pituitrin and Brain-Neoplasms

Diabetes insipidus is a heterogeneous condition characterised by polyuria and polydipsia caused by a lack of secretion of vasopressin, its physiological suppression following excessive water intake, or kidney resistance to its action. The clinical and laboratory diagnosis is confirmed by standard tests, but recent advances in molecular biology and imaging techniques have shed new light on the pathophysiology of this disease. In many patients, central diabetes insipidus is caused by a germinoma or craniopharyngioma; Langerhans' cell histiocytosis and sarcoidosis of the central nervous system; local inflammatory, autoimmune or vascular diseases; trauma from surgery or accident; and, rarely, genetic defects in vasopressin biosynthesis inherited as autosomal dominant or X-linked recessive traits. Thirty to fifty percent of cases are considered idiopathic. Tumour-associated central diabetes insipidus is uncommon in children younger than 5 years old. Biopsy of enlarged pituitary stalk should be reserved for patients with hypothalamic-pituitary mass and progressive thickening of the pituitary stalk since spontaneous recovery may occur. Molecular biology in selected patients may identify those with apparently idiopathic diabetes insipidus carrying the vasopressin-neurophysin II gene mutation.

Topics: Autoimmune Diseases; Brain Neoplasms; Child; Diabetes Insipidus, Neurogenic; Germinoma; Humans; Neurophysins; Vasopressins

Thirst and drinking are essential components of normal osmoregulation in healthy man. Abnormalities of thirst appreciation, in particular hypodipsia, have profound implications for water homeostasis. The combination of cranial diabetes insipidus and hypodipsia can have particularly serious consequences, with the potential for life-threatening hyponatraemia. Although the tools for measuring thirst are subjective and lack true specificity, their use in clinical research has contributed greatly to our understanding of the physiology of thirst appreciation and the abnormal control of thirst in osmoregulatory disorders. The precise neural control of thirst appreciation remains unknown, and perhaps as a result of this, satisfactory therapies for the treatment of disorders of thirst have not yet been developed; behavioural modification and retraining of drinking habits remain the rather limited cornerstones of management.

Topics: Adult; Aged; Aging; Brain Neoplasms; Diabetes Insipidus; Diabetes Mellitus; Drinking; Humans; Inappropriate ADH Syndrome; Middle Aged; Schizophrenia; Thirst; Vasopressins; Water-Electrolyte Balance

Topics: Adrenocorticotropic Hormone; Brain Neoplasms; Calcitonin; Carcinoma, Small Cell; Gastrins; Glucagon; Hormones; Humans; Insulin; Insulin Secretion; Lung Neoplasms; Prognosis; Prolactin; Vasopressins

Topics: Anesthesia; Brain Neoplasms; Diabetes Insipidus; Humans; Surgical Procedures, Operative; Vasopressins

Topics: Animals; Brain Neoplasms; Cell Differentiation; Cell Division; Cell Line; Cell Transformation, Neoplastic; Cell Transformation, Viral; Clone Cells; Culture Techniques; Humans; Hypothalamus; Mice; Neoplasms, Experimental; Neurons; Neurophysins; Rats; Simian virus 40; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Brain Neoplasms; Depression, Chemical; Feedback; Humans; Hypertonic Solutions; Nicotine; Osmolar Concentration; Oxytocin; Pituitary Function Tests; Pituitary Gland, Posterior; Sodium; Urine; Vasopressins; Water-Electrolyte Balance

Central diabetes insipidus is a heterogeneous condition characterized by decreased release of antidiuretic hormone by the neurohypophysis resulting in a urine concentration deficit with variable degrees of polyuria. The most common causes include idiopathic diabetes insipidus, tumors or infiltrative diseases, neurosurgery and trauma. Temozolomide is an oral DNA-alkylating agent capable of crossing the blood-brain barrier and used as chemotherapy primarily to treat glioblastoma and other brain cancers.. Two men (aged 38 and 54 years) suddenly developed polyuria and polydispsia approximately four weeks after the initiation of temozolomide for a glioblastoma. Plasma and urine parameters demonstrated the presence of a urinary concentration defect.. The clinical and laboratory abnormalities completely resolved with intranasal desmopressin therapy, allowing the continuation of temozolomide. The disorder did not relapse after cessation of temozolomide and desmopressin and relapsed in one patient after rechallenge with temozolomide.. Our report highlights the importance of a quick recognition of this exceptional complication, in order to initiate promptly treatment with desmopressin and to maintain therapy with temozolomide.

