pituitrin and Pituitary-Diseases

Most cases of acquired central diabetes insipidus are caused by destruction of the neurohypophysis by: 1) anatomic lesions that destroy the vasopressin neurons by pressure or infiltration, 2) damage to the vasopressin neurons by surgery or head trauma, and 3) autoimmune destruction of the vasopressin neurons. Because the vasopressin neurons are located in the hypothalamus, lesions confined to the sella turcica generally do not cause diabetes insipidus because the posterior pituitary is simply the site of the axon terminals that secrete vasopressin into the bloodstream. In addition, the capacity of the neurohypophysis to synthesize vasopressin is greatly in excess of the body's needs, and destruction of 80-90% of the hypothalamic vasopressin neurons is required to produce diabetes insipidus. As a result, even large lesions in the sellar and suprasellar area generally are not associated with impaired water homeostasis until they are surgically resected. Regardless of the etiology of central diabetes insipidus, deficient or absent vasopressin secretion causes impaired urine concentration with resultant polyuria. In most cases, secondary polydipsia is able to maintain water homeostasis at the expense of frequent thirst and drinking. However, destruction of the osmoreceptors in the anterior hypothalamus that regulate vasopressin neuronal activity causes a loss of thirst as well as vasopressin section, leading to severe chronic dehydration and hyperosmolality. Vasopressin deficiency also leads to down-regulation of the synthesis of aquaporin-2 water channels in the kidney collecting duct principal cells, causing a secondary nephrogenic diabetes insipidus. As a result, several days of vasopressin administration are required to achieve maximal urine concentration in patients with CDI. Consequently, the presentation of patients with central diabetes insipidus can vary greatly, depending on the size and location of the lesion, the magnitude of trauma to the neurohypophysis, the degree of destruction of the vasopressin neurons, and the presence of other hormonal deficits from damage to the anterior pituitary.

Topics: Aquaporin 2; Brain Injuries, Traumatic; Diabetes Insipidus, Nephrogenic; Diabetes Insipidus, Neurogenic; Homeostasis; Humans; Neurophysins; Pituitary Diseases; Pituitary Gland, Posterior; Polydipsia; Polyuria; Protein Precursors; Vasopressins; Water-Electrolyte Balance

Evaluation of pituitary function is essential before pituitary surgery. In hyperprolactinaemic patients with a pituitary macrolesion, tumoral secretion of prolactin must be distinguished from 'disconnection' hyperprolactinaemia; serum prolactin >200 mcg/l is virtually diagnostic of a macroprolactinoma whereas levels <80 mcg/l usually indicate 'disconnection'. The prolactin 'hook effect' should be excluded. A minimum set of pre-operative endocrine tests should include serum electrolytes, cortisol (at 08.00-09.00 h), free-T4, TSH, prolactin, oestradiol/testosterone, LH, FSH and IGF-1. Some clinicians will choose to perform pre-operative Synacthen or insulin tolerance testing to further define ACTH reserve. If basal cortisol, Synacthen or insulin tolerance test results are abnormal, steroid supplementation is indicated for at least the first 48 h after surgery. If pre-operative basal cortisol is <100 nmol/l, replacement steroids should be continued until the time of post-operative pituitary function testing (6-8 weeks after surgery). In patients with pre-operative basal cortisol >450 nmol/l, peri-operative glucocorticoid replacement is unnecessary and further cortisol levels should be checked a few days after surgery. Most clinicians defer detailed evaluation of growth hormone reserve until after surgery. Diabetes insipidus is rarely a problem before surgery in patients with pituitary adenomas but may occur post-operatively. Close co-operation between anesthetic, endocrine and surgical teams is strongly recommended.

