

Topics: Aged; Brain Diseases; Cerebellar Diseases; Electroencephalography; Humans; Hyponatremia; Male; Vasopressins

Topics: Atrophy; Brain; Brain Diseases; Chlorpropamide; Diabetes Insipidus; Female; Humans; Leukemia, Lymphoid; Middle Aged; Pituitary Gland; Vasopressins

Topics: Adolescent; Adult; Brain Diseases; Diabetes Insipidus; Female; Humans; Hypernatremia; Kidney; Male; Middle Aged; Reference Values; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Affective Symptoms; Aged; Behavior; Brain Diseases; Depression; Hormones, Ectopic; Humans; Hydrocephalus, Normal Pressure; Hypothyroidism; Male; Neurocognitive Disorders; Nutrition Disorders; Psychotherapy; Psychotropic Drugs; Risk; Suicide Prevention; Thinking; Vasopressins

Clinical aspects with disturbances in fluid and electrolytes metabolism in brain diseases were discussed reviewing 41 cases experienced in our department. These 41 cases were found in 377 patients with diseases of the central nervous system in our hospital during recent 14 months. Hyponatremia was found in 19 cases and aneurysms of A-C, A1 and A2 had the majority of the cases. The cerebral angiography suggested an unstable blood supply to the anterior portion of the hypothalamus, for instance, showing remarkable shift, spasm or obstruction A-C, A1 or A2. The duration of hyponatremia was transient and mostly less than 2 weeks after the last attack of subarachnoid hemorrhage. On the contrary, hypernatremia was seen in 9 cases and 6 of them were found in cases of tumors in the pineal region and A-C, A1 and A2 were intact angiographically. The hypernatremia was continuous and did not response to V-P shunt or any kinds of infusion therapy. The hypernatremia due to cerebral disease is thought to be a result of destruction of the supraoptic and paraventricular nuclei or adjacent area in the anterior potion of the hypothalamus in most of presumed these cases. It might be that the decreased blood supply to the anterior position of the hypothalamus offers an information not of hypoosmolarity but of hypovolemic state, and this information increases the secretion of ADH. This mechanism of hyponatremia could play an important role in S.I.A.D.H.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Child; Female; Humans; Hypernatremia; Hyponatremia; Infant; Intracranial Aneurysm; Male; Middle Aged; Pinealoma; Postoperative Complications; Vasopressins

Topics: Adult; Body Water; Brain Diseases; Child, Preschool; Diabetes Insipidus; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Vasopressins

Schwartz-Bartter-syndrome as a consequence of severe cerebral alterations like bacterial and tuberculous meningitis, encephalitis, hydrocephalus and brain haemorrhage has been observed in 7 cases. Massive natriuresis is followed by marked hyponatremia and hypochloremia which may lead to an intracellular brain edema. Sodium administered even in high dosage is lost rapidly through the kidney, and does not normalize the serum level of sodium. The Schwartz-Bartter-syndrome is caused by inadequatly elevated ADH-secretion with consecutive water retention and an increase in plasma volume. Consecutively an increased excretion of sodium takes place causing a substantial loss of bound water. An analogous situation was seen in a child with neurohormonal diabetes insipidus after an overdosage of ADH, which resulted in a hypervolemia, marked hyponatremia and massive natriuresis. The increased excretion of sodium may be the result of reduced reabsorption of sodium in the proximal tubuli of the kidney, caused by a humeral natriuretic factor (the socalled "third factor"). In the serum of one of our patients an increased natriuretic activity could be shown; this is the first time in a child with Schwartz-Bartter-syndrome.

Topics: Blood Volume; Brain Diseases; Brain Edema; Cerebral Hemorrhage; Child; Chlorides; Encephalitis; Female; Humans; Hydrocephalus; Hyponatremia; Infant; Infant, Newborn; Male; Meningitis; Natriuresis; Osmolar Concentration; Syndrome; Tuberculosis, Meningeal; Vasopressins

Topics: Brain Diseases; Humans; Hypernatremia; Hypothalamus; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventricle Neoplasms; Circadian Rhythm; Female; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Hypothalamus; Male; Metyrapone; Middle Aged; Thyrotropin-Releasing Hormone; Vasopressins

Topics: 11-Hydroxycorticosteroids; Adult; Brain Diseases; Circadian Rhythm; Female; Humans; Hydrocortisone; Male; Metyrapone; Middle Aged; Optic Atrophy; Pituitary Neoplasms; Vasopressins

