pituitrin and Syndrome

Diabetes insipidus (DI), be it from central or nephrogenic origin, must be differentiated from secondary forms of hypotonic polyuria such as primary polydipsia. Differentiation is crucial since wrong treatment can have deleterious consequences. Since decades, the gold standard for differentiation has been the water deprivation test, which has limitations leading to an overall unsatisfying diagnostic accuracy. Furthermore, it is cumbersome for patients with a long test duration. Clinical signs and symptoms and MRI characteristics overlap between patients with DI and primary polydipsia. The direct test including vasopressin (AVP) measurement upon osmotic stimulation was meant to overcome these limitations, but failed to enter clinical practice mainly due to technical constraints of the AVP assay. Copeptin is secreted in equimolar amount to AVP but can easily be measured with a sandwich immunoassay. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation and has led to a 'revival' of the direct test in the differential diagnosis of DI. We have shown that a baseline copeptin, without prior thirsting, unequivocally identifies patients with nephrogenic DI. In contrast, for the differentiation between central DI and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is superior to the water deprivation test. Close sodium monitoring during the test is a prerequisite. Further new test methods are currently evaluated and might provide an even simpler way of differential diagnosis in the future.

Topics: Awards and Prizes; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Glycopeptides; Humans; Polydipsia; Polyuria; Saline Solution, Hypertonic; Syndrome; Vasopressins

Cardiac surgery with cardiopulmonary bypass is associated with systemic inflammatory response. In some cases this clinical condition is characterized by severe hypotension due to low systemic vascular resistance during and after cardiopulmonary bypass. A few of these cases do not respond to volume or catecholamines. This condition is known as vasoplegic syndrome. Its etiology is not fully understood today and carries associated morbidity and mortality In this syndrome, vasopressin levels are reduced, as in septic and hypovolemic shock. Supplementary vasopressin improves blood pressure and might be considered as an alternative treatment. Several reports have shown benefits when used alone or in combination with catecholamines. However, further studies are necessary to find the most appropriate use of the drug for vasoplegic syndrome.

Topics: Cardiac Surgical Procedures; Cardiopulmonary Bypass; Humans; Postoperative Complications; Risk Factors; Syndrome; Vasoconstrictor Agents; Vasoplegia; Vasopressins

Hyponatremia, defined by a serum sodium concentration of less than 135 mmmol/l, is a complex clinical occurrence frequently manifested in newborns admitted to the neonatal intensive care unit. The pathogenetic mechanisms and clinical timing underlying the onset of hyponatremia have not been well established in the newborn. Aim of this review is to present a practical approach and management of hypotonic hyponatremia in newborns, with particular emphasis on nephrogenic syndrome of inappropriate antidiuresis, recently described by us for the first time in the literature in a newborn.

Topics: Administration, Oral; Diabetes Insipidus, Nephrogenic; Female; Fluid Therapy; Humans; Hyponatremia; Hypoxia-Ischemia, Brain; Inappropriate ADH Syndrome; Infant; Infant, Newborn; Male; Neurophysins; Polymorphism, Single Nucleotide; Protein Precursors; Syndrome; Urea; Vasopressins

In the kidney, the fine control of NaCl absorption takes place in the distal nephron and is controlled by aldosterone and vasopressin. This review summarizes the effects of vasopressin on Na+ transport mediated by the amiloride-sensitive epithelial sodium channel (ENaC) and the cystic fibrosis transmembrane conductance regulator (CFTR) Cl- channel in immortalized or primary cultured cortical collecting duct cells, expressing either the wild-type ENaC subunits, or mutations, or deletions of the PY domain of the beta- or gamma-ENaC subunits responsible for Liddle's syndrome, an inherited form of hypertension due to excessive salt absorption.

Topics: Absorption; Aldosterone; Amiloride; Animals; Cells, Cultured; Chlorides; Cystic Fibrosis Transmembrane Conductance Regulator; Deamino Arginine Vasopressin; Epithelial Sodium Channels; Humans; Hypertension; Ion Transport; Kidney Tubules, Collecting; Mice; Mice, Mutant Strains; Models, Biological; Natriuresis; Oocytes; Protein Subunits; Recombinant Fusion Proteins; Sodium Channels; Sodium Chloride; Syndrome; Vasopressins; Water-Electrolyte Balance; Xenopus laevis

Topics: Humans; Muscle, Smooth, Vascular; Shock; Syndrome; Vasoconstrictor Agents; Vasodilation; Vasopressins

Osmotic demyelination of the brain (ODS) is a dreaded complication that typically occurs several days after aggressive therapy for chronic hyponatraemia, but is eminently avoidable. In this teaching exercise, Professor McCance, an imaginary consultant, is asked to explain how he would have treated a 28-year-old female who had hyperkalaemia, hypoglycaemia, hypotension and hyponatraemia (118 mM) to prevent the development of ODS. He begins with a review of the physiology, including his own landmark work on chronic hyponatraemia associated with a contracted extracellular fluid volume. Adding quantitative analysis, the cause of the excessive rise in plasma sodium concentration is revealed, and a better plan for therapy is proposed.

Topics: Addison Disease; Adult; Brain Diseases; Demyelinating Diseases; Female; Humans; Hyperkalemia; Hypoglycemia; Hyponatremia; Hypotension; Renal Agents; Syndrome; Vasopressins; Water-Electrolyte Imbalance

Patients who drink more electrolyte-free water than they can excrete may develop hyponatremia. A subgroup of hyponatremic patients has a reduced excretion of electrolyte-free water and a low rate of excretion of solutes even though vasopressin is not detected in their plasma. Basal water permeability in the distal nephron, by permitting a limited volume of electrolyte-free water to be reabsorbed, offers a way to help explain these findings. Basal water permeability will also be considered from the perspective of integrative physiology in evolutionary and developmental biology settings. Its possible clinical importance will be explored in patients with chronic hyponatremia who have a low distal volume delivery. These patients may develop osmotic demyelination if a large solute load leads to a very rapid excretion of electrolyte-free water.

Topics: Capillary Permeability; Humans; Hyponatremia; Inappropriate ADH Syndrome; Kidney Tubules, Collecting; Nephrons; Syndrome; Vasopressins; Water-Electrolyte Balance

Hyponatremia in virtually all patients results from water retention due to an inability to excrete ingested water. In most cases, this defect represents the persistent secretion of ADH (such as in effective circulating volume depletion, and in the syndrome of inappropriate ADH secretion), although free water excretion can also be limited in disorders in which ADH levels may be appropriately suppressed (such as in advanced renal failure, and in primary polydipsia). The symptoms of hyponatremia primarily reflect neurologic dysfunction induced by cerebral edema and are related both to the severity and to the rapidity of reductions in the plasma sodium concentration. The degree of cerebral edema which occurs in acute hyponatremia is much less with chronic hyponatremia, because the brain cells lose solutes, leading to the osmotic movement of water out the cells and less brain swelling. In general, hyponatremia is corrected acutely by giving Na+ to patients who are volume-depleted and by restricting water intake in patients who are normovolemic or edematous. The optimal rate of correction should be defined to prevent the risk of central demyelinating lesions.

