pituitrin and Meningioma

A 52-year-old woman with hypertension and Graves' disease was scheduled for surgical removal of a meningioma. Intraoperative events were significant for hypotension requiring a vasopressin infusion. Prophylactic dolasetron was administered to the patient before emergence. The patient's trachea was easily extubated and she was neurologically intact at the end of the surgical procedure. On transport to the neurological intensive care unit, the patient developed torsades de pointes, requiring cardiopulmonary resuscitation, before a return to normal sinus rhythm.

Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Antiemetics; Cardiopulmonary Resuscitation; Electrocardiography; Female; Follow-Up Studies; Graves Disease; Humans; Hypertension; Hypotension; Indoles; Intraoperative Complications; Intubation, Intratracheal; Meningeal Neoplasms; Meningioma; Middle Aged; Postoperative Complications; Propanolamines; Quinolizines; Risk Factors; Torsades de Pointes; Vasoconstrictor Agents; Vasopressins

Endoscopic third ventriculostomy has been found to be successful for treating occlusive hydrocephalus. The complication rate ranges from 6 to 12%. Intraoperative bleeding is the most common incident. Endocrinological failures are rare, mainly due to the proximity of the hypothalamic structures. We report the case of a 33-year-old man who was referred in emergency for subacute hydrocephalus related to a tentorium meningioma. The hydrocephalus was treated by endoscopic third ventriculostomy. During the procedure, the floor of the third ventricle was found to be thick but fenestration was performed without incident. After surgery, the clinical signs of hydrocephalus disappeared but diabetes insipidus was diagnosed the same day. There were no other endocrinology disorders. Medical treatment with vasopressin allowed resolution of the diabetes insipidus in fifteen days. Surgical debulking of the meningioma was then achieved via a subtemporal approach. There was no recurrence of the endocrinology disorder. Diabetes insipidus is an unpredictable complication of third ventriculostomy. The mechanism is not well known. It is however a transient disorder that can easily be treated with vasopresin and therefore should not modify the indications of third ventriculostomy, especially in tumor-related hydrocephalus.

Topics: Adult; Diabetes Insipidus; Humans; Hydrocephalus; Male; Meningeal Neoplasms; Meningioma; Vasopressins; Ventriculostomy

Posterior and anterior pituitary functions were assessed in 8 patients before, during, and after surgery for tumors in the suprasellar region. Preoperatively, all patients but one responded adequately to an osmotic stimulus with a rise in plasma vasopressin (AVP) and all but one showed adequate cortisol response to adrenocorticotropic hormone (ACTH) and hypoglycemia. During surgery a transient rise was seen in plasma levels of AVP (5 out of 8 patients), cortisol (7 out of 8 patients) and growth hormone (4 out of 8 patients). This response could be predicted from the preoperative stimulation tests. Postoperatively the AVP response to osmotic stimuli was impaired in 4 out of 5 patients, although urine volume had returned to normal after a transient polyuric phase. The response of plasma cortisol to ACTH was still adequate but lower than preoperatively.

Topics: Adenoma; Adult; Female; Growth Hormone; Humans; Hydrocortisone; Male; Meningioma; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Sella Turcica; Skull Neoplasms; Vasopressins

The treatment of the syndrome of chronic inappropriate antidiuretic hormone (ADH) secretion by fluid restriction is often attended by poor patient compliance. The following case report illustrates successful management of this condition by oral demeclocycline therapy in a patient who had hyponatremia in association with angioblastic meningioma of the sphenoid ridge.

Topics: Demeclocycline; Drinking; Female; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Sodium; 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: 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: 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

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: 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: 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