pituitrin and Hypopituitarism

Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary. Hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy.

Topics: Acute Disease; Adenoma; Adrenocorticotropic Hormone; Chronic Disease; Deamino Arginine Vasopressin; Gonadal Steroid Hormones; Gonadotropins, Pituitary; Hormone Replacement Therapy; Human Growth Hormone; Humans; Hydrocortisone; Hypophysectomy; Hypopituitarism; Pituitary Gland; Pituitary Hormones, Anterior; Pituitary Irradiation; Pituitary Neoplasms; Prolactin; Radiotherapy; Thyrotropin; Thyroxine; Vasopressins

Topics: Animals; Diabetes Insipidus, Neurogenic; Glucocorticoids; Humans; Hypopituitarism; Vasopressins

Despite a stuttering course, gene therapy continues to provide a potential treatment avenue for many human diseases, including cancer and various inherited disorders. Gene therapy is also attractive for the treatment of local, benign disorders, such as pituitary adenomas. Advances in technology have focused on modifying existing viral vectors and developing targeted expression of therapeutic genes in an effort to achieve efficacy with minimal toxicity. Gene therapy also offers innovative strategies for treating hypopituitarism by replacing hormones such as growth hormone (GH) and vasopressin.

Topics: Adenoma; Animals; Gene Targeting; Genetic Therapy; Genetic Vectors; Growth Hormone; Hormone Replacement Therapy; Humans; Hypopituitarism; Models, Animal; Pituitary Diseases; Pituitary Neoplasms; Vasopressins

Topics: Adult; Cortisone; Dehydroepiandrosterone Sulfate; Drug Therapy, Combination; Estradiol Congeners; Female; Glucocorticoids; Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Male; Practice Guidelines as Topic; Thyroxine; Vasopressins

Topics: Adrenal Glands; Adult; Endocrine Glands; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hypopituitarism; Infarction; Luteinizing Hormone; Male; Middle Aged; Pituitary Gland; Prolactin; Thyroid Gland; 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: Addison Disease; Adrenocorticotropic Hormone; Biological Assay; Blood Chemical Analysis; Circadian Rhythm; Cushing Syndrome; Hormones, Ectopic; Humans; Hyperplasia; Hypopituitarism; Insulin; Lysine; Metyrapone; Pituitary Neoplasms; Pyrogens; Radioimmunoassay; Vasopressins

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Cushing Syndrome; Diabetes Insipidus; Diagnosis, Differential; Growth Hormone; Hormones, Ectopic; Humans; Hyperpituitarism; Hypopituitarism; Pituitary Diseases; Pituitary Function Tests; Pituitary Gland; Pituitary Gland, Posterior; Vasopressins

Topics: Acromegaly; Cushing Syndrome; Diabetes Insipidus; Gigantism; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Pituitary Diseases; Pituitary Gland, Posterior; Vasopressins

Topics: Central Nervous System Diseases; Child; Edema; Endocrine System Diseases; Humans; Hyponatremia; Hypopituitarism; Lung Diseases; Male; Middle Aged; Neoplasms; Vasopressins

Topics: Acromegaly; Addison Disease; Adrenocortical Hyperfunction; Cushing Syndrome; Diabetes Insipidus; Endocrine System Diseases; Humans; Hyperaldosteronism; Hyperparathyroidism; Hypopituitarism; Hypothyroidism; Kidney; Vasopressins; Water-Electrolyte Balance

Topics: Central Nervous System Diseases; Humans; Hypopituitarism; Lung Diseases; Neoplasms; Vasopressins

Topics: Adult; Clinical Trials as Topic; Diethylstilbestrol; Glucagon; Growth Hormone; Humans; Hypopituitarism; Male; Vasopressins

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Blood Glucose; Child; Child, Preschool; Clinical Trials as Topic; Fatty Acids, Nonesterified; Female; Growth Hormone; Humans; Hypopituitarism; Injections, Intramuscular; Insulin; Lysine; Male; Pituitary-Adrenal Function Tests; Vasopressins

Copeptin concentrations are a useful component of the diagnostic workup of paediatric patients with polyuria and polydipsia, but the value of measuring copeptin in patients with hyponatraemia is less clear.. We report 5 children with hyponatraemia in the context of different underlying pathologies. Copeptin concentrations were elevated in 4 cases (13.7, 14.4, 26.1, and 233 pmol/L; reference range 2.4-8.6 pmol/L), suggesting that non-osmoregulated vasopressin release (syndrome of inappropriate antidiuretic hormone) was the underlying mechanism for low sodium levels. In one of the patients, there was an underlying diagnosis of Schaaf-Yang syndrome (MAGEL2 gene mutation) with a clinical picture suggestive of dysregulated vasopressin production with inappropriately high and then low copeptin release. In one hyponatraemic patient, low copeptin concentrations indicated that non-osmoregulated arginine vasopressin release was not the cause of hyponatraemia and oliguria.. Copeptin measurement did not influence management acutely but helped to clarify the mechanism leading to hyponatraemia when the result was available. Relatively high and low copeptin concentrations in association with hypo- and hypernatraemia indicate dysregulated vasopressin production in Schaaf-Yang syndrome.

Topics: Arthrogryposis; Child; Craniofacial Abnormalities; Female; Glycopeptides; Humans; Hyponatremia; Hypopituitarism; Intellectual Disability; Male; Polydipsia; Proteins; Vasopressins

Hypopituitary patients are at risk for bone loss. Hypothalamic-posterior pituitary hormones oxytocin and vasopressin are anabolic and catabolic, respectively, to the skeleton. Patients with hypopituitarism may be at risk for oxytocin deficiency. Whether oxytocin and/or vasopressin contribute to impaired bone homeostasis in hypopituitarism is unknown.. To determine the relationship between plasma oxytocin and vasopressin levels and bone characteristics (bone mineral density [BMD] and hip structural analysis [HSA]) in patients who have anterior pituitary deficiencies only (APD group) or with central diabetes insipidus (CDI group).. This is a cross-sectional study. Subjects included 37 men (17 CDI and 20 APD), aged 20-60 years. Main outcome measures were fasting plasma oxytocin and vasopressin levels, and BMD and HSA using dual X-ray absorptiometry.. Mean BMD and HSA variables did not differ between the CDI and APD groups. Mean BMD Z-scores at most sites were lower in those participants who had fasting oxytocin levels below, rather than above, the median. There were positive associations between fasting oxytocin levels and (1) BMD Z-scores at the spine, femoral neck, total hip, and subtotal body and (2) favorable hip geometry and strength variables at the intertrochanteric region in CDI, but not APD, participants. No associations between vasopressin levels and bone variables were observed in the CDI or ADP groups.. This study provides evidence for a relationship between oxytocin levels and BMD and estimated hip geometry and strength in hypopituitarism with CDI. Future studies will be important to determine whether oxytocin could be used therapeutically to optimize bone health in patients with hypopituitarism.

Topics: Adult; Bone Density; Cross-Sectional Studies; Diabetes Insipidus, Neurogenic; Humans; Hypopituitarism; Male; Middle Aged; Oxytocin; Pelvic Bones; Vasopressins

A 57-year-old woman with pre-dialysis chronic kidney disease (CKD) was hospitalized because of fever and fatigue. On admission, increased inflammatory response and pyuria with bacteriuria were observed. Pyelonephritis was successfully treated with antibiotics, whereas her fatigue continued and she developed progressive hypercalcemia and hyponatremia; serum sodium level, 116 mEq/L and corrected serum calcium level, 13.4 mg/dL. Plasma concentrations of adrenocorticotropic hormone and cortisol and serum luteinizing hormone were under the detection level. Although the reaction of other anterior pituitary hormones and the serum antidiuretic hormone (ADH) was preserved, the response of serum luteinizing hormone to administration of luteinizing hormone releasing hormone was impaired. Magnetic resonance imaging showed no structural abnormality in the thalamus, hypothalamus, and pituitary gland. She was diagnosed with adrenal insufficiency caused by partial hypopituitarism in concomitant with pyelonephritis. After starting hydrocortisone replacement, serum levels of sodium and calcium were rapidly normalized. This case highlights the importance of adrenal insufficiency as a differential diagnosis of hypercalcemia in patients with pre-dialysis CKD, especially when hyponatremia was concomitantly observed. Besides, infection should be considered as an important trigger for the development of latent adrenal insufficiency since it could increase the physiological demand of corticosteroid in the body. Also, CKD may enhance the magnitude of hypercalcemia since CKD patients have decreased capacity to increase urinary calcium excretion.