Topics: Adrenal Insufficiency; Adult; Brain Edema; Edema; Female; Humans; Hyponatremia; Hypothyroidism; Inappropriate ADH Syndrome; Kidney Failure, Chronic; Models, Biological; Osmolar Concentration; Potassium; Pregnancy; Syndrome; Vasopressins

Intracellular dehydration is the major risk in case of a polyuropolydipsic syndrome. Excepting osmotic polyuria, prognosis depends on a possibly progressive functional anomaly of the hypothalamopituitary axis.. Polyuropolydipsia occurs when antidiuretic hormone (ADH) secretion is absent (central diabetes insipidis), the kidney does not respond to ADH (nephrogenic diabetes insipidus) or in case of physiological inhibition of ADH secretion (primary polydipsia).. Dynamic explorations are associated with radioimmunoassay of ADH. They are particularly useful in case of atypical diabetes insipidus and include the water restriction test and a study of the sensitivity to exogenous ADH (dDAVP). The results orient the etiologic diagnosis and allow an evaluation of the fluid intake required as a function of the maximal concentrating capacity of the kidneys.. Treatment is based on ADH analogs (dDAVP). The aim is to obtain a constant antidiuretic effect without hyponatremia or escape. In case of partial central diabetes insipidus, a non-hormone treatment using compounds which increase vasopressin release or its effect on the kidney can be proposed.

Topics: Diagnosis, Differential; Drinking; Humans; Osmolar Concentration; Polyuria; Syndrome; Thirst; Vasopressins

Topics: Alabama; Alkalosis; Animals; Arginine Vasopressin; Awards and Prizes; Desoxycorticosterone; Drug Synergism; Female; History, 20th Century; Homeostasis; Humans; Hypertension; Hypokalemia; Kidney Tubules, Collecting; Kidney Tubules, Proximal; Male; Mice; Natriuretic Agents; Nephrology; New York; Potassium; Rabbits; Rats; Signal Transduction; Societies, Medical; Sodium; Sodium-Potassium-Exchanging ATPase; Species Specificity; Syndrome; Vasopressins; Water-Electrolyte Balance

Topics: Adrenocorticotropic Hormone; Diabetes Mellitus; Dose-Response Relationship, Drug; Drug Resistance; Endocrine System Diseases; Gonadotropins; Hormones; Humans; Insulin Resistance; Neuromuscular Diseases; Obesity; Parathyroid Hormone; Receptor, Insulin; Receptors, Cell Surface; Syndrome; Thyrotropin; Vasopressins

Topics: Humans; Osmolar Concentration; Syndrome; Vasopressins; Water-Electrolyte Imbalance

Topics: Adrenocorticotropic Hormone; APUD Cells; Calcitonin; Carcinoma, Small Cell; Hormones, Ectopic; Humans; Lung Neoplasms; Syndrome; Vasopressins

Topics: Contraceptives, Oral; Diabetes Insipidus; Diethylstilbestrol; Estrogens; Female; Humans; Kinetics; Male; Neurophysins; Nicotine; Osmolar Concentration; Oxytocin; Posture; Smoking; Surgical Procedures, Operative; Syndrome; Vasopressins

Topics: Arginine Vasopressin; Biological Assay; Diabetes Insipidus; Humans; Oxytocin; Pituitary Gland, Posterior; Radioimmunoassay; Syndrome; Vasopressins; Water Deprivation

SIADH consists of hyponatremia and hyposmolality, continued urinary loss of sodium, excretion of an inappropriately concentrated urine, and absence of dehydration, usually in the presence of normal renal and adrenal function. The retention of excess water caused by the inappropriate secretion of antidiuretic hormone is central to the development of the syndrome. In pediatrics, SIADH is most commonly seen in patients with meningitis or postoperatively. Fluid restriction is vital in such patients to prevent the development of symptomatic SIADH. Fluid restriction alone will also result in the correction of serum electrolyte composition in patients with SIADH. Hypertonic saline should be used only in severely symptomatic patients.

Topics: Adult; Aldosterone; Blood Volume; Child; Diuresis; Drinking; Ethanol; Humans; Hyponatremia; Kidney Concentrating Ability; Kidney Tubules, Distal; Kidney Tubules, Proximal; Lithium; Osmolar Concentration; Saline Solution, Hypertonic; Sodium; Syndrome; Vasopressins; Water Intoxication; Water-Electrolyte Imbalance

Topics: Adrenocortical Hyperfunction; Adult; Carcinoid Heart Disease; Cushing Syndrome; Endocrine System Diseases; Gynecomastia; Humans; Hypercalcemia; Hyperparathyroidism; Hyperthyroidism; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Osteoarthropathy, Secondary Hypertrophic; Syndrome; Vasopressins

Topics: Humans; Hyponatremia; Syndrome; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Alkalosis, Respiratory; Anaphylaxis; Animals; Cardiovascular Diseases; Collagen Diseases; Gastrointestinal Diseases; Gonadotropins; Hematologic Diseases; Hormones, Ectopic; Humans; Hypoxia; In Vitro Techniques; Infant, Newborn; Lung; Lung Diseases; Lung Neoplasms; Microscopy, Electron; Neuromuscular Diseases; Neurotransmitter Agents; Paraneoplastic Endocrine Syndromes; Pulmonary Edema; Pulmonary Embolism; Pulmonary Emphysema; Rats; Respiratory Distress Syndrome, Newborn; Skin Diseases; Syndrome; Vasopressins

Topics: Adolescent; Bronchial Neoplasms; Carcinoma, Small Cell; Child, Preschool; Cushing Syndrome; Diagnosis, Differential; Hormones, Ectopic; Humans; Hyperaldosteronism; Hypercalcemia; Hyperparathyroidism; Hyponatremia; Kidney Neoplasms; Paraneoplastic Endocrine Syndromes; Renin; Sodium Chloride; Syndrome; Vasopressins

Topics: Carcinoma, Small Cell; Central Nervous System Diseases; Endocrine System Diseases; Hormones, Ectopic; Humans; Hyponatremia; Kidney; Lung Diseases; Lung Neoplasms; Osmolar Concentration; Paraneoplastic Endocrine Syndromes; Syndrome; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Acute Kidney Injury; Animals; Blood; Cardiac Glycosides; Dehydration; Diuretics; Glomerular Filtration Rate; Heart Failure; Hyponatremia; Kidney Failure, Chronic; Liver Cirrhosis; Mineralocorticoid Receptor Antagonists; Nephrotic Syndrome; Sodium; Syndrome; Vasopressins; Water

Topics: Birth Weight; Body Fluids; Edema; Estrogens; Humans; Hypoproteinemia; Infant, Newborn; Infant, Premature, Diseases; Sclerema Neonatorum; Syndrome; Vasopressins; Water-Electrolyte Balance

Topics: 5-Hydroxytryptophan; Acanthosis Nigricans; Carcinoid Tumor; Carotid Body Tumor; Catecholamines; Cushing Syndrome; Dermatomyositis; Endocrine System Diseases; Gynecomastia; Hormones, Ectopic; Humans; Hypercalcemia; Hyperthyroidism; Hypoglycemia; Hyponatremia; Neoplasms; Neuromuscular Diseases; Osteoarthropathy, Secondary Hypertrophic; Peripheral Nervous System Diseases; Polycythemia; Puberty, Precocious; Syndrome; Toxins, Biological; Vascular Diseases; Vasopressins; Zollinger-Ellison Syndrome

Topics: Adrenal Insufficiency; Carcinoma, Bronchogenic; Diagnosis, Differential; Hormones, Ectopic; Humans; Hyponatremia; Lung Neoplasms; Neurologic Manifestations; Phenytoin; Syndrome; Vasopressins

Topics: Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Breast Diseases; Endocrine System Diseases; Gynecomastia; Humans; Lung Diseases; Lung Neoplasms; Male; Neoplasms; Syndrome; Vasopressins