Topics: Adult; Antineoplastic Agents, Alkylating; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Fatal Outcome; Glioblastoma; Humans; Male; Middle Aged; Temozolomide; Vasopressins

Neurocytoma (NC) is a rare, low-grade tumor of the central nervous system, with a 10-year survival rate of 90% and local control rate of 74%. However, 25% of NCs will be atypical, with an elevated Ki-67 labeling index >2%, and will exhibit a more aggressive course, with a high propensity for local recurrence and/or craniospinal dissemination. Although no standard treatment regimen exists for these atypical cases, adjuvant stereotactic or conventional radiotherapy and/or chemotherapy have been typically offered but have yielded inconsistent results.. We have described the case of a patient with a vasopressin-secreting atypical NC of the sellar and cavernous sinus region. After subtotal resection via endoscopic transsphenoidal surgery, the residual tumor showed increased fluorodeoxyglucose uptake and high somatostatin receptor (SSTR) expression on a 68Ga-DOTA-TATE positron emission tomography/CT scan. Somatostatin receptor ligand (SRL) therapy with lanreotide (120 mg every 28 days) was initiated. Four years later, the residual tumor was stable with decreased fluorodeoxyglucose tumor uptake. Immunocytochemical SSTR2 and SSTR5 expression >80% was further confirmed in a series of NC tissues.. To the best of our knowledge, we have described the first use of SRL therapy for an atypical NC. Our results support consideration of adjuvant SRL therapy for NC refractory to surgical removal. Our findings further raise the possibility of SSTR-directed peptide receptor radionuclide therapy as NC therapy.

Topics: Adolescent; Brain Neoplasms; Cavernous Sinus; Fluorodeoxyglucose F18; Humans; Male; Neurocytoma; Peptides, Cyclic; Receptors, Somatostatin; Sella Turcica; Somatostatin; Vasopressins

We previously reported that transgenic mice produced with a transgene consisting of the SV40 T antigen and vasopressin without the 3'-flanking region exhibit brain tumors and lymphoma. In this study, transgenic mice were produced with the fusion gene containing the SV40 T antigen and the whole vasopressin gene with the 3'-flanking region. Six transgenic mice were generated, five which died after 2-6 weeks. The remaining founder mouse was investigated for fusion gene expression and tumor progression at the age of 6 weeks. Brain tumor cells were characterized for phenotypes and transgene expression. During in vitro cell cultures, the phenotypic appearances at 10, 20, and 30 passages were as a uniform monolayer with similar growth rates. The site of SV40 T antigen integration was in the A2 region of chromosome 11, and SV40 T antigen was expressed at the same level in cells of both earlier and later passages. Thirty passages were probably insufficient to reach crisis and immortalization. These cells enriched brain tumor cell compositions with astrocytes and neuronal cells.

Topics: Animals; Antigens, Polyomavirus Transforming; Blotting, Western; Brain Neoplasms; Cell Line, Tumor; Cell Proliferation; Gene Expression; Immunoenzyme Techniques; In Situ Hybridization, Fluorescence; Mice; Mice, Inbred ICR; Mice, Transgenic; Plasmids; Recombinant Fusion Proteins; Transgenes; Vasopressins

In order to understand the importance of various cis-acting elements in regulating VP gene expression, transgenic mice regulated by VP constructs were produced containing 3.8 kb of the 5' flanking region and all the exons and introns in the mouse VP gene, which was fused at the end of exon 3 to an SV40 T antigen (Tag). In the transgenic mice by the pVPSV.IGR3.6 construct, all the six transgenic mice died at the age of 2-6 weeks. In the transgenic mice by pVPSV.IGR2.1, 21% of them had brain tumors at 5 weeks and 100% of the mice had brain tumors after 24 weeks. Histological analysis of the transgenic mice revealed primitive neuroectodermal tumors (PNET) in the brain and lymphoma in the spleen and lymph nodes. The phenotype differences between the two transgenic mice suggest that tissue-specific expression might be regulated by cis-acting elements in the 1.5-kb of the 3(') flanking region, which are not contained in pVPSV.IGR2.1. In conclusion, pVPSV.IGR2.1 mice will be a valuable mouse model system for investigating PNET tumorigenesis in the brain and lymphoma in the lymph nodes and spleen.

Topics: Animals; Antigens, Polyomavirus Transforming; Brain Neoplasms; Humans; Lymph Nodes; Lymphoma; Mice; Mice, Transgenic; Recombinant Fusion Proteins; Spleen; Tissue Distribution; Transgenes; Vasopressins

New class of therapies, including bipolar therapies (BPT) and "paradoxical" unipolar therapies (PUT) were firstly proposed in relation to a clinical insight and to some results of biological investigations, then they gave rise to mathematical modeling which brought a justification of these therapies, at least from a theoretical point of view. After recalling the mathematical model for the regulation of agonistic antagonistic couples, and reporting the fundamental types of control simulation by means of it, we point out the validity of therapeutical applications inferred from this model. These therapy modalities, including BPT and PUT, now concern the following diseases: astrocytomas, epilepsia and trials on multiple sclerosis. Even if such attempts are in their early stage, noticeably for the last case where biological changes have mainly been studied, it seems that a large span of treatments is open to BPT and PUT. Improvement of these techniques in the future depends, in our opinion, on a parallel working on the dynamics of the mathematical model and the dynamics, perceived by clinical insight and confirmed by biological investigations, of the body reactions to such strategies. Justification of BPT and PUT was given, by resorting to the notion of "pathological homeostasis" which, too often, intervenes in order to nullify the effects of unilateral (not paradoxical) therapies. This research has elicited some therapies which use two agents with antagonistic effects or only an agent with effects similar to the agent already in excess in the body--in both cases at nearly physiological doses.