Topics: Acute Disease; Adrenal Insufficiency; Adrenocorticotropic Hormone; Diagnosis, Differential; Dialysis; Female; Humans; Hydrocortisone; Hypercalcemia; Hyponatremia; Hypopituitarism; Luteinizing Hormone; Magnetic Resonance Imaging; Middle Aged; Pyelonephritis; Renal Insufficiency, Chronic; Treatment Outcome; Vasopressins

Children initially diagnosed with isolated GH deficiency (IGHD) have a variable rate to progress to combined pituitary hormone deficiency (CPHD) during follow-up.. To evaluate the development of CPHD in a group of childhood-onset IGHD followed at a single tertiary center over a long period of time.. We retrospectively analyzed data from 83 patients initially diagnosed as IGHD with a mean follow-up of 15.2 years. The Kaplan-Meier method and Cox regression analysis was used to estimate the temporal progression and to identify risk factors to development of CPHD over time.. From 83 patients initially with IGHD, 37 (45%) developed CPHD after a median time of follow up of 5.4 years (range from 1.2 to 21 years). LH and FSH deficiencies were the most common pituitary hormone (38%) deficiencies developed followed by TSH (31%), ACTH (12%) and ADH deficiency (5%). ADH deficiency (3.1 ± 1 years from GHD diagnosis) presented earlier and ACTH deficiency (9.3 ± 3.5 years) presented later during follow up compared to LH/FSH (8.3 ± 4 years) and TSH (7.5 ± 5.6 years) deficiencies. In a Cox regression model, pituitary stalk abnormalities was the strongest risk factor for the development of CPHD (hazard ratio of 3.28; p = 0.002).. Our study indicated a high frequency of development of CPHD in patients initially diagnosed as IGHD at childhood. Half of our patients with IGHD developed the second hormone deficiency after 5 years of diagnosis, reinforcing the need for lifelong monitoring of pituitary function in these patients.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Child; Child, Preschool; Cohort Studies; Disease Progression; Dwarfism, Pituitary; Female; Follicle Stimulating Hormone; Follow-Up Studies; Human Growth Hormone; Humans; Hypopituitarism; Hypothalamus; Kaplan-Meier Estimate; Longitudinal Studies; Luteinizing Hormone; Magnetic Resonance Imaging; Male; Pituitary Gland; Proportional Hazards Models; Retrospective Studies; Thyrotropin; Time Factors; Vasopressins; Young Adult

Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock.. Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones.. A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived.. Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.

Topics: Acute Disease; Adrenocorticotropic Hormone; Adult; Aged; Biomarkers; Female; Humans; Hydrocortisone; Hypopituitarism; Luteinizing Hormone; Male; Middle Aged; Prospective Studies; Shock, Hemorrhagic; Thyrotropin; Vasopressins; Wounds and Injuries

Adult patients with hypopituitarism are treated by the replacement of deficient hormones, although GH has not been substituted until March 2006 in Japan except for clinical trial. This study examines which hormonal status influences the prevalence of vascular risk disorders in hypopituitary adults. A sample of 263 adult patients with hypopituitarism was studied, among whom there were various hormonal status such as no deficiency, treated or untreated deficiency of each pituitary hormone. Analysis of adult patients with hypopituitarism showed that hypertension was more prevalent in the older than in younger patients and in male than in female patients. Hypercholesterolemia and hypertriglyceridemia were more prevalent in patients with TSH deficiency even with thyroxine substitution than those without TSH deficiency. Both obesity and hypertension were less prevalent in patients with treated ACTH deficiency than those without ACTH deficiency. Obesity was more prevalent in patients with treated vasopressin deficiency than those without vasopressin deficiency. These results provide evidence that glucocorticoid substitution in ACTH deficient adults was favorable to prevent obesity and hypertension but that the thyroxine substitution in TSH deficient adults appeared rather insufficient to prevent hyperlipidemia.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Age Distribution; Aged; Aged, 80 and over; Female; Hormone Replacement Therapy; Humans; Hypercholesterolemia; Hypertension; Hypertriglyceridemia; Hypopituitarism; Male; Middle Aged; Obesity; Prevalence; Risk Factors; Sex Distribution; Thyrotropin; Thyroxine; Vascular Diseases; Vasopressins

To assess the prevalence of hypopituitarism following traumatic brain injury (TBI), describe the time-course and assess the association with trauma-related parameters and early post-traumatic hormone alterations.. A 12-month prospective study.. Forty-six consecutive patients with TBI (mild: N = 22; moderate: N = 9; severe: N = 15).. Baseline and stimulated hormone concentrations were assessed in the early phase (0-12 days post-traumatically), and at 3, 6 and 12 months postinjury. Pituitary tests included the Synacthen-test (acute +6 months) and the insulin tolerance test (ITT) or the GHRH + arginine test if the ITT was contraindicated (3 + 12 months). Insufficiencies were confirmed by retesting.. Early post-traumatic hormone alterations mimicking central hypogonadism or hypothyroidism were present in 35 of the 46 (76%) patients. Three months post-traumatically, 6 of the 46 patients failed anterior pituitary testing. At 12 months, one patient had recovered, whereas none developed new insufficiencies. All insufficient patients had GH deficiency (5 out of 46), followed by ACTH- (3 out of 46), TSH- (1 out of 46), LH/FSH- (1 out of 46) and ADH deficiency (1 out of 46). Hypopituitary patients had more frequently been exposed to severe TBI (4 out of 15) than to mild or moderate TBI (1 out of 31) (P = 0.02). Early endocrine alterations including lowered thyroid and gonadal hormones, and increased total cortisol, free cortisol and copeptin were positively associated to TBI severity (P < 0.05), but not to long-term development of hypopituitarism (P > 0.1), although it was indicative in some.. Long-term hypopituitarism was frequent only in severe TBI. During the 3-12 months follow-up, recovery but no new insufficiencies were recorded, indicating manifest hypothalamic or pituitary damage already a few months postinjury. Very early hormone alterations were not associated to long-term post-traumatic hypopituitarism. Clinicians should, nonetheless, be aware of potential ACTH deficiency in the early post-traumatic period.

Topics: Acute Disease; Adolescent; Adrenocorticotropic Hormone; Adult; Brain Injuries; Case-Control Studies; Female; Gonadotropins, Pituitary; Growth Hormone; Humans; Hypopituitarism; Logistic Models; Male; Middle Aged; Odds Ratio; Pituitary Function Tests; Prospective Studies; Thyrotropin; Time; Vasopressins

Two children with complete congenital anterior hypopituitarism developed hyponatremia; inappropriate secretion of antidiuretic hormone was documented despite adequate hormonal replacement therapy. These cases show that congenital hypopituitarism can be associated with SIADH in children later than the neonatal period, despite adequate replacement therapy.