To investigate the hypotheses that activated coagulation, catecholamine release, or arginine vasopressin release are involved in the pathogenesis of high-altitude pulmonary edema (HAPE), we measured these variables in seven subjects susceptible to HAPE and in nine control subjects at an altitude of 1,600 m, and after 6 and 12 h at a simulated altitude of 4,150 m. Each subject was studied twice, once after 3 days of placebo medication and once after 3 days of premedication with aspirin and dipyridamole. At high altitude, HAPE-susceptible subjects showed significantly exaggerated hypoxemia and a slightly higher end-tidal carbon dioxide partial pressure that did not account fully for the hypoxemia. Fibrinolytic activity was significantly accelerated in both groups at high altitude, whereas other coagulation measurements, catecholamines and arginine vasopressin levels, and pulmonary function tests were not significantly changed. Similar findings were obtained after both placebo and platelet-inhibitor premedication. The results indicate that none of the three hypothesized mechanisms, i.e., activated coagulation, excessive catecholamine release, or antidiuresis, would account for HAPE susceptibility. Instead, HAPE-susceptible subjects exhibited exaggerated hypoxemia associated with relative hypoventilation and a widened alveolar-arterial gas pressure difference.

Topics: Adolescent; Altitude; Aspirin; Blood Coagulation; Child; Dipyridamole; Fibrinolysis; Humans; Oxygen; Oxyhemoglobins; Pulmonary Edema; Respiration; Syndrome; Vasopressins

Topics: Herpes Zoster; Humans; Pain; Syndrome; Trigeminal Nerve; Vasopressins

The water deprivation test (WDT) is widely used for the differential diagnosis of the polyuria-polydipsia syndrome (PPS). However, it is inconvenient and may not always be precise in differentiating partial forms of diabetes insipidus (DI) from primary polydipsia (PP). The aim of this study was to evaluate the results of a combined outpatient and inpatient overnight WDT protocol that included an overnight unsupervised period concerning its feasibility and safety.. We performed a retrospective analysis of clinical data and laboratory results of 52 patients with PPS undergoing WDT at a single center.. PP was the most frequent diagnosis, followed by complete central DI (cCDI), partial central DI (pCDI), and nephrogenic DI (NDI). Over 90% of the patients showed an expected increase in serum osmolality at the end of the dehydration period. There were no reports of complications during the overnight deprivation period. Post-dehydration urine osmolality and urine-to-serum osmolality ratio significantly differentiated all the groups ( P<.05), except for cCDI and NDI, which could be differentiated by basal and post-dehydration vasopressin (AVP) levels ( P<.05 for both). Although these measurements were useful for differentiating patients according to their allocation groups, results from WDT and direct AVP levels may often require a comprehensive diagnostic approach, particularly in the challenging groups of PP and pCDI.. A combined outpatient and inpatient overnight WDT protocol is safe and feasible when the test is performed with special care at experienced centers. Newer diagnostic tools are expected to improve the accuracy of PPS diagnosis.. AQP2 = aquaporin-2; AVP = vasopressin; CDI = central diabetes insipidus; cCDI = complete central diabetes insipidus; DDAVP = desmopressin; DI = diabetes insipidus; IQR = interquartile range; MRI = magnetic resonance imaging; Na

Topics: Adolescent; Adult; Aged; Ambulatory Care; Child; Diabetes Insipidus, Nephrogenic; Diabetes Insipidus, Neurogenic; Female; Hospitalization; Humans; Male; Middle Aged; Neurophysins; Osmolar Concentration; Polydipsia; Polydipsia, Psychogenic; Polyuria; Protein Precursors; Retrospective Studies; Syndrome; Vasopressins; Water Deprivation; Young Adult

Diabetes insipidus (DI) and primary polydipsia (PP) are characterised by polyuria and polydipsia. It is crucial to differentiate between these two disorders since the treatment is different. The aim of this study was to evaluate the diagnostic value of the short and an extended variant of the water deprivation test (WDT) and of measuring urinary vasopressin (AVP) in patients with polyuria and polydipsia.. A retrospective, single-centre study based on WDTs performed between 2004 and 2014 including 104 consecutive patients with the polyuria-polydipsia syndrome. During a strict water deprivation, weight, urinary osmolality, urinary vasopressin and specific gravity were collected until one of the following was reached: i) >3% weight reduction, ii) Urinary specific gravity >1.020 or, urinary osmolality >800 mOsm/L, iii) Intolerable adverse symptoms such as excessive thirst.. Out of 104 patients (67 women, 37 men), 21 (20%) were diagnosed with DI and 83 (80%) with PP. The median (interquartile range; range) test duration was 14 hours (10-16; 3-36) in patients with DI and 18 hours (14-24; 7-48) in patients with PP (P=0.011). Of those diagnosed with PP, 22 (26%) did not reach urinary specific gravity >1.020 nor urine osmolality >800 mOsm/L. Urine AVP did not overlap between patients with PP and patients with central DI.. The short WDT is of limited value in the diagnostic work-up of polydipsia and polyuria and a partial DI may have been missed in every fourth patient diagnosed with PP. Urinary AVP has excellent potential in discriminating PP from central DI.

Topics: Adult; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Neurophysins; Polydipsia; Polydipsia, Psychogenic; Polyuria; Predictive Value of Tests; Protein Precursors; Retrospective Studies; Syndrome; Vasopressins; Water Deprivation

Bone cement implantation syndrome (BCIS) is a well-known entity but is poorly understood and rarely reported. It is an important cause of perioperative morbidity and mortality in the patient undergoing cemented hip arthroplasty. BCIS is characterized by hypotension, hypoxia, cardiac arrhythmias, and increased pulmonary vascular resistance and can lead to eventual cardiac arrest if not managed properly. We hereby report a case of delayed presentation of BCIS following cemented right hip arthroplasty.

Topics: Adrenergic alpha-Agonists; Aged, 80 and over; Arthroplasty, Replacement, Hip; Bone Cements; Diagnosis, Differential; Epinephrine; Female; Humans; Hypotension; Norepinephrine; Postoperative Complications; Syndrome; Vasopressins; Ventricular Outflow Obstruction

Topics: Aged, 80 and over; Autoantibodies; Diagnosis, Differential; Edema; Humans; Male; Multiple Myeloma; Syndrome; Synovitis; Vasopressins

The Asian variant of intravascular large B cell lymphoma is a special type of intravascular lymphoma with hemophagocytic syndrome and hypercytokinemia including interleukin-6, which stimulates antidiuretic hormone synthesis in the hypothalamus. We present here that the syndrome of inappropriate antidiuretic hormone secretion frequently occurs in patients with the Asian variant of intravascular large B cell lymphoma. The syndrome of inappropriate antidiuretic hormone secretion was found in eight of 118 (6.8%) lymphoma patients at the first diagnosis. Although there were six (5.1%) among 118 lymphoma patients with the Asian variant of intravascular large B cell lymphoma, four of the six patients (66.7%) developed the syndrome of inappropriate antidiuretic hormone secretion. In four patients with the Asian variant of intravascular large B cell lymphoma with the syndrome of inappropriate antidiuretic hormone secretion, elevated serum interleukin-6 and low sodium levels were almost normalized after chemotherapy. The Asian variant of intravascular large B cell lymphoma patients frequently develop the syndrome of inappropriate antidiuretic hormone secretion, and interleukin-6 might play a role in the occurrence of this disease. We should pay attention to hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion in patients with the Asian variant of intravascular large B cell lymphoma.