Topics: Adaptation, Physiological; Adrenal Cortex Hormones; Animals; Astrocytoma; Brain; Brain Neoplasms; Computer Simulation; Epilepsy; Homeostasis; Humans; Models, Theoretical; Multiple Sclerosis; Vasopressins

We report nine consecutive children and adolescents [five females and four males; aged 2 yr 8 months (m) to 18 yr 1 m] studied over the last 5 yr with idiopathic central diabetes insipidus. In addition to vasopressin deficiency, anterior pituitary hormone deficiencies were detected, either on evaluation at presentation or during follow-up studies over the following 3 yr. Four patients had an increased concentration of plasma PRL. One patient had multiple pituitary hormone deficiencies at diagnosis, and two others developed the same by 21 m of follow-up. Brain magnestic resonance imaging scans, performed at presentation, were originally interpreted as normal in four of nine patients, except for absence of the bright posterior pituitary signal; after retrospective review, two of nine were considered normal. All of the brain magnetic resonance imaging (MRI) scans showed positive findings by 14 m of follow-up. The first abnormal finding in all patients was isolated pituitary stalk thickening. Evaluation of cerebrospinal fluid (CSF) for hCG was positive in three of eight evaluated patients; the three positive CSF values were found at presentation and 3 and 9 m after presentation. All eight patients assessed were negative for CSF alpha-fetoprotein and cytology, and no patient had serum tumor markers. Transsphenoidal biopsy of the lesion in seven of nine patients showed a germinoma in six patients and inflammatory cells in one. The six patients with documented germinoma comprise 31% of the intracranial germinomas diagnosed in this age group at the University of California-San Francisco during the last 5 yr. The patient with mononuclear inflammatory cells on biopsy along with one other patient have had spontaneous resolution of their stalk thickening. So-called "idiopathic" central diabetes insipidus warrants close follow-up to determine the etiology, especially if anterior pituitary hormone deficiencies are detected. Normal brain MRI scans or scans that show isolated pituitary stalk thickening merit follow-up with serial contrast enhanced brain MRI for the early detection of an evolving occult hypothalamic-stalk lesion. CSF evaluation is recommended at presentation because elevated CSF hCG may precede MRI abnormalities.

Topics: Adolescent; alpha-Fetoproteins; Biopsy; Brain Neoplasms; Child; Child, Preschool; Chorionic Gonadotropin; Diabetes Insipidus; Female; Germinoma; Humans; Hypothalamus; Magnetic Resonance Imaging; Male; Pituitary Gland; Pituitary Hormones, Anterior; Vasopressins

Patients who have suprasellar germinomas in childhood often present with central diabetes insipidus (CDI). The authors investigated the use of aqueous vasopressin (AVP) by continuous infusion to control the fluid and electrolyte balance in germinoma patients with CDI during aggressive fluid hydration as a part of a preirradiation chemotherapy protocol.. Three patients with suprasellar germinomas and CDI were treated with four courses of preirradiation chemotherapy. Two patients were treated with a continuous AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration. Fluid intake, urine output, body weight, urine specific gravity, and serum electrolyte concentrations were monitored closely, and the infusion rate was adjusted accordingly.. Very low dose AVP infusion controlled fluid balance while allowing appropriate diuresis during chemotherapy. Fluid intake and output were markedly less in the AVP-treated patients (3.8 L/m2 per day) than in the untreated patient (20 L/m2 per day).. The use of very low dose AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration therapy allowed easily titratable control of fluid and electrolyte balance in the patients studied and avoided the complications associated with desmopressin acetate antidiuresis or withholding antidiuretic treatment altogether.

Topics: Adolescent; Brain Neoplasms; Child; Combined Modality Therapy; Diabetes Insipidus; Female; Germinoma; Humans; Infusions, Intravenous; Male; Vasopressins

Vasopressin (VP) levels were evaluated by radioimmunoassay (RIA) in the arterial (A), peripheral (Vp) and jugular (Vj) vein blood and in CSF in 102 patients with brain tumors. In 60 cases the patients' state was complicated by brain edema (BE) and hemodynamic disturbances (HDD). The obtained data revealed significantly higher VP levels: 1) in A, Vp and CSF in patients with BE (Group A) in comparison with patients without BE (Group B), 2) in Vj in patients with HDD only (Group Bc) and 3) in Vp in patients with HDD and BE (Group Ac) in comparison with Group Bc (p < 0.05). There were marked extremely high VP levels in Vj in patients with severe haemorrhage, tachycardia and high blood pressure (BP) and in CSF in patients with tachycardia, high BP and cardiac arrest (p < 0.05 correspondingly in each of the cases). Our results on a clinical basis confirmed CSF VP influence on BE development. We also confirmed the neurohumoral (through blood) and neurotransmitter (possibly through CSF and/or vasopressinergic pathways) VP influences on cardiovascular regulation mechanisms. We content that this is a pathogenetic basis for application of VP direct or indirect antagonists for preventing and treating brain edema in neurosurgical patients.