Topics: Adolescent; Child, Preschool; Female; Fluid Therapy; Hormone Replacement Therapy; Humans; Hyponatremia; Hypopituitarism; Inappropriate ADH Syndrome; Magnetic Resonance Imaging; Male; Pituitary Gland, Anterior; Treatment Outcome; Vasopressins

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

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

Partial diabetes insipidus has been documented in patients with congenital hypopituitarism and posterior pituitary ectopia, some cases being clinically silent except for enuresis. The objective of our study was to evaluate vasopressin (AVP) secretion and thirst appreciation in hypopituitary patients with posterior pituitary ectopia.. Twelve males and three females, aged between 13 and 38 years (median 19 years). Eleven had multiple pituitary deficiencies, adequately replaced at the time of the study, and four were only growth hormone deficient. None of the patients suffered from polyuria, polydipsia or nocturnal enuresis. We tested the patients with a 5% NaCl infusion. Five patients with abnormal vasopressin production were also tested with nitroprusside, which affects baroceptor vasopressin secretion.. We found that only two out of 12 patients had normal AVP secretion. Thirst assessment showed severe hypodipsia in one patient, hyperdipsia in three out of 15 and more subtle abnormalities in two out of 15 patients. Concordance was found between osmotically and baroceptor-stimulated vasopressin.. Patients with posterior pituitary ectopia showed a high prevalence of subclinical subnormal vasopressin response to the osmolar stimulus and moreover an impairment of thirst appreciation. Our data on nonosmotically stimulated AVP release suggest the existence of a damage in the hypothalamic vasopressin secreting centres.

Topics: Adolescent; Adult; Female; Humans; Hypopituitarism; Male; Nitroprusside; Osmolar Concentration; Pituitary Gland, Posterior; Saline Solution, Hypertonic; Thirst; Vasodilator Agents; Vasopressins

Septo-optic dysplasia (De Morsier syndrome) is a developmental anomaly of mid-line brain structures and includes optic nerve hypoplasia, absence of the septum pellucidum and hypothalamo-pituitary abnormalities. We describe seven patients (four female, three male) who had at least two out of the three features necessary for the diagnosis of septo-optic dysplasia. Four patients had hypopituitarism and yet normal gonadotrophin secretion: one of these also had anti-diuretic hormone insufficiency; three had isolated GH deficiency and yet had premature puberty, with the onset of puberty at least a year earlier than would have been expected for their bone age. In any progressive and evolving anterior pituitary lesion it is extremely unusual to lose corticotrophin-releasing hormone/ACTH and TRH/TSH secretion and yet to retain gonadotrophin secretion. GnRH neurons develop in the nasal mucosa and migrate to the hypothalamus in early fetal life. We hypothesise that the arrival of GnRH neurons in the hypothalamus after the development of a midline hypothalamic defect may explain these phenomena. Progress in spontaneous/premature puberty in children with De Morsier syndrome may have important implications for management. The combination of GH deficiency and premature puberty may allow an apparently normal growth rate but with an inappropriately advanced bone age resulting in impaired final stature. GnRH analogues may be a therapeutic option. In conclusion, some patients with De Morsier syndrome appear to retain the ability to secrete gonadotrophins in the face of loss of other hypothalamic releasing factors. The migration of GnRH neurons after the development of the midline defect may be an explanation.

Topics: Child; Child, Preschool; Female; Gonadotropins; Growth Hormone; Humans; Hypopituitarism; Infant; Infant, Newborn; Male; Optic Nerve; Septum Pellucidum; Syndrome; Vasopressins

To study the role of vasopressin in osmoregulation in two successive pregnancies in a woman with Sheehan's syndrome.. Diabetes insipidus (DI) became manifest during two pregnancies in a woman with postpartum hypopituitarism.. Water deprivation-vasopressin administration tests demonstrated partial central DI, corrected with vasopressin in week 12, but only with desmopressin in the third trimester, when placental cystylamino peptidase (vasopressinase) contributes to the severity of the DI.. If DI occurs during pregnancy it may be the first manifestation of a latent central DI, which is often idiopathic, but rarely the first symptom of a pituitary or hypothalamic abnormality. It may also be part of Sheehan's syndrome.

Topics: Adult; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gestational Age; Humans; Hypopituitarism; Osmolar Concentration; Ovulation Induction; Placenta; Pregnancy; Pregnancy Complications; Urine; Vasopressins; Water Deprivation

Neurohypophyseal function was studied by hypertonic saline infusion with plasma vasopressin measurement in 3 patients with adrenal insufficiency before and after cortisol replacement. Although each patient had different causes of adrenal insufficiency, all showed impaired water excretion before replacement. The first patient with isolated adrenocorticotropin deficiency had marked hyponatremia and inappropriate vasopressin secretion which was normalized after replacement, indicating vasopressin hypersecretion during hypoadrenocorticism. The second patient had combined anterior and posterior pituitary deficiency due to postpartum hypopituitarism and showed completely absent vasopressin secretion, with her polyuria being masked before cortisol replacement, suggesting a vasopressin-independent intrarenal mechanism of antidiuresis. The third patient with panhypopituitarism due to a pituitary tumor also had preexisting diabetes insipidus with defective vasopressin secretion. In this case, however, plasma vasopressin was found to be elevated when adrenal insufficiency and hyponatremia subsequently developed. Together, these results indicate that vasopressin hypersecretion does occur during adrenal insufficiency, but that the accompanying urinary diluting defect may be attributable either to vasopressin-dependent or to vasopressin-independent mechanisms.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Diabetes Insipidus; Female; Humans; Hydrocortisone; Hyponatremia; Hypopituitarism; Male; Pituitary Neoplasms; Polyuria; Vasopressins; Water-Electrolyte Balance

A neonate with cleft lip and palate and hypopituitarism had persistent hyponatremia despite treatment with hydrocortisone, L-thyroxine, and growth hormone. Serum sodium concentration and urinary osmolality increased and decreased appropriately and concurrently with alterations in sodium and water intake. The ability to regulate serum concentrations of antidiuretic hormone at subnormal serum sodium concentrations indicated a reset osmostat.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Hyponatremia; Hypopituitarism; Infant, Newborn; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Chlorides; Craniopharyngioma; Humans; Hyponatremia; Hypopituitarism; Male; Neoplasm Recurrence, Local; Pituitary Neoplasms; Postoperative Complications; Sodium; Syndrome; Vasopressins

The neurohypophyseal function was assessed in a group of 15 patients with postpartum hypopituitarism by measuring plasma arginine-vasopressin concentrations during 5% hypertonic saline infusion. None of the patients had symptoms of diabetes insipidus and all patients were on adequate cortisone and thyroxine replacement therapy before testing. The mean basal plasma vasopressin value in the patients (0.6 +/- 0.1 pmol/l) was significantly lower than that in the normal subjects (2.9 +/- 0.3 pmol/l; p < 0.01), whereas the mean serum sodium, plasma osmolality, plasma renin activity and serum aldosterone values were similar in the two groups. During the osmolar load (5% hypertonic saline), the patients revealed varying degrees of arginine-vasopressin responses to the increase in plasma osmolality. Three patients showed normal arginine-vasopressin responses, 10 had subnormal responses, and 2 had no response. During the dehydration test, the patients revealed significantly lower maximum urine osmolalities (p < 0.0025) with significantly higher concurrent mean plasma osmolality (p < 0.0025) than the controls. None of the patients showed overt polyuria at the time of the study. The results indicate the impaired osmoregulation of arginine-vasopressin secretion to an osmolar stimuli in patients with postpartum hypopituitarism, suggesting neurohypophyseal damage. In patients with Sheehan's syndrome, partial diabetes insipidus seems to be much more frequent than previously believed.

Topics: Adult; Aldosterone; Female; Humans; Hypopituitarism; Middle Aged; Osmosis; Pituitary Gland; Puerperal Disorders; Radioimmunoassay; Renin; Saline Solution, Hypertonic; Vasopressins; Water Deprivation

As endogenous opiates are known to be involved in regulation of appetite, an obese patient with panhypopituitarism and frequent episodes of ravenous hunger was treated with the oral opiate antagonist naltrexone for 13 months. This resulted in loss of body weight and attacks of severe hunger. The increased serum prolactin concentration and the dose of vasopressin required for substitution could be reduced. Long-term application of opiate antagonists may be useful in related cases.