Topics: Adult; Aged; Aged, 80 and over; Asia; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Interleukin-6; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Sodium; Syndrome; Vasopressins; Young Adult

Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. A 36-year-old man with SAH was admitted to our ICU. His urine volume increased excessively 3 days after ICU admission, and it reached a peak (39,250 ml x day(-1)) on the 6th day in ICU. Since infusion volume was controlled with regard to daily urinary output, hyponatremia was not noticeable and excessive urine volume stood out conspicuously. Though vasopressin and desmopressin were administered, the symptoms of natriuresis and hyponatremia were aggravated, associated with hyper secretion of natriuretic peptides (ANP 160 pg x dl(-1), BNP 172 pg x dl(-1)). Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.

Topics: Adult; Animals; Atrial Natriuretic Factor; Brain Diseases; Contraindications; Humans; Hyponatremia; Hypovolemia; Male; Natriuresis; Rats; Subarachnoid Hemorrhage; Syndrome; Urination Disorders; Vasopressins

Liddle's syndrome is a genetic form of hypertension linked to Na(+) retention caused by activating mutations in the COOH terminus of the beta or gamma subunit of the epithelial sodium channel (ENaC). In this study, we used the short-circuit current (I(sc)) method to investigate the effects of deamino-8-d-arginine vasopressin (dDAVP) on Na(+) and Cl(-) fluxes in primary cultures of cortical collecting ducts (CCDs) microdissected from the kidneys of mice with Liddle's syndrome carrying a stop codon mutation, corresponding to the beta-ENaC R(566) stop mutation (L) found in the original pedigree. Compared to wild-type (+/+) CCD cells, untreated L/+ and L/L CCD cells exhibited 2.7- and 4.2-fold increases, respectively, in amiloride-sensitive (Ams) I(sc), reflecting ENaC-dependent Na(+) absorption. Short-term incubation with dDAVP caused a rapid and significant increase (approximately 2-fold) in Ams I(sc) in +/+, but not in L/+ or L/L CCD cells. In sharp contrast, dDAVP induced a greater increase in 5-nitro-2-(3-phenylpropamino)benzoate (NPPB)-inhibited apical Cl(-) currents in amiloride-treated L/L and L/+ cells than in their +/+ counterparts. I(sc) recordings performed under apical ion substituted conditions revealed that the dDAVP-stimulated apical secretion of Cl(-), which was absent in cultured CCDs lacking CFTR, was 1.8-fold greater in L/+ and 3.7-fold greater in L/L CCD cells than in their +/+ CCD counterparts. After the basal membrane had been permeabilized with nystatin and a basal-to-apical Cl(-) gradient had been imposed, dDAVP also stimulated larger Cl(-) currents across L/L and L/+ CCD layers than +/+ CCD layers. These findings demonstrate that vasopressin stimulates greater apical CFTR Cl(-) conductance in the renal CCD cells of mice with Liddle's syndrome than in wild-type mice. This effect could contribute to the enhanced NaCl reabsorption observed in the distal nephron of patients with Liddle's syndrome.

Topics: Animals; Cells, Cultured; Chloride Channel Agonists; Chloride Channels; Chlorides; Codon; Cystic Fibrosis Transmembrane Conductance Regulator; Deamino Arginine Vasopressin; Electrophysiology; Epithelial Sodium Channels; Hypertension; Kidney Tubules, Collecting; Mice; Mice, Knockout; Nephrons; Nystatin; Organ Culture Techniques; Phenotype; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Sodium; Sodium Channels; Syndrome; Vasopressins

Adipsic hypernatraemia is an uncommon disorder in childhood caused by a defect in the osmoregulation of thirst, leading to impairment of water homeostasis and chronic hyperosmolality of body fluids. Adipsia is often associated with an abnormality in osmoregulated vasopressin secretion due to the close proximity of the hypothalamic osmoreceptors that control thirst with those regulating vasopressin secretion. Hypothalamic lesions of diverse aetiology (vascular abnormalities, neoplasms, granulomatous diseases, trauma etc.) have been described in this syndrome. We report a 12-year-old boy with evident weight loss due to hypernatraemic dehydration with a selective defect in osmoregulation of thirst and normal vasopressin secretion with no demonstrable structural lesion. To date, only six paediatric patients with this condition have been described in the literature.. Hypothalamic adipsic hypernatraemia syndrome must be suspected when a dehydrated patient denies thirst. The study of antidiuretic function is necessary because the osmoregulation of vasopressin secretion could be altered.

Topics: Brain; Child; Dehydration; Drinking; Humans; Hypernatremia; Hypothalamic Diseases; Magnetic Resonance Imaging; Male; Prognosis; Syndrome; Vasopressins; Water-Electrolyte Balance

We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). The failure of norepinephrine to improve the patient's hemodynamics prompted us to start treatment with vasopressin; within 30 minutes, the hemodynamics began to improve. After 12 hours, the patient was stable enough to be weaned from the vasopressin. He was discharged from the hospital on the 10th postoperative day. To our knowledge, ours is the 1st report of vasopressin use for vasodilatory shock after OPCAB in the English-language medical literature. Herein, we discuss the pathophysiology and management of vasoplegic syndrome--which is controversial--with special emphasis on the use of vasopressin in this situation.

Topics: Aged; Blood Pressure; Cardiac Output, High; Coronary Artery Bypass, Off-Pump; Humans; Hypotension; Male; Syndrome; Tachycardia; Vascular Resistance; Vasoconstrictor Agents; Vasopressins

Liddle's syndrome is a monogenic form of hypertension caused by mutations in the PY motif of the COOH terminus of beta- and gamma-epithelial Na+ channel (ENaC) subunits. These mutations lead to retention of active channels at the cell surface. Because of the critical role of this PY motif in the stability of ENaCs at the cell surface, we have investigated its contribution to the ENaC response to aldosterone and vasopressin. Mutants of the PY motif in beta- and gamma-ENaC subunits (beta-Y618A, beta-P616L, beta-R564stop, and gamma-K570stop) were stably expressed by retroviral gene transfer in a renal cortical collecting duct cell line (mpkCCDcl4), and transepithelial Na+ transport was assessed by measurements of the benzamil-sensitive short-circuit current (Isc). Cells that express ENaC mutants of the PY motif showed a five- to sixfold higher basal Isc compared with control cells and responded to stimulation by aldosterone (10(-6) M) or vasopressin (10(-9) M) with a further increase in Isc. The rates of the initial increases in Isc after aldosterone or vasopressin stimulation were comparable in cells transduced with wild-type and mutant ENaCs, but reversal of the effects of aldosterone and vasopressin was slower in cells that expressed the ENaC mutants. The conserved sensitivity of ENaC mutants to stimulation by aldosterone and vasopressin together with the prolonged activity at the cell surface likely contribute to the increased Na+ absorption in the distal nephron of patients with Liddle's syndrome.