Topics: Adolescent; Adult; Aged; Blood-Brain Barrier; Brain Edema; Brain Neoplasms; Cerebral Hemorrhage; Child; Child, Preschool; Female; Heart Arrest; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Postoperative Complications; Radioimmunoassay; Synaptic Transmission; Tachycardia; Vasopressins

The study of renin-angiotensin-aldosterone (RAA) and vasopressin (VP) systems in neurosurgical patients with brain tumors and brain edema (BE) had revealed an excessive activity of these systems with secondary hyperaldosteronism especially with BE that proves the pathogenetic role of these systems. Measurement of Aldosterone (Ald) in CSF may serve as a diagnostic test to help manage the patient's clinical condition. Mechanisms of Ald penetration in CSF assumed to be the result of blood-brain-barrier (BBB) destruction (especially in astrocytomas) and/or the mediation by neuropeptides (for example increasing activity of VP V1-receptors). Results serve as a basis for application of the neuropeptide and hormone antagonists and inhibitors on all stages of cascade reactions taking part in the water and sodium retention.

Topics: Adolescent; Adult; Aged; Aldosterone; Astrocytoma; Blood-Brain Barrier; Brain Edema; Brain Neoplasms; Cerebral Hemorrhage; Child; Child, Preschool; Female; Heart Arrest; Hemodynamics; Humans; Hyperaldosteronism; Hypertension; Male; Middle Aged; Postoperative Complications; Prognosis; Radioimmunoassay; Renin-Angiotensin System; Tachycardia; Vasopressins

To evaluate the effect of Brain Tomour (BT) and Neurosurgery (NS) on the renal handling of H2O and Na, and the clinical importance of SIADH in this setting.. Fourteen patients with BT pre-op for NS and 6 controls (C) pre-op for general surgery, were assessed in a controlled prospective trial. All patients were normovolaemic, with normal renal function. They received 400 mg of lithium carbonate (Li) 8 hours before each of two test periods (I and II) and a standard water load only before period II. Clearances studies were performed pre-op (period I) and 24 hours post-op (period II).. Serum Na was normal at all times. Despite normovolaemia, a 1% decrement in serum osmolality and the water load, ADH dramaticaly increased from time I to II mainly in the BT group (36.2 +/- 9.4 vs 7.1 +/- 0.6 pmol/L, p = 0.02). FENa, FELi and FEUricA were significantly more elevated in the BT group pre and post-op (at time II respectively 4.6 +/- 1.6 vs 1.1 +/- 0.3%; 29.3 +/- 4.9 vs 22.6 +/- 5.5; 26.0 +/- 8.1 vs 11.3 +/- 2.2, p = 0.03). Proximal and distal H2O re-absorption and distal fractional Na re-absorption were identical in both groups pre and post-operatively.. 1-BT and NS always induce a SIADH. 2-There was a primary Na loss at the proximal tubule level not explained by ADH increment, that did not significantly changed H2O handling. 3-To prevent hyponatraemia, hypotonic I.V. fluids should be avoided, but more importantly saline must be provided to this potentially salt-wasting condition.

Topics: Adult; Aged; Brain Neoplasms; Craniotomy; Female; Humans; Inappropriate ADH Syndrome; Kidney Concentrating Ability; Kidney Tubules; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Reference Values; Vasopressins; Water-Electrolyte Balance

Changes in the clinical condition, CT scans and MRIs of patients with recurrent or inoperable astrocytomas and brain metastasis have been observed following treatment with a combination of vasopressin and corticoids. These changes have not been reported with corticoids alone--at least not over the short time reported for this therapy. Ten cases of grade II astrocytomas, seven cases of grade III or IV astrocytomas and six cases of metastasis of bronchial or breast origin were studied. To explain the results, it is proposed that vasopressin delays the 'escape' from the effects of corticoids alone and some facts and theories are recalled to help the reader understand the reasoning behind this explanation.

Topics: Adrenal Cortex Hormones; Adult; Antineoplastic Combined Chemotherapy Protocols; Astrocytoma; Brain Neoplasms; Female; Glioblastoma; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Tomography, X-Ray Computed; Vasopressins

Hyponatremia, in patients with central nervous system disease, can be attributable to impaired free water excretion (syndrome of inappropriate secretion of antidiuretic hormone) or to excessive sodium excretion (cerebral salt wasting). We present a patient with a parietal glioma and hyponatremia characterized by salt wasting and dehydration. Rehydration and sodium repletion corrected the sodium and volume deficits; withdrawal of supplemental sodium resulted in recurrence of dehydration and hyponatremia. We determined sodium and water balance and measured plasma atriopeptin, antidiuretic hormone, and aldosterone. Plasma atriopeptin ranged from 8 to 44 pg/mL (normal, less than 45 pg/mL); antidiuretic hormone was not elevated at 4 to 5 pg/mL, and aldosterone was slightly elevated at 1040.25 pmol/L. The concentrations of these hormones could not directly explain the natriuresis; interactions with neural or other humoral factors may be involved. In evaluating such patients, careful attention to sodium and water balance is important to guide appropriate therapy.