Topics: Adult; Appetite; Drug Administration Schedule; Female; Humans; Hypopituitarism; Naltrexone; Obesity, Morbid; Prolactin; Vasopressins; Weight Loss

The case of a 30-year-old pregnant patient suffering from panhypopituitarism is presented. Pregnancy induced by HMG/HCG had been uneventful. Induction of labor by PGE2 vaginal tablets and by intravenous oxytocin at 42 gestational weeks failed and the patient was operated. Following the operation severe exacerbation of her diabetes insipidus occurred. Fluid balance mechanism failed and electrolyte status deteriorated rapidly. The importance of pitressin in maintenance of fluid and electrolyte balance in panhypopituitaric patients in labor and surgical trauma is stressed.

Topics: Adult; Female; Fluid Therapy; Humans; Hydrocortisone; Hypopituitarism; Labor, Induced; Prednisone; Pregnancy; Pregnancy Complications; Thyroxine; Vasopressins; Water-Electrolyte Imbalance

Severe hyponatremia occurs in some patients with untreated hypopituitarism, but it is not known whether such hyponatremia is caused by the hypersecretion of vasopressin (antidiuretic hormone). This report describes severe, symptomatic hyponatremia in five women 59 to 83 years old (serum sodium, 111 to 118 mmol per liter) who presented with hypopituitarism (which had been previously undiagnosed in four). Plasma vasopressin was inappropriately high (1.3 to 25.8 pmol per liter [1.4 to 28 ng per liter]) in relation to plasma osmolality (236 to 260 mOsm per kilogram of body weight). All five patients had normal renal function and no signs of dehydration or volume depletion. The hyponatremia was resolved within a few days after the institution of hydrocortisone therapy, after infusion of normotonic or hypertonic saline had been found to be less effective. When four of the patients were later restudied while receiving maintenance hydrocortisone treatment, the relation between plasma vasopressin and osmolality was normal. We conclude that ACTH deficiency may cause the syndrome of inappropriate secretion of antidiuretic hormone. The beneficial effect of hydrocortisone is probably exerted through the suppression of vasopressin secretion.

Topics: Adrenocorticotropic Hormone; Aged; Aged, 80 and over; Female; Humans; Hydrocortisone; Hyponatremia; Hypopituitarism; Inappropriate ADH Syndrome; Middle Aged; Osmolar Concentration; Retrospective Studies; Vasopressins

Antidiuretic hormone (ADH) function was assessed in a group of 16 patients with Sheehan's syndrome and 17 controls. All patients were on adequate cortisone and thyroxine replacement therapy before testing. During the dehydration test the patients revealed an impairment of ADH function. The maximum urine osmolalities and the urine-plasma osmolality ratios were significantly lower in the patients with Sheehan's syndrome compared to controls (maximum urine osmolalities 633 +/- 38 (SEM) and 873 +/- 29 (SEM) mOsm/kg, respectively, P less than 0.001; urine-plasma osmolality ratios 2.15 +/- 0.14 (SEM) and 3.01 +/- 0.10 (SEM), respectively, P less than 0.001). Plasma osmolalities were significantly higher in the patients (296.1 +/- 1.2 (SEM) and 290 +/- 0.9 (SEM), respectively, P less than 0.001). The patients took a longer period to achieve these maximum urine osmolalities. Three of the patients with Sheehan's syndrome were diagnosed as having diabetes insipidus since their maximum urine osmolalities were below 600 mOsm/kg and following desmopressin all three had an increment in urine osmolality which exceeded 9%. In addition these three patients had a maximum urine-plasma osmolality ratio below 1.9. Thus, it appears the patients with Sheehan's syndrome have an impairment of ADH function which manifests in some as diabetes insipidus.

Topics: Adult; Diabetes Insipidus; Female; Humans; Hypopituitarism; Kidney Concentrating Ability; Middle Aged; Pituitary Gland, Posterior; Vasopressins

Topics: Gonadotropin-Releasing Hormone; Growth Hormone; Growth Hormone-Releasing Hormone; Humans; Hypopituitarism; Thyrotropin-Releasing Hormone; Vasopressins

We studied the clinical characteristics and hypothalamic-pituitary function in 23 patients with optic nerve hypoplasia (ONH), 6 months to 19 years old. All patients had decreased visual acuity and small optic discs; the septum pellucidum was absent in five of 19. Nine of 11 patients had minor EEG abnormalities, and two had microcephaly. The height, weight, and growth rate were normal in all patients 6 months to 3 1/2 years old. Hypopituitarism was found in 15 patients. Fasting and stimulated prolactin levels and the area under the prolactin curve after thyrotropin releasing hormone were significantly greater than in controls and in patients with idiopathic hypopituitarism. These results associate ONH with a high incidence of hypopituitarism, hyperprolactinemia, and neurologic abnormalities. The normal growth in the absence of measurable growth hormone suggests that hyperprolactinemia may stimulate growth temporarily and that a normal height in childhood or the presence of the septum pellucidum do not exclude the possibility of hypopituitarism.

Topics: Abnormalities, Multiple; Adolescent; Adrenocorticotropic Hormone; Adult; Child; Child, Preschool; Female; Growth; Growth Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Infant; Male; Optic Nerve; Prolactin; Septum Pellucidum; Thyrotropin; Thyroxine; Triiodothyronine; Vasopressins

Sixteen children had congenital optic nerve hypoplasia and hypothalamic-pituitary dysplasia. Investigation disclosed an extremely variable spectrum of neuroendocrinological findings that ranged from deficiency to hypersecretion of trophic hormone. Neuroendocrine abnormalities consisted mainly of trophic hormone deficiencies, the most common being growth hormone deficiency, but trophic hormone hypersecretion, including growth hormone, corticotropin, and prolactin was found as well. The extent of anterior pituitary hormone deficiency was variable. Anti-diuretic hormone deficiency was presented in two patients. Our findings support the concept of hypothalamic defect as the major cause for the pituitary dysfunction in this syndrome. Physicians should be aware of this syndrome as a common cause for growth failure and multiple pituitary hormone deficiencies in visually impaired children, which would facilitate the diagnosis and early institution of therapy for this treatable but potentially serious entity.

Topics: Adolescent; Adult; Brain; Child; Child, Preschool; Female; Gonads; Growth Hormone; Humans; Hypoglycemia; Hypopituitarism; Hypothalamo-Hypophyseal System; Infant; Male; Optic Nerve; Pituitary-Adrenal System; Pneumoencephalography; Prolactin; Thyroid Gland; Tomography, X-Ray Computed; Vasopressins

Eighteen patients aged between 14 and 60 years suffering from diabetes insipidus were studied. Diabetes insipidus was diagnosed by means of Robertson's test. All patients underwent C.T. scanning and evaluation of PRL basally and after TRH (200 mcg e.v.). Twelve patients (66%) showed neurological lesions (secondary central diabetes insipidus). Six of these patients had hyperprolactinaemia. Our data suggest that most of central diabetes insipidus are associated with central system nervous (S.N.C.) damage. In same cases the presence of hyperprolactinaemia suggests a brain damage. Therefore neuroradiological study is very important in all cases of neurohypophyseal diabetes insipidus.

Topics: Adolescent; Adult; Diabetes Insipidus; Female; Humans; Hypopituitarism; Male; Middle Aged; Pituitary Gland, Posterior; Pituitary Neoplasms; Prolactin; Vasopressins

Topics: Aged; Humans; Hyponatremia; Hypopituitarism; Hypothalamic Neoplasms; Kidney Concentrating Ability; Lung Neoplasms; Male; Pituitary Neoplasms; Polyuria; Vasopressins

4 patients with presumed pituitary hypothalamic sarcoidosis are described. 3 had histological diagnoses compatible with sarcoidosis and in the other this diagnosis was strongly suspected from chest X-rays. 2 patients presented with diabetes insipidus. ACTH reserve was diminished in 3 out of 4 and growth hormone reserve was diminished in the 3 who were tested. All 4 patients developed secondary amenorrhea. 3 patients had hypothalamic hypothyroidism. Prolactin dynamics were intact. Tomograms of the sella turcica in all 4 and computerized tomography of the hypothalamic area in 2 patients failed to reveal any abnormality.