Topics: Aldosterone; Amiloride; Animals; Cell Line; Electric Conductivity; Epithelial Cells; Gene Expression; Humans; Hypertension; Mice; Mutation; Sodium Channels; Syndrome; Vasopressins

Topics: Anti-Inflammatory Agents; Child, Preschool; Familial Mediterranean Fever; Humans; Hydrocortisone; Hypergammaglobulinemia; Immunoglobulin D; Male; Syndrome; Vasopressins

To determine whether intraprostatic vasopressin (IPVP) prevents the transurethral resection (TUR) syndrome during prostatectomy.. The study comprised 36 consecutive patients (mean age 68 years) with prostates clinically assessed as >/= 20 g who underwent standard transurethral prostatectomy (TURP). Ten units of vasopressin in 0.5 mL were diluted with 9.5 mL isotonic saline and injected into the prostate transrectally before TURP. Blood samples were taken before and immediately after TURP to measure serum sodium concentration and free haemoglobin levels. The TURP irrigant used was cooled, boiled water maintained at 70-80 cmH2O pressure during resection. Twenty patients had alcohol added to the irrigant and their breath alcohol assessed at 10-min intervals during TURP. All patients had their pulse rate, blood pressure and sensorium monitored continuously. Extreme care was taken to avoid and/or identify capsular damage during resection.. The mean weight of tissue resected was 36 g and the mean resection time 24 min. There was no significant change in clinical variables during TURP. In 19 patients the breath alcohol changes were insignificant. Changes in free haemoglobin were not significant, but the levels decreased after TURP in four patients, caused by the dilution consequent on the infusion of 800-1000 mL isotonic saline during surgery. Serum sodium concentrations showed only insignificant decreases, except in one patient whose breath alcohol suggested the absorption of 500 mL of irrigant. This patient's serum sodium concentration decreased by 9 mmol/L; 1 L of 5% dextrose was infused during the procedure and capsular damage was recognized early during TURP.. Insignificant volumes of irrigant entered the circulation of the patients during TURP with water irrigation and IPVP. The greatest risk factor for fluid entry during TURP is capsular damage. IPVP decreases bleeding and therefore improves visibility, so allowing the early identification of capsular damage. IPVP seems therefore to be of help during TURP by decreasing bleeding and allowing insignificant volumes of irrigant to enter the vasoconstricted vessels; it appears to prevent the TUR syndrome.

Topics: Aged; Aged, 80 and over; Blood Volume; Humans; Male; Middle Aged; Prospective Studies; Prostatic Diseases; Syndrome; Therapeutic Irrigation; Transurethral Resection of Prostate; Vasoconstrictor Agents; Vasopressins

Topics: Child; Craniopharyngioma; Craniotomy; Dehydration; Diagnosis, Differential; Female; Humans; Hypernatremia; Hypothalamic Diseases; Pituitary Neoplasms; Syndrome; 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

Hyponatremia is commonly seen in patients with severe and moderate head injury, but it is rarely reported in those with mild head injury. The authors report a patient with mild head injury who presented with data typical of inappropriate secretion of antidiuretic hormone (SIADH), but showed no clinical deterioration. Though the clinical significance of this condition is unclear, the true incidence of this pathology might well be found to be higher than expected, should it receive more clinical and/or serological attention. Continuing clinical assessment will be needed to determine the significance of this condition in relation to that in patients with SIADH following the various causes reported previously.

Topics: Aged; Craniocerebral Trauma; Female; Humans; Hyponatremia; Syndrome; Vasopressins

Gitelman disease was diagnosed in two unrelated children with hypokalemic metabolic alkalosis and growth failure (a boy and a girl aged 7 mo and 9.5 y, respectively, at clinical presentation) on the basis of mutations detected in the gene encoding the thiazide-sensitive NaCl cotransporter of the distal convoluted tubule. GH deficiency was demonstrated by specific diagnostic tests in both children. Hypertonic saline infusion tests showed a partial vasopressin deficiency in the girl and delayed secretion of this hormone in the boy. Magnetic resonance imaging revealed an empty sella in both cases. Up to now, hypomagnesemia and hypocalciuria have been considered obligatory criteria for the diagnosis of Gitelman disease; however, our two patients had hypomagnesemia and hypocalciuria in less than half the determinations. GH replacement treatment was associated with a good clinical response in both children. It appears that these cases represent a new phenotype, not previously described in Gitelman disease, and that the entity may be considered a new complex hereditary renal tubular-pituitary syndrome.

Topics: Bartter Syndrome; Carrier Proteins; Child; Empty Sella Syndrome; Female; Human Growth Hormone; Humans; Kidney Tubules; Male; Pituitary Gland; Sodium-Potassium-Chloride Symporters; Syndrome; Vasopressins

We report the first case of the syndrome of periodic adrenocorticotropin (ACTH) and vasopressin (ADH) discharge associated with focal glomerulosclerosis. Approximately 30 cases of this syndrome have so far been reported in Japan, but no cases associated with renal dysfunction have yet been reported. The patient, a 10-year-old Japanese boy, was referred to our hospital because of recurrent attacks of vomiting. He was diagnosed as having this syndrome from clinical and laboratory findings. While various drugs were tried to manage his vomiting attacks, only valproic acid appeared to be effective in reducing the frequency of the attacks. Chronic nephritis was manifested when the patient was 12 years old, which required treatment with continuous ambulatory peritoneal dialysis. Valproic acid was proved to be effective in reducing the number of attacks over 4 months.

Topics: Adrenocorticotropic Hormone; Child; Glomerulosclerosis, Focal Segmental; Humans; Kidney Failure, Chronic; Male; Periodicity; Recurrence; Syndrome; Valproic Acid; Vasopressins; Vomiting

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

The effect of dextroamphetamine sulfate (Dexedrine) on plasma opioid peptides, hormones, and other metabolites was studied in eight female subjects with idiopathic (orthostatic) edema and five healthy females. All subjects were given 20 mg of dextroamphetamine sulfate, a drug widely used in the treatment of this disorder, and blood samples were collected before and 30, 60, and 90 minutes after treatment. Patients with idiopathic (orthostatic) edema had significantly lower plasma sodium levels but higher blood urea nitrogen, aldosterone, and renin levels. D-amphetamine decreased aldosterone and renin levels in both groups. Plasma adrenocorticotropin levels were lower whereas met-enkephalin levels were higher in idiopathic (orthostatic) edema subjects compared to control subjects. D-amphetamine had no significant effect on plasma beta-endorphin, adrenocorticotrophic hormone, or enkephalins. Our data indicate that opioid peptides, especially enkephalins, and adrenocorticotrophic hormone may be involved in the pathogenesis of idiopathic (orthostatic) edema syndrome, but they seem uninvolved in the aldosterone- and renin-lowering action of amphetamine. It is possible that amphetamine is acting further down the chain, either directly on the adrenal and kidney or the microvasculature, rather than at hypothalamus-pituitary axis.

Topics: Adrenocorticotropic Hormone; Adult; Aldosterone; beta-Endorphin; Blood Urea Nitrogen; Body Weight; Dextroamphetamine; Dopamine; Edema; Endorphins; Enkephalin, Leucine; Enkephalin, Methionine; Female; Humans; Hypotension, Orthostatic; Middle Aged; Renin; Sodium; Spironolactone; Syndrome; Vasopressins

Blood contents of pressor peptide hormones vasopressin and angiotonin II were studied in patients with neuro-endocrine syndrome before and after single intake and prolonged treatment with anti-serotonin drug peritol and cholinergic agent parlodel which affect biogenic amine metabolism and, consequently, influence blood pressure. Single doses of the drugs were established to cause different blood dynamics of vasopressin and angiotonin II which classified as marked and paradoxic reactions on peritol and parlodel used separately and associatively. Fall of blood vasopressin content induced by single dose of parlodel was accompanied by blood pressure decrease. Tree-week treatment with peritol and parlodel exerted hypotensive effect and significantly reduced vasopressin blood content.