Topics: Gonads; Human Growth Hormone; Humans; Hypothalamo-Hypophyseal System; Insulin-Like Growth Factor I; Pituitary Diseases; Pituitary Gland; Pituitary-Adrenal System; Preoperative Care; Prolactin; Thyroid Gland; 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: Adrenocorticotropic Hormone; Animals; Arachidonic Acids; Cattle; Diabetes Insipidus; Glycolysis; Humans; Inappropriate ADH Syndrome; Liver; Pituitary Diseases; Pituitary Gland, Posterior; Rats; Second Messenger Systems; Signal Transduction; Vasopressins

Advances in genetic engineering will make possible treatment of many pediatric endocrine disorders with replacement therapy. Some of these conditions include short stature, precocious puberty, and diabetes mellitus. Although the availability of such hormonal replacement offers new treatment modalities, an understanding of their mechanism of action and pharmacologic characteristics is crucial to maximize their effectiveness while minimizing possible untoward effects. The clinician must evaluate potential risks and benefits as these substances come to market without definitive answers being available as to their long-term effects.

Topics: Child; Child, Preschool; Diabetes Mellitus, Type 1; Growth Disorders; Growth Hormone; Hormones; Humans; Infant; Insulin; Pituitary Diseases; Pituitary Hormone-Releasing Hormones; Prolactin; Puberty, Precocious; Recombinant Proteins; Somatostatin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Benzothiadiazines; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Hypothalamo-Hypophyseal System; Pituitary Diseases; Postoperative Complications; Prognosis; Prostaglandin Antagonists; Sodium Chloride Symporter Inhibitors; Vasopressins

Topics: Adrenocorticotropic Hormone; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Luteinizing Hormone; Male; Melanocyte-Stimulating Hormones; Oxytocin; Pituitary Diseases; Pituitary Function Tests; Prolactin; Thyrotropin; Vasopressins

Topics: Chemical Phenomena; Chemistry; Diabetes Insipidus; Exocytosis; Hormones, Ectopic; Humans; Molecular Weight; Neurophysins; Oxytocin; Paraneoplastic Endocrine Syndromes; Pituitary Diseases; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Radioimmunoassay; Sodium; 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: 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: Adrenocorticotropic Hormone; Animals; Biological Assay; Dexamethasone; Growth Hormone; Humans; Insulin; Melanocyte-Stimulating Hormones; Metyrapone; Pituitary Diseases; Pituitary Function Tests; Pituitary-Adrenal Function Tests; Pyrogens; Radioimmunoassay; Thyrotropin; Vasopressins

Topics: Central Nervous System Diseases; Humans; Lung Diseases; Lung Neoplasms; Pituitary Diseases; Pituitary Gland, Posterior; Sodium; Vasopressins

Topics: Arginine; Diabetes Insipidus; Diuresis; Humans; Hyponatremia; Lung Neoplasms; Pituitary Diseases; Pituitary Gland, Posterior; Vasopressins; Water-Electrolyte Balance

Topics: Adrenal Insufficiency; Animals; Congenital Hypothyroidism; Diabetes Insipidus; Heart Failure; Humans; Liver Cirrhosis; Osmolar Concentration; Pituitary Diseases; Vasopressins

Topics: Acromegaly; Addison Disease; Adult; Central Nervous System Diseases; Diabetes Insipidus; Humans; Hyperthyroidism; Hypothyroidism; Kidney; Lung Diseases; Male; Neoplasms; Pituitary Diseases; Thyroid Diseases; Vasopressins

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

Because of antidiuretic hormone (ADH) disorder on production or function we can observe dysnatremia. In the absence of production by posterior pituitary, central diabetes insipidus (DI) occurs with hypernatremia. There are hereditary autosomal dominant, autosomal recessive or X- linked forms. When ADH is secreted but there is an alteration on his receptor AVPR2, it is a nephrogenic diabetes insipidus in acquired or hereditary form. We can make difference on AVP levels and/or on desmopressine response which is negative in nephrogenic forms. Hyponatremia occurs when there is an excess of ADH production: it is a euvolemic hypoosmolar hyponatremia. The most frequent etiology is SIADH (syndrome of inappropriate secretion of ADH), a diagnostic of exclusion which is made after eliminating corticotropin deficiency and hypothyroidism. In case of brain injury the differential diagnosis of cerebral salt wasting (CSW) syndrome has to be discussed, because its treatment is perfusion of isotonic saline whereas in SIADH, the treatment consists in administration of hypertonic saline if hyponatremia is acute and/or severe. If not, fluid restriction demeclocycline or vaptans (antagonists of V2 receptors) can be used in some European countries. Four types of SIADH exist; 10 % of cases represent not SIADH but SIAD (syndrome of inappropriate antidiuresis) due to a constitutive activation of vasopressin receptor that produces water excess. c 2013 Published by Elsevier Masson SAS.