Topics: 17-Hydroxycorticosteroids; Adolescent; Adrenocorticotropic Hormone; Adult; Female; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hydrocortisone; Hydroxysteroids; Hypoglycemia; Hypopituitarism; Hypothalamo-Hypophyseal System; Insulin; Luteinizing Hormone; Metyrapone; Middle Aged; Prolactin; Sarcoidosis; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Deficiencies of corticotrophin (ACTH), growth hormone, and prolactin were documented in a woman with diabetes mellitus and Sheehan's syndrome. The patient's ACTH deficit appeared to be secondary to a hypothalamic abnormality since on two occasions the patient had a marked plasma ACTH response to vasopressin but not to insulin induced hypoglycaemia. It is postulated that the deficits of these three adenohypophysial hormones were instrumental in causing a severely impaired aldosterone secretory capacity in response to sodium restriction and an angiotensin infusion. In addition, the patient had an unusual form of thyroid dysfunction that was in part reversed with hydrocortisone replacement. The patient's unfortunate death during a hypoglycaemic crisis allowed correlation between her extensive antemortum endocrine testing and her pathologic anatomy.

Topics: Adrenal Glands; Adrenocorticotropic Hormone; Adult; Aldosterone; Angiotensin II; Diabetes Complications; Female; Growth Hormone; Humans; Hypopituitarism; Hypothyroidism; Insulin; Pituitary Gland, Anterior; Prolactin; Vasopressins

A syndrome of chronic hypernatremia (range 148 to 161 mmoles/l) and partial hypopituitarism (growth hormone and gonadotropin deficiencies) is reported in a 27 year-old man with sarcoid hypothalamic involvement. The patient did not complain of thirst and spontaneous fluid intake was not sufficient to restore the serum sodium to normal. However, when larger amounts of water were given (50 ml/kg for 180 min), the plasma osmolality returned to normal values in 3 hours. Blood volume values were found subnormal on two occasions on free diet (63 and 74% of the theorical normal values) and plasma renin activity was elevated (22 ng/ml/hour). Plasma vasopressin (AVP) concentrations (range < 1 to 1.9 pg/ml) were inappropriately low for the degree of plasma osmolality and remained markedly subnormal when hypertonic saline was infused (NaCl 5%, 10 ml/min for 60 min). However, the secretory stores and hemodynamic control of AVP release were intact since a rise in plasma AVP to 10.8 pg/ml was observed after induction of arterial hypotension with sodium nitroprusside infusion. These results provide further direct evidence fo the dysfunction of the thirst mechanism and the osmotic contol of AVP release. They support the concept that osmoreceptor areas are anatomically distinct from the neurohypophyseal AVP secretory system and that neural inputs from baroreceptor and osmoreceptor cells are completely separated.

Topics: Adult; Blood Volume; Fluid Therapy; Humans; Hypernatremia; Hypopituitarism; Hypotension; Hypothalamus; Male; Nitroprusside; Osmolar Concentration; Renin; Sarcoidosis; Thirst; Vasopressins; Water-Electrolyte Balance

A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.

Topics: Adenoma; Female; Humans; Hypopituitarism; Male; Metyrapone; Microsurgery; Pituitary Neoplasms; Postoperative Care; Prednisone; Preoperative Care; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Child; Child, Preschool; Evaluation Studies as Topic; Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Hypothalamo-Hypophyseal System; Infant; Insulin; Pituitary-Adrenal System; Vasopressins

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Catecholamines; Child; Child, Preschool; Diabetes Insipidus; Emotions; Endocrine System Diseases; Growth Disorders; Hormones; Humans; Hyperthyroidism; Hypopituitarism; Hypothyroidism; Infant; Infant, Newborn; Protein-Energy Malnutrition; Vasopressins

A hypothyroid, 72-year-old woman with idiopathic hypopituitarism manifested severe hyponatremia, plasma hypoosmolality, and inappropriately elevated urine osmolality suggestive of a syndrome of inappropriate antidiuretic hormone secretions. The hyponatremia did not respond to demeclocycline hydrochloride, and antidiuretic hormone (ADH) levels measured by a specific radioimmunoassay were appropriately suppressed. Subsequent replacement therapy with levothyroxine sodium resulted in correction of the hyponatremia. Thus, both direct assay as well as hormone blockade failed to show an action of ADH in mediating the water retention.

Topics: Aged; Demeclocycline; Female; Humans; Hyponatremia; Hypopituitarism; Hypothyroidism; Sodium; Thyroxine; Vasopressins

Although impaired water diuresis in adrenocortical insufficiency is well-known, little attention has been paid to the diuretic pattern at night. In two cases of panhypopituitarism, the nocturnal diuretic pattern was found to be quite different from that in the morning, and marked diuresis did occur after water loading at night, without any significant change of serum cortisol which remained at a low level throughout the day. At the antidiuretic stage in the morning, urine osmolality continued to rise gradually, in spite of the water loading, to the level of 666 mOsm/liter. At the water restriction test, the urine was concentrated only to the same level of 600-700mOsm/liter. At the ascending stage of urine osmolality, exogenously injected pitressin showed little antidiuretic effect, although the kidney was able concentrate urine to the higher level later. In the morning, 3 liters of 5% glucose infusion failed to produce a marked diuresis in spite of extreme plasma dilution and expansion. Furosemide immediately induced diuresis even in the morning and the kidney recovered its ability to respond to pitressin. Glucocorticoid also improved the diuretic pattern in the morning, but a latent period of about 2 hr was always observed before the appearance of the effect. What happened during this latent period was unclear, but it was interesting to note that a mechanism similar to that which induces diuretic response seemed to occur without glucocorticoid at night.

Topics: Betamethasone; Circadian Rhythm; Diuresis; Female; Glucose; Humans; Hypopituitarism; Middle Aged; Osmolar Concentration; Vasopressins; Water

Three cases of septo-optic dysplasia are related in infants. A neurogenic diabetes insipidus and an central adrenocortical insufficiency is proved. An growth hormone deficiency is founded in one case. The other anterior pituitary functions are normal. The pneumo-encephalography with congenital absence of septum lucidum and the ophtalmologic anomalies are typical. The treatment is envisaged. In one case an autopsy sustains the radiologic aspect.

Topics: Adrenal Insufficiency; Child, Preschool; Diabetes Insipidus; Female; Humans; Hypopituitarism; Infant; Infant, Newborn; Male; Optic Nerve; Septum Pellucidum; Vasopressins

Topics: Adrenocorticotropic Hormone; Bromocriptine; Clomiphene; Diabetes Insipidus; Female; Growth Hormone; Humans; Hyperpituitarism; Hypogonadism; Hypopituitarism; Infertility, Female; Male; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Prolactin; Thyrotropin; 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

Six children with human growth hormone (hGH) deficiency became hypothyroid during the course of their therapy with hGH. This was accompanied by a decreasing growth rate, clinical symptoms of hypothyroidism and decreased serum T4 concentrations. Three of the 6 patients returned to the euthyroid state, both clinically and biochemically, with cessation of hGH therapy, and reinstitution of hGH precipitated hypothyroidism again in 2 of the three. The patients who remained hypothyroid have evidence of multiple pituitary trophic hormone deficiencies while those who reverted to euthyroidism appear to have isolated hGH deficiency. Evaluation of thyroid function while on hGH showed low T4, free T4 and T3 concentrations. The serum thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was absent or markedly blunted in 4 of 6 patients while receiving long-term hGH therapy but was normal or exaggerated in all patients when tested before or after only 5 days of hGH therapy. These data indicate that exogenous hGH results in an inhibition of the TSH response to TRH. The mechanism of this inhibition is unclear, but we postulate that it may be mediated by somatostatin secretion in response to pulse doses of hGH.