Topics: Adolescent; Adult; Angiotensin II; Biogenic Amines; Blood Pressure; Bromocriptine; Chronic Disease; Cyproheptadine; Drug Evaluation; Female; Humans; Hypertension; Hypothalamic Diseases; Male; Middle Aged; Syndrome; Time Factors; Vasopressins

Topics: Female; Humans; Hypertension, Portal; Injections, Intravenous; Middle Aged; Myocardial Infarction; Syndrome; Vasopressins

Assessment of vasopressin by radioimmunoassay has shown an increase in its blood concentration and a disturbed reaction of the vasopressinergic structures of the hypothalamus to metoclopramide, furosemide, insulin hypoglycemia, and exercise. Functional tests with the dopaminergic drug bromocriptine and antiserotoninergic drug cyproheptadine help to make an individual choice of the most effective drug for therapy of the hypothalamic syndrome of neuroendocrine-metabolic type. The patients can be divided into sensitive to either the first or the second drug of both which is important for adequate pathogenetic therapy.

Topics: Adolescent; Adult; Chronic Disease; Exercise Test; Humans; Hypothalamic Diseases; Hypothalamo-Hypophyseal System; Middle Aged; Pituitary Gland, Posterior; Radioimmunoassay; Syndrome; Time Factors; Vasopressins

Topics: Diabetes Insipidus; Diabetes Mellitus; Diagnosis, Differential; Diuresis; Humans; Hypothalamo-Hypophyseal System; Polyuria; Syndrome; Thirst; 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

Topics: Adult; Animals; Cell Membrane; Humans; Hyponatremia; Inappropriate ADH Syndrome; Kidney; Male; Syndrome; Vasopressins; Water

The authors discuss about five cases of diabetes insipidus observed in patients affected by traumatic cervical spine fractures and/or dislocations, without either evident lesions of the cerebral structures at CT scan examination, or important craniocerebral trauma. In all patients polyuria and hyperthermia arose some days after the traumatic accident and regressed spontaneously or after exogeneous vasopressin administration. Vasopressin urinary levels confirmed the presence of a true diabetes insipidus, the origin of which is in largely obscure. A central medullary vasopressin mediated pathway, demonstrated only in experimental animals, may be responsible for such a finding.

Topics: Adolescent; Adult; Cervical Vertebrae; Diabetes Insipidus; Female; Fever; Fractures, Bone; Humans; Hypothalamo-Hypophyseal System; Joint Dislocations; Male; Polyuria; Radiography; Spinal Cord Injuries; Syndrome; Vasopressins

Red blood cell indices in four adolescent and preadolescent patients with documented inappropriate antidiuretic hormone secretion (SIADH) following spinal fusion were examined for evidence of dilution. The blood indices in these preoperative patients demonstrated evidence of dilution on both the intracellular and extracellular levels. The major factors causing these dilutional effects were elevated ADH, intravenous fluid overloading, and mobilization of "third space" fluids. It appears that extracellular dilution secondary to these factors results in spuriously low blood indices (namely, hemoglobin, hematocrit, and red blood cells) during the postoperative period. These findings suggest that an awareness of SIADH and avoiding intravenous fluid overloads by accurately managing intraoperative and postoperative fluids will decrease the dilutional effects observed on blood indices and perhaps save patients from unwarranted transfusions.

Topics: Adolescent; Adult; Female; Humans; Infusions, Intravenous; Male; Postoperative Complications; Spinal Fusion; Syndrome; Vasopressins

Glycosaminoglycan (GAG) content in the kidney of homo (DI) Brattleboro rats was shown to be minimal whereas the activity of glycanohydrolases (GH) in the papilla of diabetic rats was comparatively high. Injection of the antidiuretic hormone (ADH) increased the GH in the renal papillae of both the DI and HZ (heterozygous) rats. Disappearance of the beta-glucuronidase staining occurred in the collecting tubule's epithelial cells under the effect of adiuretin--SD and water deprivation for 2 days. The activation and redistribution of the GH under the ADH influence and the role of GAG and GH in the mechanism of ADH action, were discussed.

Topics: Animals; Female; Glucuronidase; Glycosaminoglycans; Glycoside Hydrolases; Heterozygote; Histocytochemistry; Homozygote; Kidney; Male; Pituitary Hormones, Posterior; Rats; Rats, Brattleboro; Rats, Inbred Strains; Rats, Mutant Strains; Syndrome; Vasopressins

We describe three patients who have polydipsia and polyuria due to an abnormality in the osmoregulation of thirst. The clinical manifestations of the syndrome are similar to those of neurogenic diabetes insipidus. Thus, under basal conditions the patients have thirst, normal to high normal levels of plasma osmolality, and low levels of plasma vasopressin. Moreover, antidiuretic therapy greatly reduces thirst and polydipsia as well as polyuria. The only clinically distinguishing feature of the response is that thirst and water intake decrease less rapidly than water excretion. As a consequence, the patients with this syndrome develop variable degrees of dilutional hyponatremia and hypoosmolemia during treatment. The plasma vasopressin response to osmotic stimulation is relatively normal. In most of the patients, the osmotic threshold for vasopressin release is at the upper limit of normal, but this finding only explains their modest elevation in basal plasma osmolality. Thirst and water intake also change as a function of plasma osmolality. However, the threshold or "set" of the thirst osmostat appears to be abnormally low. The degree of downward resetting varies from patient to patient, but is always sufficient to stimulate thirst and water intake at levels of plasma osmolality below the normal range. This abnormality can account not only for the thirst and polyuria under basal conditions but also for the overhydration that occurs during antidiuretic therapy. The pathogenesis of the osmoregulatory abnormality is unknown but may be due to disruption of one or more of the afferent pathways that regulate the "set" of the thirst and vasopressin osmostats.

Topics: Adult; Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Humans; Male; Syndrome; Thirst; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Diabetes Insipidus; Humans; Inappropriate ADH Syndrome; Polyuria; Syndrome; Thirst; Vasopressins

Hyponatremia and hypo-osmolality developed in a 70-year-old patient. It was probably mediated by hypersecretion of antidiuretic hormone, which, in turn, was due to prolonged nausea and vomiting. Severe esophagitis was the cause of the nausea. The patient was not given large amounts of fluids intravenously, and it is likely that she continued to drink for nondipsetic reasons. In view of her medical history of neurosyphilis, the possibility of a disturbance in the mechanism of thirst regulation is discussed, but remains unproved.

Topics: Aged; Esophagitis, Peptic; Female; Humans; Hyponatremia; Nausea; Osmolar Concentration; Syndrome; Time Factors; Vasopressins; Vomiting; Water-Electrolyte Imbalance

A patient with lifelong severe polyuria and polydipsia had normal serum antidiuretic hormone (ADH) levels and responded to water deprivation with a prompt increase in urine osmolality and maintenance of normal plasma osmolality (less than 290 mOsm/kg), despite extreme thirst. When treated with desmopressin acetate and allowed free access to water, she was able to reduce plasma osmolality below 270 mOsm/kg, and her compelling thirst disappeared. The disorder is interpreted to be the result of excessive fluid intake in response to a thirst stimulus that was not inhibited by normal plasma osmolality. This study indicates that osmoreceptor control of ADH secretion is normal. Continued administration of vasopressin has relieved the symptoms and has not resulted in water intoxication.