Topics: Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diagnosis, Differential; Humans; Hypernatremia; Hyponatremia; Inappropriate ADH Syndrome; Pituitary Diseases; Pituitary Gland, Posterior; Receptors, Vasopressin; Sodium Chloride; Vasopressins; Water-Electrolyte Imbalance

Lymphocytic hypophysitis is classically defined as an inflammatory disorder confined to adenohypophysis. However, it has recently been indicated that infundibuloneurohypophysitis underlies some subsets of central diabetes insipidus (DI). Therefore, lymphocytic hypophysitis can be considered a syndrome including disorders of both the anterior pituitary (lymphocytic adenohypophysitis) and the posterior pituitary (lymphocytic infundibuloneurohypophysitis). We describe a 77-yr-old woman with lymphocytic hypophysitis presenting with headache, diplopia, general malaise and appetite loss. Head magnetic resonance imaging (MRI) demonstrated pituitary swelling and dura mater thickening on the dorsum sella. Endocrinological investigations revealed both anterior and posterior pituitary dysfunction associated with primary hypothyroidism due to Hashimoto's thyroiditis. Headache and diplopia spontaneously disappeared, and anterior pituitary dysfunction, general malaise and appetite loss improved after taking 10 mg hydrocortisone daily, although ACTH hyposecretion persisted. Pituitary swelling was thereafter reduced but the dura mater thickening persisted. We suggest that this case may represent a variant of lymphocytic hypophysitis in which chronic inflammatory process involves both the anterior and the posterior pituitary gland, infundibulum, dura mater on the dorsum sella and cavernous sinus. Regarding expanding features of lymphocytic hypophysitis, it may be considered a syndrome including heterogeneous disorders, of which the pathogenesis remains to be elucidated.

Topics: Aged; Diplopia; Dura Mater; Female; Hormones; Humans; Hypoglycemia; Insulin; Lymphocytes; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Hormones; Vasopressins

Involvement of brain parenchyma or meninges in ANCA-associated small-vessel vasculitis such as Wegener's granulomatosis (WG) is not uncommon. In contrast, involvement of the pituitary is exceedingly rare with only a few cases reported so far. The diagnosis is usually made on the basis of imaging techniques and abnormal pituitary function tests in the setting of active systemic vasculitis. However, histology-proven involvement of the pituitary by WG has not been reported so far. We report a case of WG with histology-proven granulomatous necrotizing inflammation of the pituitary and hypothalamo-pituitary stalk, disclosed at autopsy after the patient had died suddenly and unexpectedly in his sleep. In a setting of histology-proven WG, these findings were regarded as a pituitary manifestation of the disorder. A distinct cause of death could not be found, hence we speculate that hypothalamo-pituitary inflammation due to WG may have caused the sudden death in this patient.

Topics: Adult; Death, Sudden; Granulomatosis with Polyangiitis; Humans; Immunoglobulins, Intravenous; Magnetic Resonance Imaging; Male; Pituitary Diseases; Pituitary Gland, Anterior; Vasopressins

We present the eldest case ever reported of central diabetes insipidus (DI) associated with infundibulo-neurohypophysitis. A 77-year old woman, who complained of recent development of excessive thirst, polyuria and polydipsia, was referred to our hospital. The daily urine volume was markedly increased to 6 L. DDAVP administration effectively reduced urine volume and increased urine osmolality. The loading test using high-osmolar sodium chloride showed impaired excretion of vasopressin discordant with plasma osmolar changes. The anterior pituitary function was normal. Pituitary magnetic resonance imaging (MRI) showed thickening of the pituitary stalk and a lack of high-intensity signal of the neurohypophysis on T1-weighted images, suggestive of lymphocytic infundibulo-neurohypophysitis. The thickness of pituitary stalk on MRI improved 6 months later. DI was controlled with DDAVP for 40 days. This was followed by stabilization of the daily urine volume to less than 2.5 L without DDAVP. Our case is the eldest case of central DI associated with infundibulo-neurohypophysitis. The rapid remission of pituitary changes on MRI provides an insight that spontaneously partial remission of central DI may occur, resulting in transient polyuria and polydipsia.