Topics: Age Determination by Skeleton; Body Height; Craniopharyngioma; Diabetes Insipidus; Dwarfism, Pituitary; Female; Growth; Growth Hormone; Humans; Hypopituitarism; Hypothyroidism; Male; Thyroid Gland; Thyroxine; Vasopressins

A sensitive bioassay for the measurement of plasma ACTH is presented. The use of silicic acid adsorption of plasma, with a subsequent acid wash and aqueous acetone desorption, was successful in removing those substances which had interfered with the steroidogenic response of dispersed adrenal cells when unextracted plasma was employed. This extraction procedure extracted 72-76% of ACTH present in plasma. Two pg ACTH1-39 could be consistently detected. Alpha-hACTH1-39 and alpha-pACTH1-39 exhibited equal potencies. Beta-MSH was ineffective at dosage levels up to 2 x 10(8) pg. One x 10(8) pg of ACTH1-10, ACTH4-10, or alpha-MSH had a steroidogenic effect equivalent to that of 40 pg ACTH1-39. ACTH 17-39 and ACTH 11-24 were incapable of stimulating steroid production at doses of 1 x 10(8) pg. Excesses of the latter, but not of the former appeared to be able to antagonize the steroidogenic effect of ACTH1-39. Plasma from normal subjects, bioassayed by this extraction procedure, contained 12-186 pg/ml ACTH at 0400-0800: 14-93 pg/ml ACTH at 1000-1300, and less than 10-34 pg/ml ACTH at 1600-2200. Hypoglycemia and vasopressin administration were followed by increases in plasma ACTH concentratrations. Plasma ACTH concentrations in untreated patients with Cushing's disease (sampled over the period 0900-1300) ranged from 65-220 pg/ml. Three patients with Addison's disease (untreated or 12 h following replacement steroid withdrawal) had ACTH concentrations of 223, 370 and 1226 pg/ml. Markedly elevated ACTH concentrations were observed in a patient with Nelson's syndrome (391 and 835 pg/ml). Bioassayable ACTH was not detected in 2 patients with panhypopituitarism.

Topics: Acetone; Addison Disease; Adrenal Glands; Adrenocorticotropic Hormone; Adsorption; Animals; Biological Assay; Blood Glucose; Cushing Syndrome; Humans; Hypopituitarism; Melanocyte-Stimulating Hormones; Radioimmunoassay; Rats; Silicic Acid; Time Factors; Vasopressins

Nineteen boys with true isolated growth hormone deficiency developed the first stages of puberty at an average bone age of 12.0"years" (Tanner Whitehouse Method 2, RUS score). The average chronological age was 15.0 years. Seven similar girls entered puberty at 10.9"years" in bone age and 13.7 years in chronological age. The means and ranges of bone age at beginning of puberty of these patients are very close to those of normal children.

Topics: Adolescent; Age Determination by Skeleton; Age Factors; Child; Female; Growth Hormone; Humans; Hypopituitarism; Male; Puberty; Vasopressins

Topics: Adipose Tissue; Amino Acids; Animals; Epinephrine; Fatty Acids, Nonesterified; Female; Growth Hormone; Humans; Hypopituitarism; Neurophysins; Obesity; Oxytocin; Species Specificity; Vasopressins

A 20-yr-old male was found to have diabetes insipidus is association with panhypopituitarism but without any focal neurological lesion being identified. He was initially treated with steroid supplements, the features of diabetes insipidus being controlled with a thiazide diuretic. Eighteen months later the patient lost thirst sensation and stopped treatment, subsequently being re-admitted with severe dehydration, oliguria and focal neurological signs. Further investigation, including brain biopsy, confirmed the presence of an atypical pinealoma which was considered inoperable. Measurements of plasma antidiuretic hormone (ADH) and angiotensin II (AII) concentrations during the severe dehydration showed very high levels of AII, but inappropriately low plasma ADH levels for the severity of dehydration. We consider that the evidence obtained from this case supports the view that the oliguria with hypertonic urine present during severe dehydration was due to a direct renal action of the very high AII levels, possibly supplemented by the residual ADH secretion.

Topics: Adult; Angiotensin II; Circadian Rhythm; Dehydration; Diabetes Insipidus; Growth Hormone; Humans; Hypopituitarism; Male; Osmolar Concentration; Time Factors; Urine; Vasopressins

Topics: Adrenal Cortex Hormones; Arginine; Child; Child, Preschool; Diabetes Insipidus; Follicle Stimulating Hormone; Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Insulin; Luteinizing Hormone; Male; Optic Chiasm; Radiography; Sella Turcica; Skull; Thyrotropin-Releasing Hormone; Thyroxine; Tuberculoma; Tuberculosis, Meningeal; Vasopressins; Vision Disorders

Topics: Acromegaly; Addison Disease; Adrenalectomy; Blood Glucose; Cushing Syndrome; Diabetes Insipidus; Dwarfism; Dwarfism, Pituitary; Female; Glucagon; Growth Hormone; Humans; Hyperthyroidism; Hypogonadism; Hypopituitarism; Insulin; Lysine; Male; Pyrogens; Radioimmunoassay; Vasopressins

A 29-year-old woman with evidence of a craniopharyngioma and documented panhypopituitarism is described. Clinical and laboratory evaluation revealed deficiencies of follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, growth hormone, prolactin, adrenocorticotropic hormone and antidiuretic hormone. Prompt release of several pituitary hormones was noticed after administration of the hypothalamic releasing hormones FSH/LH-RF and thyrotropin-releasing hormone, whereas insulin-induced hypoglycemia, levodopa, chlorpromazine and clomiphene citrate, all of which act at the level of the hypothalamus, did not alter basal pituitary secretion. The patient's height of 60 inches, despite panhypopituitarism, and the interpretation of the above data are discussed in the light of current concepts regarding the dynamics of the hypothalamic-hypophyseal system.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Child; Chlorpromazine; Clomiphene; Craniopharyngioma; Dwarfism, Pituitary; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Insulin; Levodopa; Luteinizing Hormone; Pituitary Function Tests; Pituitary Gland; Pituitary Hormones; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma, Chromophobe; Cortisone; Drinking; Ethanol; Growth Hormone; Humans; Hyponatremia; Hypopituitarism; Male; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Urination; Vasopressins

Topics: Administration, Intranasal; Adult; Arginine; Diabetes Insipidus; Drug Evaluation; Humans; Hypopituitarism; Male; Osmolar Concentration; Urination; Vasopressins

Topics: Adenoma, Chromophobe; Adrenocorticotropic Hormone; Adult; Aged; Child; Craniopharyngioma; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hypopituitarism; Hypothalamus; Hypothyroidism; Luteinizing Hormone; Male; Meningioma; Middle Aged; Pituitary Neoplasms; Radioimmunoassay; Thyrotropin; Thyrotropin-Releasing Hormone; Time Factors; 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: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aldosterone; Dehydroepiandrosterone; Estriol; Female; Humans; Hydroxycorticosteroids; Hypopituitarism; Lysine; Pregnancy; Pregnancy Complications; Vasopressins

Topics: Antibody Formation; Antibody Specificity; Diabetes Insipidus; Drug Hypersensitivity; Electrocardiography; Humans; Hypergammaglobulinemia; Hypopituitarism; Iatrogenic Disease; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin G; Male; Middle Aged; Pituitary Hormones, Posterior; Powders; Vasopressins

Topics: Adrenal Glands; Adrenal Insufficiency; Blindness; Bradycardia; Brain; Electrolytes; Female; Glucagon; Glucose; Glucose Tolerance Test; Growth Hormone; Humans; Hypoglycemia; Hypopituitarism; Infant; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Intellectual Disability; Male; Pituitary Gland; Seizures; Vasopressins