Topics: Adult; Deamino Arginine Vasopressin; Female; Humans; Osmolar Concentration; Polyuria; Pregnancy; Syndrome; Thirst; Vasopressins

An 8-yr-old girl is presented who had periodic attacks of vomiting, psychotic depression, drowsiness, and hypertension (160/110 mm Hg) for a period of 16 months after head injury. At the initiation of the attack, serum ACTH and vasopressin levels were prominently increased (610 pg/ml and 41 microunits/ml, respectively), followed by hypercortisolemia, hyponatremia, and hypoosmolality in plasma. Serum PRL also was elevated (91 ng/ml). Responses of GH and cortisol to insulin-induced hypoglycemia and those of TSH to TRH were reduced. Urinary excretion of epinephrine and norepinephrine were increased, while dopamine (DA) excretion was reciprocally decreased, resulting in a marked elevation of the epinephrine plus norepinephrine to DA ratio during the episodes (0.4-4.5); this was normalized on attack-free days (0.08-0.25). During the attack, the concentration of homovanillic acid, a major metabolite of DA in the brain, also was reduced in cerebrospinal fluids from 70 to 23 ng/ml. The administration of methyl-dopa and reserpine effectively suppressed the recurrence of the episode. Although the exact cause of this syndrome is unknown, a periodic metabolic dysfunction of catecholamine in the central nervous system might be postulated.

Topics: Adrenocorticotropic Hormone; Brain Concussion; Catecholamines; Child; Female; Humans; Hypertension; Insulin; Methyldopa; Periodicity; Pituitary Hormones, Anterior; Prolactin; Reserpine; Syndrome; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins; Vomiting

Seven subjects with Kallmann's syndrome were studied to determine whether they had disturbances of fluid homeostasis. Simultaneous measurements of urine and plasma osmolality (Uosm and Posm, respectively) were made during free access to fluids. The Uosm-Posm relationship was abnormal in five patients on at least one occasion. Patient 2 was frequently overhydrated (Posm less than or equal to 280 mosmol/kg) and patient 5 excreted a dilute urine when his Posm was 290 mosmol/kg. The three subjects (1, 5, and 7) tending to have an increased Psom (greater than or equal to 300 mosmol/kg) were able to concentrate their urine (Uosm greater than 800 mosmol/kg) and denied polyuria and polydipsia. Their elevated Posms could be explained by impairment of thirst, rather than increased excretion of water, because the patients concentrated their urines at normal Posms during fluid deprivation. The osmotic threshold for vasopressin release was decreased (Posm = 270.6 mosmol/kg) in one patient and increased (Posm greater than or equal to 295 mosmol/kg) in two others of the seven patients. The elevated osmotic threshold was not due to chronic hyperosmolality or a generalized defect in vasopressin secretion. In the patient with the highest osmotic threshold (Posm = 296 mosmol/kg) and Posms between 289--301 mosmol/kg during free access to fluid, the osmotic threshold decreased to only 293 mosmol/kg after 6 weeks of adequate hydration and desmopressin acetate. However, in response to hypotension induced by trimethaphan, he increased his plasma vasopressin from 1--26 microU/ml. In conclusion, some patients with Kallmann's syndrome may have osmoreceptor dysfunction and abnormal thirst regulation, indicating more extensive hypothalamic involvement than previously appreciated.

Topics: Adolescent; Adult; Diuresis; Female; Humans; Hypogonadism; Male; Osmolar Concentration; Syndrome; Thirst; Trimethaphan; Vasopressins; Water Deprivation; Water-Electrolyte Imbalance

Topics: Adult; Female; Hemodynamics; Humans; Hypothalamic Diseases; Male; Middle Aged; Plethysmography, Impedance; Syndrome; Vasopressins

We have studied plasma and cerebrospinal fluid vasopressin (CSF-AVP) and osmolality in 28 patients with cervical or lumbar pain syndromes (control patients), 11 patients with normal pressure hydrocephalus (NPH) and in 5 patients with benign intracranial hypertension (BIH). Vasopressin concentration in lumbar CSF to a high extent reflected the actual ventricular CSF-AVP concentration. In all groups CSF-AVP was lower than plasma AVP. Mean CSF-AVP in the control group was 1.3 pg/ml +/- 0.1 (SEM). In the NPH patients, who all suffered from severe dementia, CSF-AVP level was not different from that found in the control group (1.4 pg/ml +/- 0.2). In contrast to the findings in the two other groups CSF osmolality in BIH patients was higher than plasma osmolality (P less than 0.0). CSF-AVP in the BIH patients, characterized by an elevated intracranial pressure (ICP), was higher than in the control group (2.7 pg/ml +/- 0.4, P less than 0.001).

Topics: Adult; Aged; Cervical Vertebrae; Female; Humans; Hydrocephalus; Hydrocephalus, Normal Pressure; Lumbar Vertebrae; Male; Middle Aged; Osmolar Concentration; Pain; Pseudotumor Cerebri; Syndrome; Vasopressins

A case is described of a patient with an oat cell carcinoma of the bronchus with moderately elevated levels of plasma corticotrophin (ACTH) and antidiuretic hormone (ADH). Ectopic secretion of ACTH induced severe hypokalaemia and concealed the effects of concomitant ADH secretion on renal function. Normal renal responsiveness was restored following correction of hypokalaemia. The hypokalaemia was associated with evidence of a marked increase in corticosteroid secretion but plasma ACTH concentrations did not show a proportionate elevation. Chromatographic studies on tumour extracts suggest that the presence of a large fraction of high molecular weight ACTH in plasma could explain this discrepancy.

Topics: Adrenocorticotropic Hormone; Aged; Carcinoma, Small Cell; Electrolytes; Female; Humans; Hypokalemia; Lung Neoplasms; Syndrome; Vasopressins

Topics: Anuria; Diabetes Insipidus; Edema; Humans; Inappropriate ADH Syndrome; Oliguria; Syndrome; Vasopressins; Water-Electrolyte Balance

Topics: Arrhythmias, Cardiac; Humans; Syndrome; Vasopressins; Ventricular Fibrillation

The pathogenesis of the rare hypernatremia, usually described in the literature as "neurogenic" or "essential" hypernatremia, consists of defective thirst mechanism either alone or in combination with impaired osmoregulation of ADH release. As etiology, disturbances of the neoplastic, vascular and degenerative type and malformations in the hypothalamic area are known. In patients with the hypodipsia-hypernatremia syndrome, dysfunction of the anterior pituitary lobe, obesity, abnormal regulation of body temperature, psychomotor retardation and episodic muscular weakness are frequently encountered as additional abnormalities. A 6-year-old patient is described with hypodipsia-hypernatremia syndrome manifest for 3 years. Besides hypernatremia, hypodipsia and the relative insensitivity of the osmoreceptors regulating ADH release, elevated body temperature, polyphagia and obesity, partial hypothalamic-hypophyseal dysfunction, lethargy and psychomotor retardation are the principal findings. An inflammatory lesion or one occupying an intracranial space was not demonstrable until now. Under forced water intake and hypocaloric diet the patient has progressed well with nearly complete normalization of the hypernatremia, body temperature and obesity.

Topics: Child; Diet, Reducing; Glomerular Filtration Rate; Humans; Hypernatremia; Hypothalamus; Kidney Concentrating Ability; Kidney Function Tests; Male; Pituitary Gland; Syndrome; Thirst; Vasopressins; Water; Water-Electrolyte Balance

17 patients with severe hyponatraemia (none had cardiac failure or had lately had an operation) all had excessively high plasma-antidiuretic hormone (A.D.H.). Only 13 had features typical of the syndrome of inappropriate secretion of A.D.H. (S.I.A.D.H.). Plasma-A.D.H. was not related to either plasma-sodium or diagnosis. There were as many patients with chest infection as with carcinoma of the lung. Plasma-sodium and plasma-A.D.H. returned rapidly towards normal in the patients with chest infection or volume depletion but these concentrations corrected much more slowly in patients with carcinoma of the lung. The increase in plasma-sodium in patients with chest infection was too rapid to be produced by water-deprivation treatment and was due to return of plasma-A.D.H. to normal. The term S.I.A.D.H. implies an understanding of pathophysiology that does not exist. As a diagnosis it does not help in management or prognosis. A simpler, more descriptive terminology such as "hyponatraemia with carcinoma of the lung" would be more useful and less confusing in the clinical situation.

