pituitrin and Sarcoidosis

A 59 year old man presenting fever, serum hyponatremia and hypoosmolality in association with hyperosmotic urine was hospitalized in our unit in February 1988. We demonstrated evidence of systemic sarcoidosis and inappropriate secretion of antidiuretic hormone (ADH). The patient was treated with corticosteroid therapy for a period of about 1 year, with regression of signs of the inappropriate vasopressin secretion as well as the symptomatology related to systemic sarcoidosis. This study identified systemic sarcoidosis as a definite cause of "syndrome of inappropriate ADH secretion".

Topics: Arginine Vasopressin; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Prednisone; Radioimmunoassay; Sarcoidosis; Vasopressins

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

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

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

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

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

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

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

Topics: Biopsy; Black People; Chlorothiazide; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diagnosis, Differential; Humans; Hypercalcemia; Hypertonic Solutions; Kidney Diseases; Pathology; Prednisone; Sarcoidosis; Skin Tests; Vasopressins

Topics: Alcoholic Intoxication; Calcium Metabolism Disorders; Child; Diabetes Insipidus; Diagnosis; Diuresis; Genetics, Medical; Histiocytosis, Langerhans-Cell; Humans; Kidney Diseases; Measles; Polyuria; Prednisone; Psychosomatic Medicine; Sarcoidosis; Syndrome; Thirst; Toxicology; Urine; Vasopressins; Whooping Cough