Topics: Adolescent; Aminosalicylic Acids; Blood Glucose; Body Height; Calcinosis; Child; Child, Preschool; Diabetes Insipidus; Female; Growth Hormone; Hemiplegia; Humans; Hypopituitarism; Isoniazid; Obesity; Prednisone; Pyrazinamide; Streptomycin; Tuberculosis, Meningeal; Vasopressins

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: Adrenocorticotropic Hormone; Adult; Animals; Cattle; Diabetes Insipidus; Histamine Release; Humans; Hypersensitivity, Immediate; Hypopituitarism; Immunoglobulin E; Immunoglobulin G; Leukocytes; Male; Oxytocin; Pinealoma; Pituitary Gland; Rabbits; Sheep; Skin Tests; Swine; Thyrotropin; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Arginine; Child; Female; Gonadotropins; Gonadotropins, Pituitary; Growth Hormone; Humans; Hypopituitarism; Male; Melanocyte-Stimulating Hormones; Pituitary Neoplasms; Prolactin; Thyrotropin; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Anthropometry; Arginine; Arm; Body Height; Body Weight; Eunuchism; Gigantism; Glucagon; Gonadotropins; Growth Disorders; Growth Hormone; Humans; Hypoglycemia; Hypopituitarism; Insulin; Male; Pituitary Hormones; Thyrotropin; Vasopressins

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; Adolescent; Adrenal Glands; Adrenal Insufficiency; Blood Glucose; Child; Child, Preschool; Dwarfism; Evaluation Studies as Topic; Female; Humans; Hypoglycemia; Hypopituitarism; Hypothalamus; Insulin; Lysine; Male; Metyrapone; Obesity; Pituitary Gland; Pituitary-Adrenal Function Tests; Time Factors; Vasopressins

Topics: Adult; Chorionic Gonadotropin; Cortisone; Craniopharyngioma; Desoxycorticosterone; Estrogens; Female; Gestational Age; Gonadotropins, Pituitary; Humans; Hypophysectomy; Hypopituitarism; Infertility, Female; Menopause; Ovulation; Pituitary Neoplasms; Pregnancy; Pregnanediol; Vasopressins

Topics: Adolescent; Adrenal Cortex Hormones; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Circadian Rhythm; Desoxycorticosterone; Female; Humans; Hydrocortisone; Hypopituitarism; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Addison Disease; Adolescent; Adrenal Gland Diseases; Adrenal Glands; Adrenalectomy; Adrenocorticotropic Hormone; Adult; Aged; Child; Cushing Syndrome; Dexamethasone; Female; Fluorometry; Humans; Hydrocortisone; Hyperplasia; Hypopituitarism; Hypothalamo-Hypophyseal System; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Adrenocorticotropic Hormone; Estrogens; Female; Glucocorticoids; Humans; Hypogonadism; Hypopituitarism; Hypothalamo-Hypophyseal System; Injections, Intramuscular; Injections, Intravenous; Lysine; Male; Menstruation Disturbances; Obesity; Pituitary Function Tests; Prednisolone; Turner Syndrome; Vasopressins

Topics: Adult; Clomiphene; Craniocerebral Trauma; Endocrine System Diseases; Estrogens, Conjugated (USP); Humans; Hyperaldosteronism; Hypoglycemia; Hypopituitarism; Insulin; Laurence-Moon Syndrome; Luteinizing Hormone; Male; Puberty, Precocious; Radioimmunoassay; Turner Syndrome; Vasopressins

Topics: Adult; Aged; Alkalosis; Bendroflumethiazide; Biological Assay; Blood Urea Nitrogen; Bromine; Carbon Dioxide; Chlorides; Chlorpropamide; Chlorthalidone; Creatinine; Diagnosis, Differential; Diuretics; Female; Furosemide; Humans; Hydrochlorothiazide; Hypokalemia; Hyponatremia; Hypopituitarism; Hypothyroidism; Male; Methyclothiazide; Middle Aged; Natriuresis; Osmolar Concentration; Polythiazide; Potassium Isotopes; Radioisotope Dilution Technique; Radioisotopes; Sodium Isotopes; Tritium; Vasopressins; Vomiting; Water-Electrolyte Balance

Topics: Adolescent; Adult; Brain Neoplasms; Craniopharyngioma; Diabetes Insipidus; Diuresis; Humans; Hydrocortisone; Hypopituitarism; Pituitary-Adrenal Function Tests; Vasopressins; Water-Electrolyte Balance

To evaluate the role of antidiuretic hormone (ADH) in the defect in water excretion which is characteristic of glucocorticoid deficiency, the effects of hydrocortisone and ethanol upon urinary dilution during a sustained water load were studied in patients with anterior hypopituitarism. A spectrum of defects in urinary dilution was found in the seven patients with anterior hypopituitarism, and the subjects were separable into two groups. Four patients were unable to excrete a urine hypotonic to plasma (group I) while three diluted the urine (group II). In two of the group II patients, despite maintenance of hydration, urinary osmolality later rose to hypertonicity. Physiological doses of hydrocortisone improved urinary dilution in all patients. Submaximal doses of oral hydrocortisone, when given to the group I patients, converted their response to hydration to one characteristic of the group II patients, i.e., an initial hypotonic urine followed by a secondary rise to hypertonicity. Ethanol, a known inhibitor of ADH secretion, had no effect in the group I patients. When two of these patients were pretreated with sub-maximal doses of hydrocortisone, however, so that they were able to transiently dilute the urine, ethanol prevented the secondary rise in urine osmolality. Similarly, the administration of ethanol to the untreated group II patients, when the urine was hypotonic, improved diluting ability as characterized by a lowering of urinary osmolality and an increased excretion of solute-free water in all three patients. Hydrocortisone did not improve urinary dilution in three patients with complete hypophyseal diabetes insipidus and one with both anterior and posterior insufficiency receiving constant infusions of vasopressin. These data suggest, therefore, that inappropriately elevated levels of ADH play a major role in the defect in water excretion of anterior hypopituitarism. Glucocorticoids appear to be necessary for a normal neurohypophyseal response to inhibitory stimuli.

Topics: Diabetes Insipidus; Diuresis; Ethanol; Humans; Hydrocortisone; Hypopituitarism; Kidney; Kidney Concentrating Ability; Osmolar Concentration; Pituitary Gland; Vasopressins; Water-Electrolyte Balance

Topics: Adrenal Cortex Hormones; Body Weight; Coma; Electrocardiography; Electroencephalography; Female; Humans; Hyponatremia; Hypopituitarism; Middle Aged; Sodium; Vasopressins; Water; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Blood Glucose; Calcinosis; Dehydration; Diabetes Insipidus; Follicle Stimulating Hormone; Glucose Tolerance Test; Growth Hormone; Humans; Hypopituitarism; Hypothalamus; Insulin; Iodine Isotopes; Luteinizing Hormone; Male; Radiography; Skull; Tuberculosis, Meningeal; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adrenocorticotropic Hormone; Carcinoma, Bronchogenic; Cushing Syndrome; Diagnosis, Differential; Female; Gonadotropins; Hormones, Ectopic; Humans; Hypopituitarism; Lung Neoplasms; Male; Parathyroid Hormone; Vasopressins

Topics: Adult; Dehydration; Humans; Hypernatremia; Hypopituitarism; Hypothalamus; Male; Osmolar Concentration; Pinealoma; Thirst; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Animals; Biological Assay; Blood Glucose; Fatty Acids, Nonesterified; Female; Gonadotropins, Pituitary; Growth Hormone; Humans; Hypopituitarism; Insulin; Male; Mice; Middle Aged; Radioimmunoassay; Thyrotropin; Uterus; Vasopressins

Topics: Adult; Diabetes Insipidus; Humans; Hypogonadism; Hypopituitarism; Male; Parotid Neoplasms; Sarcoidosis; Vasopressins