Topics: Aged; Blood; Chlorides; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Headache; Humans; Lymphocytes; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Diseases; Pituitary Gland, Posterior; Potassium; Sodium; Thirst; Urine; Vasopressins

Familial neurohypophyseal diabetes insipidus (FNDI) is an autosomal dominant disease caused by deficiency in the antidiuretic hormone arginine vasopressin (AVP) encoded by the AVP-neurophysin II (AVP-NPII) gene on chromosome 20p13. In this study, we analyzed two families with FNDI using direct automated fluorescent, solid phase, single-stranded DNA sequencing of PCR-amplified AVP-NPII DNA. In one of the families, affected individuals presented a novel nonsense mutation in exon 3 of the gene, consisting in a G to T transition at nucleotide 2101, which produces a stop signal in codon 82 (Glu) of NPII. The premature termination eliminates part of the C-terminal domain of NPII, including a cysteine residue in position 85, which could be involved in the correct folding of the prohormone. In the second family, a G279A substitution at position -1 of the signal peptide was observed in all affected individuals. This missense mutation, which replaces Ala with Thr, is frequent among FNDI patients and is thought to reduce the efficiency of cleavage by signal peptidases.

Topics: Adolescent; Amino Acid Sequence; Base Sequence; Child, Preschool; Diabetes Insipidus; Humans; Male; Mutation; Neurophysins; Pedigree; Pituitary Diseases; Pituitary Gland, Posterior; Spain; Vasopressins

Central diabetes insipidus is a chronic disorder which in most patients occurs secondary to tumor, infection, trauma or other lesions. In about 20-30% of patients etiology is unclear, however a destructive autoimmune process in the hypophysis may play a role. We report the case of an 18-year-old girl with central diabetes insipidus. Vasopressin levels were typically decreased. Examinations performed 1.5 years after manifestation showed no pathologic changes on MRI and no additional endocrine disorder. MRI was repeated 1.5 years later whereon a thickening of the pituitary stalk as a typical sign of hypophysitis was apparent. No other reasons could be found for the vasopressin deficiency. The finding of hypophysitis in our patient 3 years after disease manifestation suggests that the characteristic MRI changes may take as long as 3 years to become apparent.

Topics: Adolescent; Diabetes Insipidus; Disease Progression; Female; Humans; Inflammation; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland; Vasopressins

Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery were studied. To evaluate posterior pituitary damage, a questionnaire was completed immediately after surgery in 61 patients. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after surgery. Patients were categorized on the basis of postoperative plasma sodium patterns. After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 +/- 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients after water-load testing. Only one-third of the normonatremic patients excreted the water load and suppressed AVP normally. Hyponatremic patients were more natriuretic, had lower dietary sodium intake, and had similar fluid intake and cortisol and atrial natriuretic peptide (ANP) levels compared with normonatremic patients. Normnonatremia, hyponatremia, and diabetes insipidus were associated with increasing degrees of surgical manipulation of the posterior lobe and pituitary stalk during surgery. The pathophysiology of hyponatremia after transsphenoidal surgery is complex. It is initiated by pituitary damage that produces AVP secretion and dysfunctional osmoregulation in most surgically treated patients. Additional events that act together to promote the clinical expression of hyponatremia include nonatrial natriuretic peptide-related excess natriuresis, inappropriately normal fluid intake and thirst, as well as low dietary sodium intake. Patients should be monitored closely for plasma sodium, plentiful dietary sodium replacement, mild fluid restriction, and attention to symptoms of hyponatremia during the first 2 weeks after transsphenoidal surgery.