Topics: Adult; Aldosterone; Brain Neoplasms; Dehydration; Glioma; Humans; Hyponatremia; Male; Sodium; Vasopressins; Water-Electrolyte Balance

The etiology of diabetes insipidus (DI) was determined in 73 children evaluated from 1962 through 1983. Intracranial tumors produced DI in 34 children, but 27 of these 34 children developed DI only after excision of the tumor. Diabetes insipidus occurred in ten children with intracranial birth defects, eight with severe central nervous system infections, and six with histiocytosis. Six had other causes. No etiology was detected in nine. Division of the cases into two time periods (1962 through 1972 and 1973 through 1983) revealed a decrease in the frequency of idiopathic DI (26.7% to 8.6%), an increase in the frequency of intracranial birth defects (0% to 17.3%), and an increase in the frequency of severe central nervous system infections (0% to 13.8%). Significant changes in therapy for DI have occurred during these 22 years. Use of desmopressin acetate has facilitated treatment of this complex management problem.

Topics: Brain Neoplasms; Child; Child, Preschool; Diabetes Insipidus; Female; Humans; Infant; Male; 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

Thyrotrophin-releasing hormone and gonadotrophin-releasing hormone were measured in lumbar CSF from patients with idiopathic senile dementia, cerebral tumours and spinal disc lesions. Somatostatin was also measured in lumbar CSF from patients with dementia and patients with other neurological disorders, but the numbers involved were much smaller. The levels of these neuropeptides were significantly reduced in the patients with senile dementia. These results suggest a possible involvement of hpothalamic neuropeptides in idiopathic senile dementia.

Topics: Aged; Brain Neoplasms; Dementia; Gonadotropin-Releasing Hormone; Humans; Intervertebral Disc Displacement; Nervous System Diseases; Somatostatin; Thyrotropin-Releasing Hormone; Vasopressins

We describe the results of clinical and endocrinological investigations performed on 10 children and adolescents (5 males and 5 females) with a primary central nervous system germinoma. Eight of 10 patients were between 10-20 yr of age at the time of initial presentation. Polyuria (7 of 10) and a decrease in or cessation of linear growth (5 of 10) were the most common presenting symptoms, while only 2 of 10 patients complained of visual problems. Two patients presented with the syndrome of polyuria, adipsia, hypernatremia, profound muscle weakness, and hyperlipidemia. Initial physical exam revealed abnormal eye findings in 60%, short stature (greater than or equal to 2.5 SD) in 50%, and abnormal pubertal development in 30% of the patients. The neoplasm was located in the suprasellar-hypothalamic region in 8, caudate nucleus in 1, and pineal region in 1. Biopsy performed in 7 patients revealed the classic two-cell germinoma in all cases. Assessment of endocrine function before radiotherapy documented pituitary deficits in all patients studied. Antidiuretic hormone was deficient in 8 of 10 patients and was associated with hypoadipsia in 4. GH was deficient in al patients tested (7 of 7). TSH (5 of 8), ACTH (3 of 7), and gonadotropin (1 of 1) deficiencies were also common before treatment. Plasma PRL concentrations were elevated in 5 of 8 patients, all with suprasellar tumors. The hCG values were elevated only in the patient with sexual precocity (1 of 10). Endocrine evaluation during the postirradiation period revealed additional instances of GH (1), ACTH (1), and gonadotropin (5) deficiencies. All 10 patients are alive without evidence of active disease 6 months to 10 yr after radiation therapy (4500-5100 R). Evidence of hypothalamic-pituitary dysfunction is an early and almost universal feature of central nervous system germ cell tumors. The importance of careful evaluation and follow-up of children with acquired anterior or combined anterior and posterior pituitary dysfunction for a suprasellar tumor is stressed.

Topics: Adolescent; Adrenocorticotropic Hormone; Brain Neoplasms; Caudate Nucleus; Child; Child, Preschool; Dysgerminoma; Female; Gonadotropins, Pituitary; Growth Hormone; Humans; Hypothalamic Neoplasms; Male; Pinealoma; Prolactin; Thyrotropin; Tomography, X-Ray Computed; Vasopressins

A follow-up study was carried out on 12 children with vasopressin sensitive diabetes insipidus. 1) Nine cases (75%) of 12 were finally diagnosed as having brain tumor in later course. There were 3 cases (25%) who could not be decided as having brain tumor during the follow-up period of more than 6 years. 2) There was one case who developed the overt signs of brain tumor 9 years after the onset of diabetes insipidus. Therefore, it seems necessary to follow-up cases with diabetes insipidus for at least 10 years before determining it as idiopathic type. 3) In cases with diabetes insipidus due to brain tumor, associated growth retardation, autonomic symptoms, behavior disorder, endocrine dysfunction and metabolic dysfunction were frequently observed. In the case where these symptoms become aggravated with lapse of time, these findings should be taken seriously as indicating brain tumor. 4) In the case showing either anterior or posterior focal slow waves in the EEG, if such focal slow waves aggravate with age, the findings should be considered as indicative of brain tumor. 5) We would like to emphasize the significance of brain tumor as the underlying pathology of childhood diabetes insipidus.