Topics: Autopsy; Blood Glucose; Blood Urea Nitrogen; Brain Diseases; Caudate Nucleus; Cerebral Cortex; Corpus Callosum; Creatinine; Demyelinating Diseases; Diabetic Coma; Female; Humans; Hypotension; Male; Metabolic Diseases; Middle Aged; Osmolar Concentration; Pons; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; Adult; Brain Diseases; Chorionic Gonadotropin; Growth Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothalamus; Injections, Intravenous; Iodine Isotopes; Male; Radioimmunoassay; Thyroid Function Tests; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Adolescent; Adult; Brain Diseases; Child; Female; Goiter, Endemic; Growth Hormone; Humans; Hypothalamo-Hypophyseal System; Hypothalamus; Hypothyroidism; Male; Pituitary Function Tests; Pituitary Hormone-Releasing Hormones; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Adolescent; Adrenal Insufficiency; Arachnoid; Arachnoiditis; Brain Diseases; Carbamazepine; Diabetes Insipidus; Drinking; Growth Hormone; Humans; Hydrocortisone; Hypogonadism; Hypothalamo-Hypophyseal System; Male; Osmolar Concentration; Pituitary Diseases; Thirst; Thyroid Hormones; Vasopressins

Topics: Brain Diseases; Carcinoma, Bronchogenic; Humans; Hypernatremia; Hyponatremia; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adolescent; Adrenocorticotropic Hormone; Brain Diseases; Child; Child, Preschool; Circadian Rhythm; Dexamethasone; Female; Humans; Hypothalamo-Hypophyseal System; Insulin; Male; Metyrapone; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Vasopressins

Topics: Adult; Analgesia; Anesthesia, General; Anesthetics, Local; Blood Pressure; Brain Diseases; Brain Neoplasms; Craniotomy; Epinephrine; Female; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Ornithine; Pallor; Parkinson Disease; Postoperative Complications; Pulse; Stereotaxic Techniques; Trephining; Vasoconstrictor Agents; Vasopressins; Wound Healing

Topics: Arachnoid; Brain Diseases; Cerebral Ventricles; Cysts; Humans; Hydrocephalus; Hypernatremia; Hypothalamus; Male; Middle Aged; Thirst; Vasopressins

Topics: Adult; Brain Diseases; Edema; Female; Humans; Hypothalamus; Male; Middle Aged; Vasopressins

Topics: Brain Diseases; Carcinoma, Bronchogenic; Humans; Lung Diseases; Osmosis; Phenytoin; Urination; Vasopressins; Water-Electrolyte Balance

Topics: Aged; Atrophy; Blood; Brain Diseases; Chlorpropamide; Diabetes Complications; Diabetes Mellitus; Female; Fludrocortisone; Humans; Hyperpituitarism; Hyponatremia; Natriuresis; Osmolar Concentration; Tolbutamide; Urine; Vasopressins

Topics: Brain Diseases; Diabetes Insipidus; Diencephalon; Diuresis; Humans; Thirst; Vasopressins

Topics: Acromegaly; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Anorexia Nervosa; Brain Diseases; Brain Neoplasms; Cushing Syndrome; Endocrine System Diseases; Female; Humans; Hydrocortisone; Hypothalamus; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Biopsy; Body Temperature; Body Weight; Brain Diseases; Calcium; Child; Child, Preschool; Chlorides; Creatine; Dehydration; Diabetes Insipidus; Diagnosis, Differential; Diet; Diuresis; Feeding and Eating Disorders; Female; Humans; Hydrochlorothiazide; Hypothalamus; Infant; Kidney; Male; Mineralocorticoid Receptor Antagonists; Obesity; Osmolar Concentration; Osmosis; Piperidines; Potassium; Sodium; Urography; Vasopressins

Topics: Affective Symptoms; Brain Diseases; Child; Child Behavior Disorders; Compulsive Behavior; Diabetes Insipidus; Drinking; Humans; Hypothalamus; Male; Psychological Tests; Psychophysiologic Disorders; Thirst; Vasopressins

Topics: Adult; Brain Diseases; Endocrine System Diseases; Humans; Male; Mesencephalon; Prednisolone; Sarcoidosis; Vasopressins

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Adult; Aged; Brain Diseases; Endocrine System Diseases; Female; Humans; Male; Middle Aged; Neoplasms; Oxytocin; Vasopressins; Water-Electrolyte Balance

Topics: Brain Diseases; Bronchial Neoplasms; Humans; Hyponatremia; Vasopressins; Water Intoxication

Topics: Aldosterone; Brain Diseases; Humans; Hyponatremia; Natriuresis; Vasopressins; Water-Electrolyte Balance

Topics: Adrenal Cortex Function Tests; Animals; Arginine Vasopressin; Brain Diseases; Epinephrine; Median Eminence; Oxytocin; Rats; Vasopressins