Topics: Adult; Arginine Vasopressin; Atrial Natriuretic Factor; Child; Diabetes Insipidus; Diuresis; Female; Fluid Therapy; Humans; Hydrocortisone; Hyponatremia; Incidence; Intraoperative Complications; Male; Natriuresis; Pituitary Diseases; Pituitary Gland; Pituitary Gland, Posterior; Postoperative Complications; Prospective Studies; Renal Agents; Sodium; Sodium, Dietary; Sphenoid Bone; Thirst; Vasopressins; Water; Water-Electrolyte Balance; Water-Electrolyte Imbalance

Sarcoidosis is a generalized disorder which involves the central nervous system in 5 per cent of patients presenting with the disease. We describe the case of a 22-year-old man who developed central diabetes insipidus with a daily urine production of 14,81 seven weeks after diagnosis of pulmonary sarcoidosis and parotid gland enlargement. Computed tomography showed a contrast enhancement of pituitary gland and stalk, no other intracranial manifestations were demonstrated. Intranasal administration of synthetic antidiuretic hormone (ADH) reduced urine volume to normal levels immediately. After discontinuation of 15 months therapy with corticosteroids and administration of ADH for 29 months spontaneous urine volume didn't exceed 31. The patient has been free of symptoms since discontinuation of therapy.

Topics: Administration, Intranasal; Adult; Diabetes Insipidus; Humans; Lung Diseases; Male; Parotid Diseases; Pituitary Diseases; Sarcoidosis; Vasopressins

Polyuria subsequent to pituitary surgery was studied in 64 cases. Most cases of postoperative polyuria were due to diabetes insipidus. These cases showed a triphasic pattern in daily urinary volume. Observation of hourly urinary volume in polyuria revealed four diurnal patterns of urinary excretion: rhythmic, continuous, transient, and unspecific. Clinical observation of diurnal patterns has an advantage, in terms of simplicity of procedure, in immediately determining the nature of the polyuria, prognosticating diabetes insipidus, and eliminating inappropriate procedures in treatment. Indomethacin suppository is considered to be a favorable agent in reducing polyuria without disturbing the diurnal pattern in diabetes insipidus.

Topics: Adenoma; Adolescent; Adult; Aged; Circadian Rhythm; Diabetes Insipidus; Female; Humans; Indomethacin; Male; Middle Aged; Pituitary Diseases; Pituitary Neoplasms; Polyuria; Postoperative Complications; Sodium; Vasopressins

Topics: Humans; Hypothalamus; Pituitary Diseases; Pituitary Gland; Pituitary Hormones, Anterior; Pituitary Hormones, Posterior; Pituitary Neoplasms; Vasopressins

A 23-year-old man, diagnosed as having a pituitary adenoma at the age of 17 and received an operation 1 month ago showed a fluctuating hypernatremia and hypodipsia. The water deprivation, water load and hypertonic saline infusion tests were carried out. After a 14-hr water deprivation test, plasma osmolality was 310 mOsm/kg, plasma ADH was 1.5 microunits/ml, and urine osmolality was 591 mOsm/kg. On the water load test subsequently performed, the plasma osmolality decreased to 297 mOsm/kg, but the urine was still hypertonic. Infusion of 2.5% saline solution elicited paradoxically a marked diuresis and dilution of urine despite the elevàtion of plasma osmolality. On the treatment with carbamazepine and clofibrate, the urinary osmolality increased, the hypernatremia was normalized, and a marked natriuresis was elicited with a gain in body weight. These results suggested that the secretion of ADH is regulated by changes in blood volume rather than by the plasma osmolality in this patient. The hypernatremia may be explained as a disturbance or lack of osmoreceptor function for ADH release and the loss of thirst sensation, though the volume receptor still remains functioning for ADH secretion. Depletion of the extracellular fluid volume may be another contributing factor to the elevation of serum sodium level by enhancing the reabsorption of sodium from renal tubules.