Topics: Astrocytoma; Brain Neoplasms; Child; Child, Preschool; Diabetes Insipidus; Diagnosis, Differential; Electroencephalography; Female; Follow-Up Studies; Humans; Infant; Male; Vasopressins

There are complex osmotic and non-osmotic factors regulating release of antidiuretic hormone (ADH). A wide variety of intracranial pathological processes may trigger ADH release sufficient to produce clinically recognizable hyponatremia, or the "inappropriate ADH syndrome." We systematically studied one non-osmotic trigger, namely mass-induced elevated intracranial pressure (ICP). Initial experiments established baseline data in normal rhesus monkeys: anesthetized animals displayed appropriate rises and falls in immunoreactive urinary ADH in response to intravenously administered hypertonic and hypotonic infusions. Next, ballon catherters were implanted subdurally over temporal lobes and the animals were allowed to recover. The final experiment consisted of anethetizing the animals, monitoring arterial blood pressure and blood gases, and retrieving timed urinary specimens while continuously recording ICP during infusion-pump expansion of the subdural ballon. A nonlethal and a lethal series of ballon-expansion experiments were done. Control values of urinary ADH were 783 +/- 125 muU/15 min, and ICP was less than 10 mm Hg. During nonlethal mass expansion ADH output rose of 3433 +/- 269 millimicronU/15 min while ICP averaged 65 mm Hg (measured at completion of mass expansion). While the mass was maintained, hypotonic infusion produced unchanged urinary ADH output of 3452 +/- 277 muU/15 min. During lethal experiments, urinary ADH rose still higher to 4339 +/- 1887 muU/15 min associated with ICP averaging 100 mm Hg. We concluded that there is a direct relationship between the magnitude of ICP and the amount of ADH release, and that during elevated ICP the ADH release is not suppressed by hypotonic infusion.

Topics: Animals; Brain Neoplasms; Female; Haplorhini; Intracranial Pressure; Macaca mulatta; Vasopressins

Topics: Adolescent; Brain Neoplasms; Homeostasis; Humans; Hypernatremia; Male; Pineal Gland; Vasopressins; Water

Topics: Adolescent; Adult; Brain Injuries; Brain Neoplasms; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Kidney Diseases; Male; Vasopressins

The physiologic factors involved in vaseopressin (ADH) release and action are reviewed with emphasis on the interaction between osmotic and volume stimuli to the discharge of ADH. Abnormalities in reception of stimuli to ADH release, and in the impaired synthesis and release of ADH, are reviewed in relation to the causes of diabetes insipidus, and information on the biochemical changes which have been described in patients with nephrogenic diabetes insipidus is also discussed. We summarize the pathologic lesions and associated diseases found in 54 of our patients with diabetes insipidus. Criteria for establishing the diagnosis of diabetes insipdus are reviewed with emphasis on the dehydration test, including the importance of measuring plasma osmolality at the conclusion of water deprivation. Treatment of diabetes insipidus is briefly discussed with emphasis on the use of DDAVP and oral agents. The syndrome of inappropriate ADH secretion (SIADH) is reviewed including our experience with 39 patients. The differential diagnosis of SIADH, including the value of water loading and the measurement of ADH levels, is discussed. We comment on treatment of these patients including the use of investigational drugs. Lastly, we review the pharmacologic features and clinical relevance of some drugs which alter the release and action of ADH.

Topics: Analgesics; Animals; Antidepressive Agents, Tricyclic; Antineoplastic Agents; Brain; Brain Neoplasms; Carbamazepine; Craniocerebral Trauma; Demeclocycline; Diabetes Insipidus; Diuresis; Diuretics; Humans; Lithium; Osmolar Concentration; Pituitary Gland, Posterior; Sodium Chloride; Sulfonamides; Sulfonylurea Compounds; 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

The Medical Research Council of Canada has initiated human growth hormone (hGH) therapy in 151 patients with documented complete hGH deficiency that was idiopathic in 76% of cases, secondary to craniopharyngioma (organic) in 17% and of varied cause in 7%. Approximately 50% of the patients with idiopathic disease had isolated hGH deficiency; during therapy thyroid deficiency developed in five patients and cortisol deficiency in three. A similar increase in mean height velocity occurred in the first treatment phase for patients less than 12 years old (0.93 plus or minus 0.30 cm/mo) and those 12 years and older (0.86 plus or minus 0.29 cm/mo). Although subsequent courses of hGH therapy yielded significantly diminished response in both age groups, this diminution was not progressive: the height velocity of the younger patients returned to 0.82 plus or minus 0.26 cm/ml in the fifth therapy phase. The mean height velocity attained at the optimal dosage (0.20 to 0.29 units/kg three times per week) for each age group did not differ significantly. Despite therapy being carried out for only 6 months of the year, normal increment ratios for height age and bone age against chronologic age were observed in the patients with idiopathic disease. In only four patients did treatment failure occur, and three of these were more than 20 years old. The addition of fluoxymesterone (10 mg/d) to the hGH therapeutic regimen (15 units/wk), when diminished response to hGH alone became evident, promoted an enhanced growth response in 9 of 11 older patients. These data indicate that age of the patient and dosage of hGH, but not diagnostic category, were important influences on the response to therapy. Younger patients responded best and maintained a higher mean growth velocity than older patients during intermittent hGH therapy