Topics: Aged; Humans; Hypopituitarism; Male; Multiple Myeloma; Pituitary Neoplasms; Prednisolone; Vasopressins

Topics: Adrenal Glands; Adult; Angiotensin II; Animals; Child; Diabetes Insipidus; Diet, Sodium-Restricted; Diuresis; Diuretics; Dogs; Female; Humans; Hypopituitarism; Natriuresis; Polyuria; Pregnancy; Renin; Vasopressins

Topics: Child, Preschool; Chlorpropamide; Diabetes Insipidus; Diuresis; Female; Humans; Hypopituitarism; Lymphatic Diseases; Vasopressins

Topics: Adrenocorticotropic Hormone; Aldosterone; Autopsy; Chlorides; Humans; Hyponatremia; Hypopituitarism; Kidney Concentrating Ability; Male; Middle Aged; Nitrogen; Pituitary-Adrenal Function Tests; Potassium; Sodium; Syphilis; Vasopressins

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Insufficiency; Adrenocorticotropic Hormone; Dexamethasone; Diuresis; Ethanol; Extracellular Space; Female; Glucocorticoids; Growth Hormone; Humans; Hyponatremia; Hypopituitarism; Infusions, Parenteral; Metyrapone; Middle Aged; Natriuresis; Sodium Chloride; Vasopressins; Water-Electrolyte Balance

Topics: Adenoma, Acidophil; Adenoma, Chromophobe; Adrenocorticotropic Hormone; Adult; Aged; Diagnosis, Differential; Female; Humans; Hydrocortisone; Hypopituitarism; Hypothalamus; Male; Meningioma; Metyrapone; Middle Aged; Pituitary Neoplasms; Sella Turcica; Vasopressins

Topics: Adult; Age Factors; Animals; Behavior, Animal; Diabetes Insipidus; Female; Headache; Humans; Hypertonic Solutions; Hypopituitarism; Hypothalamo-Hypophyseal System; Kidney; Necrosis; Osmolar Concentration; Oxytocin; Parity; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Vasopressins; Water-Electrolyte Balance

Topics: Animals; Chromium Isotopes; Diabetes Insipidus; Erythropoiesis; Erythropoietin; Hemoglobinometry; Humans; Hypopituitarism; Iron; Iron Isotopes; Male; Mice; Middle Aged; Osmotic Fragility; Plasma Volume; Polycythemia; Serum Albumin, Radio-Iodinated; Testosterone; Vasopressins

Topics: Aged; Cerebrovascular Disorders; Coma; Female; Humans; Hyponatremia; Hypopituitarism; Potassium Deficiency; Vasopressins

Topics: Addison Disease; Adolescent; Adult; Blood Glucose; Diethylstilbestrol; Female; Growth Hormone; Humans; Hypopituitarism; Insulin; Male; Middle Aged; Physical Exertion; Pituitary Gland; Vasopressins

Topics: Adult; Diabetes Insipidus; Female; Humans; Hypopituitarism; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy Complications; Vasopressins

Trichloroacetic acid extracts of plasma were fractionated on a CG-50 resin column and the 50% acetic acid eluents chromatographed on silicic acid-impregnated glass paper in butanol-acetic acid-water. The specific arginine vasopressin (AVP) zone was eluted and assayed for antidiuretic activity in the diuretic rat. Thioglycolate inactivation was used to confirm AVP activity. Recovery of as little as 4 muU AVP per ml plasma ranged between 80 and 90%. In normal subjects after an overnight fast, plasma AVP ranged between 2.5 and 10.0 muU per ml. AVP secretion was inhibited by hemodilution and stimulated with nicotine and hypertonic saline. Plasma AVP was absent in patients with diabetes insipidus even after neurohypophyseal stimulation. Plasma AVP was abnormally elevated during mild dehydration and remained above the normal range despite hemodilution in patients with untreated adrenocortical insufficiency demonstrating a delayed water diuresis. Glucosteroid therapy lowered plasma AVP to normal in dehydrated patients. A normal diuretic response to hydration was accompanied by a fall in plasma AVP to zero in steroid-treated patients. These findings suggest that hypersecretion of AVP may play an important role in the abnormal water metabolism of adrenocortical insufficiency and that the glucosteroids promote normal water diuresis by inhibiting the secretion of AVP from the neurohypophysis.

Topics: Addison Disease; Adrenal Insufficiency; Adult; Animals; Arginine; Chromatography, Paper; Diuresis; Female; Glucose; Glycolates; Humans; Hydrocortisone; Hypopituitarism; Hypothalamo-Hypophyseal System; Male; Middle Aged; Nicotine; Rats; Sodium Chloride; Steroids; Thioglycolates; Trichloroacetic Acid; Vasopressins

Topics: Adult; Diabetes Insipidus; Diagnosis, Differential; Diuresis; Female; Humans; Hypertonic Solutions; Hypopituitarism; Male; Middle Aged; Nicotine; Osmosis; Polyuria; Sodium Chloride; Thirst; Vasopressins

Topics: Adolescent; Adult; Child; Chorionic Gonadotropin; Craniopharyngioma; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hypopituitarism; Infertility, Female; Male; Ovulation; Pituitary Function Tests; Pregnancy; Vasopressins

Topics: Aged; Heart Failure; Humans; Hyponatremia; Hypopituitarism; Male; Myxedema; Propylthiouracil; Triiodothyronine; Vasopressins

Topics: Aged; Animals; Anura; Bronchial Neoplasms; Carcinoma; Humans; Hyponatremia; Hypopituitarism; Male; Neoplasm Metastasis; Pancreatic Neoplasms; Permeability; Sodium; Urinary Bladder; Vasopressins; Water

Topics: Adenoma, Chromophobe; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Craniopharyngioma; Female; Glucose Tolerance Test; Gonadotropins; Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Iodine; Male; Melanocyte-Stimulating Hormones; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Thyroid Function Tests; Thyrotropin; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Child; Child, Preschool; Female; Gonadotropins, Pituitary; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Insulin; Iodine Radioisotopes; Male; Metyrapone; Middle Aged; Pituitary Function Tests; Pyrogens; Serotonin; Steroids; Thyrotropin; Vasopressins

Topics: 17-Ketosteroids; Adrenocorticotropic Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Pituitary-Adrenal Function Tests; Tannins; Vasopressins

Topics: Adult; Diabetes Insipidus; Humans; Hypopituitarism; Male; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Blood Cell Count; Blood Chemical Analysis; Child; Cortisone; Craniopharyngioma; Diabetes Insipidus; Electroencephalography; Humans; Hyponatremia; Hypopituitarism; Male; Radiography; Sella Turcica; Vasopressins; Water-Electrolyte Balance

Topics: Adrenal Insufficiency; Adrenalectomy; Animals; Arginine; Blood; Creatine; Creatinine; Diuresis; Dogs; Hydrocortisone; Hypopituitarism; Permeability; Pharmacology; Physiology; Rats; Research; Urine; Vasopressins; Water

Topics: Diabetes Insipidus; Estradiol; Female; Humans; Hypopituitarism; Postpartum Hemorrhage; Postpartum Period; Prednisolone; Pregnancy; Testosterone; Thyroid Gland; Tissue Extracts; Vasopressins

Topics: Adrenocortical Hyperfunction; Amenorrhea; Anorexia Nervosa; Diabetes Insipidus; Endocrine System Diseases; Female; Goiter; Graves Disease; Humans; Hypopituitarism; Metabolism; Obesity; Psychology; Psychosomatic Medicine; Psychotherapy; Syndrome; Vasopressins; Water-Electrolyte Balance

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

Topics: Alcohols; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diuresis; Ethanol; Humans; Hydrocortisone; Hypopituitarism; Vasopressins

Topics: Adrenal Cortex Hormones; Diabetes Insipidus; Diuresis; Humans; Hypopituitarism; Vasopressins; Water