Topics: Adult; Blood Volume; Carbamazepine; Clofibrate; Humans; Hypernatremia; Male; Osmolar Concentration; Perfusion; Pituitary Diseases; Saline Solution, Hypertonic; Vasopressins; Water Deprivation

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

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

Topics: Adult; Humans; Hyponatremia; Male; Pituitary Diseases; Pituitary Gland, Posterior; Vasopressins

Topics: Aged; Cavernous Sinus; Humans; Hyponatremia; Male; Phenytoin; Pituitary Diseases; Secretory Rate; Syndrome; Thrombosis; Vasopressins

The usual treatment for recurrent syndrome of inappropriate secretion of antidiuretic hormone has been fluid restriction. Recently White and Fetner described an adult with SIADH successfully managed with lithium carbonate. Described here is a child with recurrent SIADH who was diagnosed as having an acute hyponatremic episode and who then relapsed twice in a two-month period while chronic fluid restriction was attempted. He has now been maintained on 300 mg/day of lithium carbonate and is asymptomatic with normal serum sodium concentration and urine osmolalities. Lithium appears to be effective in the management of recurrent SIADH and may allow control in a patient who cannot comply with long-term fluid restriction.

Topics: Child; Humans; Lithium; Male; Pituitary Diseases; Pituitary Gland, Posterior; Recurrence; Syndrome; Vasopressins

We report two patients in whom the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) developed during the administration of psychotherapeutic drugs. In one, the syndrome occurred after administration of a phenothiazine drug and in the other, a butyrophenone. Both the patients were diagnostically studied for evidence of other disorders, either neurologic or systemic, which could cause this syndrome with negative results. They responded to fluid and free water restriction with remarkable recovery and no sequelae. It is stressed that psychotherapeutic drug administration must be considered as one of the iatrogenic causes of SIADH.

Topics: Adult; Female; Haloperidol; Humans; Middle Aged; Pituitary Diseases; Syndrome; Thioridazine; 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

Patients underlying the permanent endocrine substitution need a particular control and a competent conduction on account of their endangering by intercurrent events. Highly specialised knowledge of the physician and intensive collaboration of the patient from this reciprocity lead to essential aspects of the prophylaxis of the crisis-like exacerbations exhibited in detail. The optimum substitution is supplemented by issuing information and emergency cards. When the patient possesses such cards they will become of decisive importance in an urgent therapy necessary outside the controlling facility.

Topics: Arginine Vasopressin; Brain Edema; Diabetes Insipidus; Dihydrotachysterol; Humans; Hydrocortisone; Hypoparathyroidism; Hypothyroidism; Muscle Cramp; Pituitary Diseases; Thyroid Hormones; Vasopressins

Topics: Humans; Pituitary Diseases; Pituitary-Adrenal Function Tests; Syndrome; Vasopressins

Topics: Humans; Osmolar Concentration; Pituitary Diseases; Pituitary Gland, Posterior; Sensory Receptor Cells; Vasopressins; Water-Electrolyte Imbalance

A patient with Ewing's sarcoma presented with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (1). Plasma values for vasopressin were found to be over four times the normal values expected for the plasma osmolality. At postmortem examination, the arginine vasopressin concentration in the tumor tissue was ten times that of the plasma. These data suggest that Ewing's sarcoma may cause SIADH.

Topics: Adolescent; Arginine Vasopressin; Blood; Body Weight; Humans; Male; Osmolar Concentration; Pituitary Diseases; Pituitary Gland, Posterior; Sarcoma, Ewing; Urine; Vasopressins

Topics: Adolescent; Carbohydrate Metabolism, Inborn Errors; Chorionic Gonadotropin; Deficiency Diseases; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hydroxysteroids; Hypogonadism; Intellectual Disability; Luteinizing Hormone; Male; Obesity; Pituitary Diseases; Syndrome; Testosterone; Thyrotropin; Vasopressins

Topics: Heart Failure; Humans; Hyponatremia; Liver Cirrhosis; Myxedema; Pituitary Diseases; Radioimmunoassay; Vasopressins