Topics: Adolescent; Age Determination by Skeleton; Antibodies; Body Height; Brain Neoplasms; Canada; Child; Cortisone; Craniopharyngioma; Female; Fluoxymesterone; Growth Disorders; Growth Hormone; Humans; Hypopituitarism; Male; Pituitary Hormones; Prolactin; Puberty; Thyroxine; Vasopressins

Topics: Brain Neoplasms; Craniopharyngioma; Drug Therapy, Combination; Female; Glioma; Humans; Male; Methylprednisolone; Vasopressins

Topics: Acromegaly; Adenoma, Acidophil; Adenoma, Chromophobe; Adult; Brain Neoplasms; Craniopharyngioma; Diabetes Insipidus; Female; Humans; Luteinizing Hormone; Male; Meningioma; Metyrapone; Pinealoma; Pituitary Hormone-Releasing Hormones; Pituitary Neoplasms; Radioimmunoassay; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Autopsy; Brain Neoplasms; Bronchial Neoplasms; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Humans; Hypopituitarism; Hypothalamus; Male; Microscopy, Electron; Middle Aged; Neoplasm Metastasis; Paraneoplastic Endocrine Syndromes; Pituitary Gland; Pituitary Neoplasms; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Aged; Astrocytoma; Brain Neoplasms; Cerebral Ventriculography; Craniopharyngioma; Echoencephalography; Electroencephalography; Female; Glucocorticoids; Humans; Male; Meningioma; Methylprednisolone; Middle Aged; Neurofibromatosis 1; Vasopressins; Visual Field Tests

A patient with ectopic pinealoma first presented with apparent anorexia nervosa and hypernatraemic coma. A history of diabetes insipidus two months previously was not known on admission to hospital. The diabetes insipidus was unmasked by the administration of steroids. Neuroendocrinal and neuropathological aspects of the case are discussed with reference to the march of symptoms due to the growth of the tumour. Histochemical evidence is presented supporting the similarity between ectopic pinealoma and seminoma which suggests that they may more properly be referred to as atypical teratomas.

Topics: Acid Phosphatase; Adult; Alkaline Phosphatase; Anorexia Nervosa; Brain Neoplasms; Coma; Diabetes Insipidus; Dihydrolipoamide Dehydrogenase; Dysgerminoma; Electron Transport Complex IV; Esterases; Female; Humans; Hydrocortisone; Hypernatremia; Hypothalamus; Male; Osmolar Concentration; Oxidoreductases; Pinealoma; Sodium; Testicular Neoplasms; Thyroxine; Tuberculosis; Vasopressins

Topics: Adolescent; Aldosterone; Brain Neoplasms; Chlorothiazide; Humans; Hypernatremia; Male; Osmolar Concentration; Pituitary Gland; Prednisone; Renin; Teratoma; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Adult; Blood Urea Nitrogen; Brain Neoplasms; Chlorides; Craniopharyngioma; Diabetes Insipidus; Drinking Behavior; Dysgerminoma; Female; Humans; Hydrocortisone; Hypernatremia; Hypothalamus; Male; Middle Aged; Osmolar Concentration; Potassium; Sella Turcica; Sodium; Thirst; Thyroid Function Tests; Triiodothyronine; Vasopressins; Water-Electrolyte Balance

Topics: Adrenal Cortex Hormones; Adult; Astrocytoma; Brain Neoplasms; Drug Synergism; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Remission, Spontaneous; Vasopressins

Ectopic production of polypeptide hormones by tumors of nonendocrine tissues can serve as a clue to diagnosis of the tumor and as a focus for management of the patient with cancer. In the differential diagnosis of syndromes of endocrine hyperfunction, the ectopic hormone syndromes have achieved an increasingly prominent position. Available evidence on the properties of ectopic ACTH, MSH, parathyroid hormone, erythropoietin, gonadotropins, and thyrotropin is consistent with the unifying hypothesis of genetic derepression.