Topics: Age Factors; Aldosterone; Desoxycorticosterone; Diuresis; Female; Fludrocortisone; Humans; Hyponatremia; Infant; Osmolar Concentration; Pituitary Diseases; Pituitary-Adrenal System; Renin; Seizures; Sodium Chloride; Vasopressins; Water Intoxication

Topics: Adrenocorticotropic Hormone; Adult; Female; Fluorometry; Growth Hormone; Humans; Hydrocortisone; Lysine; Male; Metyrapone; Pituitary Diseases; Pituitary Function Tests; Pituitary Hormones, Anterior; Radioimmunoassay; Thyrotropin; Vasopressins

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

Topics: Acid-Base Equilibrium; Blood Cell Count; Cortisone; Depression; Diabetes Insipidus; Diuresis; Electrocardiography; Heart Failure; Hemorrhage; Humans; Hypophysectomy; Kidney Diseases; Methods; Pituitary Diseases; Pituitary Neoplasms; Postoperative Care; Postoperative Complications; Posture; Preoperative Care; Sodium; Time Factors; 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: Aged; Carcinoma, Bronchogenic; Hormones, Ectopic; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Pituitary Diseases; Tuberculosis; Vasopressins

Topics: Adrenal Gland Diseases; Humans; Hypophysectomy; Hypothalamo-Hypophyseal System; Lysine; Pituitary Diseases; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Vasopressins

Topics: Aged; Chronic Disease; Dehydration; Female; Humans; Hydrochlorothiazide; Hypernatremia; Inflammation; Natriuresis; Pituitary Diseases; Pituitary Gland, Posterior; Sodium; Thirst; Vasopressins

Topics: Diuretics; Extracellular Space; Heart Diseases; Hepatitis; Homeostasis; Humans; Hypothalamo-Hypophyseal System; Pericarditis, Constrictive; Pituitary Diseases; Polyuria; Vasopressins

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Adult; Cushing Syndrome; Diagnosis, Differential; Female; Humans; Hydrocortisone; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary Gland; 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: 17-Hydroxycorticosteroids; Adolescent; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Blood Glucose; Child; Child, Preschool; Female; Growth Disorders; Growth Hormone; Humans; Hypoglycemia; Infant; Insulin; Male; Metyrapone; Obesity; Pituitary Diseases; Pituitary-Adrenal Function Tests; Psychosexual Development; Puberty; Puberty, Precocious; Urine; Vasopressins; Virilism

Topics: Acromegaly; Adrenal Glands; Adult; Aged; Cushing Syndrome; Female; Fever; Glucocorticoids; Growth Hormone; Humans; Hypothalamus; Insulin; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary Gland; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Humans; Male; Middle Aged; Natriuresis; Pituitary Diseases; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Humans; Hyponatremia; Male; Pituitary Diseases; Tuberculosis, Meningeal; Vasopressins; Water-Electrolyte Balance

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: Carcinoma, Bronchogenic; Endocrine System Diseases; Hormones, Ectopic; Humans; Hyponatremia; Infections; Lung Neoplasms; Male; Middle Aged; Myxedema; Pituitary Diseases; Porphyrias; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adolescent; Adult; Blood Glucose; Blood Pressure; Fatty Acids, Nonesterified; Female; Humans; Lipid Metabolism; Lysine; Male; Middle Aged; Pituitary Diseases; Pituitary Gland, Posterior; Tissue Extracts; Vasopressins

The insulin test carried out with adequate safeguards under standardized conditions yields valuable information regarding hypothalamic and pituitary function when plasma levels of sugar, cortisol, and growth hormone are determined. The use of a test based on the plasma cortisol response to the infusion of lysine-vasopressin, a polypeptide with a corticotrophin-releasing action, is also of value as a test of pituitary function. Used in conjunction with the insulin test it enables pituitary disorders to be differentiated from those involving the hypothalamus.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Blood; Child; Diagnosis, Differential; Endocrine System Diseases; Female; Growth Hormone; Humans; Hydrocortisone; Hypoglycemia; Hypothalamo-Hypophyseal System; Hypothalamus; Insulin; Lysine; Male; Pituitary Diseases; Pituitary Function Tests; Stress, Physiological; Urine; Vasopressins

Topics: Adrenal Glands; Adrenocorticotropic Hormone; Blood Pressure; Body Temperature; Body Weight; Child; Corticosterone; Pharmacology; Physiology; Pituitary Diseases; Pituitary Gland; Polysaccharides; Polysaccharides, Bacterial; Vasopressins

Topics: Adrenocorticotropic Hormone; Arginine Vasopressin; Avoidance Learning; Conditioning, Psychological; Corticosterone; Extinction, Psychological; Hypophysectomy; Melanocyte-Stimulating Hormones; Pharmacology; Phosphates; Physiology; Pituitary Diseases; Pituitary Gland; Pituitary Gland, Posterior; Rats; Research; Tannins; Vasopressins; Zinc

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Blood; Humans; Injections, Intramuscular; Pituitary Diseases; Pituitary Function Tests; Vasopressins

Topics: Adolescent; Adrenal Gland Diseases; Adrenocorticotropic Hormone; Adult; Blood; Female; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Insulin; Lysine; Male; Middle Aged; Pituitary Diseases; Pituitary Function Tests; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Adolescent; Bone Development; Child; Cortisone; Dwarfism; Dwarfism, Pituitary; Growth; Growth Hormone; Humans; Hypogonadism; Ketones; Metyrapone; Mineralocorticoid Receptor Antagonists; Pituitary Diseases; Pituitary-Adrenal Function Tests; Statistics as Topic; Thyroid Function Tests; Thyroid Hormones; Vasopressins

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Blood; Circadian Rhythm; Humans; Male; Periodicity; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Blood Chemical Analysis; Electricity; Estrogens; Gonadotropins; Hypothalamus; Pharmacology; Physiology; Pituitary Diseases; Pituitary Gland; Thyrotropin; Urine; Vasopressins

Topics: Animals; Aqueous Humor; Arginine Vasopressin; Pituitary Diseases; Pituitary Gland; Rabbits; Vasopressins

Topics: Aldosterone; Arginine Vasopressin; Cortisone; Electrolytes; Pituitary Diseases; Pituitary Gland; Potassium; Sodium; Vasopressins; Water

Topics: Adrenocorticotropic Hormone; Arginine Vasopressin; Glucagon; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Arginine Vasopressin; Body Fluids; Cortisone; Desoxycorticosterone; Pituitary Diseases; Pituitary Gland, Anterior; Pituitary Gland, Posterior; Potassium; Sodium; Vasopressins; Water; Water-Electrolyte Balance

Topics: Arginine Vasopressin; Humans; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Adrenal Glands; Animals; Arginine Vasopressin; Pituitary Diseases; Pituitary Gland; Rats; Vasopressins

Topics: Adrenocorticotropic Hormone; Arginine; Arginine Vasopressin; In Vitro Techniques; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Diuresis; Diuretics; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Animals; Pituitary Diseases; Pituitary Gland; Rats; Sodium; Sodium Chloride; Sodium Radioisotopes; Vasopressins

Topics: Humans; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Humans; Liver; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Animals; Dipodomys; Diuresis; Diuretics; Pituitary Diseases; Pituitary Gland; Urine; Vasopressins

Topics: Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Vasopressins

Topics: Liver; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Pituitary Hormones, Posterior; Vasopressins

Topics: Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Vasopressins

Topics: Adrenal Glands; Animals; Desoxycorticosterone; Dogs; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Potassium; Sodium; Tissue Extracts; Vasopressins; Water

Topics: Female; Humans; Labor, Obstetric; Oxytocics; Oxytocin; Pharmaceutical Preparations; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Pregnancy; Uterus; Vasopressins

Topics: Animals; Dogs; Morphine; Pituitary Diseases; Pituitary Gland; Vasopressins

Topics: Androgens; Atropine; Cardiovascular Diseases; Heart; Infarction; Myocardial Infarction; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Testosterone; Vasopressins

Topics: Blood Pressure; Hypertension; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Vasopressins