Topics: Abdominal Neoplasms; Adenocarcinoma; Adrenocortical Hyperfunction; Brain Neoplasms; Carcinoma, Bronchogenic; Carcinoma, Hepatocellular; Carcinoma, Small Cell; Cysts; Diagnosis, Differential; Fibroma; Hemangiosarcoma; Humans; Hyperparathyroidism; Hypoglycemia; Kidney Diseases; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Paraneoplastic Endocrine Syndromes; Pheochromocytoma; Polycythemia; Sarcoma; Thoracic Neoplasms; 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: Adolescent; Adult; Brain Neoplasms; Craniopharyngioma; Diabetes Insipidus; Diuresis; Humans; Hydrocortisone; Hypopituitarism; Pituitary-Adrenal Function Tests; Vasopressins; Water-Electrolyte Balance

Topics: Brain Neoplasms; Child; Chlorpropamide; Craniopharyngioma; Cysts; Dehydration; Diabetes Insipidus; Drinking Behavior; Female; Humans; Kidney Concentrating Ability; Male; Obesity; Osmolar Concentration; Sodium; Thirst; Vasopressins; Water-Electrolyte Balance

Topics: Blood; Brain Neoplasms; Child; Dehydration; Glioma; Humans; Hyponatremia; Hypothalamus; Osmolar Concentration; Sodium; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adenine Nucleotides; Aldosterone; Brain Neoplasms; Child; Ethanol; Glioma; Humans; Hypertonic Solutions; Hyponatremia; Hypothalamus; Male; Osmolar Concentration; Vasopressins; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; Adolescent; Adult; Blood Glucose; Brain Neoplasms; Female; Growth Hormone; Humans; Hydrocortisone; Hypoglycemia; Insulin; Male; Meningioma; Metyrapone; Pituitary Function Tests; Sex Factors; Sodium Chloride; Vasopressins

Topics: Adrenal Gland Diseases; Adrenocorticotropic Hormone; Aldosterone; Angiotensin II; Biological Assay; Brain Neoplasms; Bronchial Neoplasms; Central Nervous System Diseases; Child; Edema; Endocrine System Diseases; Glioblastoma; Humans; Male; Osmolar Concentration; Pituitary Diseases; Renin; Sodium Chloride; Vasopressins

Topics: Aged; Blood Urea Nitrogen; Brain Neoplasms; Female; Humans; Hypertonic Solutions; Hyponatremia; Hypothalamus; Lung Neoplasms; Neoplasm Metastasis; Osmolar Concentration; Plasma Volume; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Astrocytoma; Brain Neoplasms; Child; Diet, Sodium-Restricted; Electromyography; Humans; Hyponatremia; Male; Metyrapone; Neural Conduction; Pituitary Function Tests; Sodium; Vasopressins

Topics: Brain Neoplasms; Carcinoma, Bronchogenic; Cerebral Cortex; Dementia; Glioma; Humans; Hyponatremia; Liver Neoplasms; Lymph Nodes; Male; Mental Disorders; Middle Aged; Neoplasm Metastasis; Seizures; Sodium; Thalamus; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Brain Neoplasms; Circadian Rhythm; Dexamethasone; Diabetes Insipidus; Female; Hepatitis; Humans; Hydrocortisone; Injections, Intravenous; Lysine; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Prednisolone; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Blood Glucose; Body Height; Body Weight; Brain Neoplasms; Child; Craniopharyngioma; Exercise Test; Feeding and Eating Disorders; Female; Glucose Tolerance Test; Gonadotropins; Growth; Growth Hormone; Humans; Hypothalamus; Insulin; Male; Obesity; Pituitary Neoplasms; Postoperative Complications; Radioimmunoassay; Thirst; Thyrotropin; Vasopressins; Vision Disorders

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: Astrocytoma; Brain Neoplasms; Cysts; Epidermal Cyst; Glioblastoma; Humans; Hypothalamo-Hypophyseal System; Lymphoma, Large B-Cell, Diffuse; Meningioma; Neuroectodermal Tumors, Primitive, Peripheral; Oligodendroglioma; Pituitary Gland, Posterior; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Aged; Astrocytoma; Brain Edema; Brain Neoplasms; Cerebral Angiography; Echoencephalography; Electroencephalography; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Pituitary Gland; Radionuclide Imaging; Vasopressins

Topics: Brain Neoplasms; DNA, Neoplasm; Humans; In Vitro Techniques; Lysine; RNA, Neoplasm; Vasopressins

Topics: Brain Neoplasms; Electroencephalography; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Natriuresis; Neoplasm Metastasis; Vasopressins; Water Intoxication

Topics: Brain Neoplasms; Breast Neoplasms; Diuresis; Female; Humans; Inappropriate ADH Syndrome; Neoplasms; Vasopressins

Topics: Adult; Brain Neoplasms; Chlorothiazide; Diabetes Insipidus; Diagnosis, Differential; Humans; Hypertonic Solutions; Infusions, Parenteral; Male; Nicotine; Obsessive-Compulsive Disorder; Polyuria; Psychosomatic Medicine; Sodium Chloride; Thirst; Vasopressins

Topics: Aldosterone; Brain Neoplasms; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lung Neoplasms; Natriuresis; Neoplasm Metastasis; Physiology; Vasopressins

Topics: Brain; Brain Injuries; Brain Neoplasms; Humans; Hyponatremia; Vasopressins; Water-Electrolyte Balance