Topics: Aged; Female; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Respiratory Tract Infections; Sodium; Syndrome; Terminology as Topic; Vasopressins

Topics: Antineoplastic Agents; Carcinoma, Small Cell; Demeclocycline; Humans; Lung Neoplasms; Syndrome; Vasopressins

We evaluated demeclocycline and lithium therapy in 10 patients with the syndrome of inappropriate secretion of antidiuretic hormone. Despite severe water restriction, all patients had hyponatremia (mean +/- S.E.M. serum sodium of 122 +/- 1.1 meq per liter) and elevated urine osmolality (744 +/- 59 mOsm per kilogram) before treatment. Demeclocycline (600 to 1200 mg daily) restored serum sodium concentration to 139 +/- 1.1 meq per liter within five to 14 days, permitting unrestricted water intake in all patients. In three patients given lithium carbonate (900 mg daily) the serum sodium concentration, urine osmolality and urine volume were unchanged; since two patients had adverse central-nervous-system symptoms during lithium therapy, further study of this agent was abandoned. A patient with an unusual 22-year history of the syndrome was unresponsive to lithium, whereas long-term treatment with demeclocyline was markedly effective. Demeclocycline is superior to lithium in the treatment of the syndrome and may obviate the need for severe water restriction.

Topics: Adult; Aged; Child; Chronic Disease; Demeclocycline; Drug Evaluation; Female; Humans; Hyponatremia; Lithium; Male; Middle Aged; Osmolar Concentration; Sodium; Syndrome; Vasopressins

Topics: Demeclocycline; Humans; Hyponatremia; Lithium; Osmolar Concentration; Syndrome; Vasopressins

Topics: Carcinoma, Bronchogenic; Deficiency Diseases; Humans; Hyponatremia; Male; Methods; Middle Aged; Syndrome; Vasopressins

Topics: Diseases in Twins; Humans; Hyponatremia; Hypothyroidism; Infant; Kidney; Male; Sodium; Syndrome; Vasopressins; Water-Electrolyte Imbalance

The syndrome of inappropriate antidiuretic hormone secretion, with marked hyponatremia, was observed in an elderly women who was taking carbamazepine for trigeminal neuralgia. Subsequent studies revealed this effect to be directly related to the administration of the drug. Substantial water retention has not been previously described in patients taking normal volumes of fluid and taking standard doses of carbamazepine. Additionally, it was determined that the antidiuretic effect of carbamazepine could be blocked by phenytoin. The actions of both drugs on renal water excretion, and the interactions of the drugs were observed to be dose-related.

Topics: Aged; Carbamazepine; Diuresis; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Hyponatremia; Phenytoin; Syndrome; Trigeminal Neuralgia; Vasopressins

Plasma concentrations of arginine vasopressin were determined by radioimmunoassay in 13 normal children, 21 patients with febrile illnesses (not bacterial meningitis), and 17 patients with bacterial meningitis. The mean +/- 1 SD concentrations of AVP in the normal children and patients with various febrile illnesses were 0.7 +/- 0.6 and 1.0 +/- 1.2 muU/ml, respectively. The mean +/- 1 SD concentration of AVP in patients with bacterial meningitis was 3.3 +/- 2.3 muU/ml. The concentrations of AVP in the patients with bacterial meningitis were significantly greater (P less than 0.001) than those noted in the normal children or children with other febrile diseases.

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Fever; Humans; Infant; Meningitis; Radioimmunoassay; Syndrome; Vasopressins

Topics: Aged; Chlorpropamide; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Syndrome; Vasopressins

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; Female; Fluphenazine; Humans; Syndrome; Vasopressins; Water-Electrolyte Imbalance

Topics: Adult; Bronchial Neoplasms; Carcinoma; Guanidines; Humans; Hyponatremia; Male; Muscular Diseases; Osmolar Concentration; Syndrome; Vasopressins

Topics: Female; Humans; Middle Aged; Syndrome; Thioridazine; Vasopressins; Water-Electrolyte Imbalance

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

The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary diseases, including tuberculosis and bacterial and viral pneumonia: however, it has not been reported with anaerobic infections or empyema in the absence of pneumonia. We report a patient with empyema due to Bacteroides melaninogenicus, Bacteroides oralis, and Peptostreptococcus who developed the syndrome. Eight hours before the start of therapy, his serum sodium concentration was 127 mEq per liter; serum osmolality, 255 mOsm per kg; urine osmolality, 522 mOsm per kg; urinary sodium concentration, 39 mEq per liter. The creatinine clearance and the adrenocorticotropic hormone stimulation test were normal, and there was no evidence of dehydration. No other causes of the syndrome of inappropriate secretion of antidiuretic hormone were apparent. With drainage and antimicrobial drug therapy, the empyema cleared, and the syndrome resolved in 8 days. The patient has been well, without evidence of inappropriate secretion of antidiuretic hormone, for 9 months. Anaerobic infections and/or empyema without pneumonia can be associated with the syndrome of inappropriate secretion of antidiuretic hormone.

Topics: Adult; Anaerobiosis; Bacterial Infections; Bacteroides Infections; Empyema; Humans; Hyponatremia; Male; Osmolar Concentration; Peptostreptococcus; Prevotella melaninogenica; Syndrome; Vasopressins

Topics: Benzothiadiazines; Chlorpropamide; Clofibrate; Demeclocycline; Diabetes Insipidus; Diuretics; Humans; Morphinans; Osmolar Concentration; Sodium Chloride Symporter Inhibitors; Syndrome; Vasopressins

The efficacy of demeclocycline hydrochloride in suppressing the tubular action of tumoral antidiuretic products was tested in seven patients with the syndrome of inappropriate antidiuretic hormone secretion. In all patients, demeclocycline hydrochloride (1,200 mg/day) induced production of hypotonic urine and corrected hyponatremia despite large fluid intakes. Comparison of the response to a standard water load before and during treatment showed a notable improvement in the response to water ingestion. Even though demeclocycline moderately impairs renal function, it appears to be the treatment of choice in the chronic form of the syndrome.

Topics: Administration, Oral; Aged; Carcinoma, Small Cell; Chronic Disease; Demeclocycline; Depression, Chemical; Dose-Response Relationship, Drug; Humans; Hyponatremia; Kidney Concentrating Ability; Lung Neoplasms; Male; Middle Aged; Syndrome; Vasopressins

3 cases of inappropriate vasopressin secretion during one case of anaplastic carcinoma of the lung, one case of carcinoma of the prostate with bony metastases and one case of acute intermittent porphyria are presented. The plasma levels of vasopressin, measured by radioimmunoassay were high. Treatment with demeclocycline was attempted in one case. The clearance of free water was positive but the treatment was poorly tolerated by the digestive tract.

Topics: Acute Disease; Aged; Carcinoma; Demeclocycline; Female; Humans; Lung Neoplasms; Male; Paraneoplastic Endocrine Syndromes; Porphyrias; Prostatic Neoplasms; Syndrome; Vasopressins; Water-Electrolyte Imbalance

Topics: Aged; Carcinoma, Small Cell; Humans; Lung Neoplasms; Male; Myasthenia Gravis; Syndrome; Vasopressins

Topics: Demeclocycline; Humans; Hyponatremia; Male; Middle Aged; Osmolar Concentration; Syndrome; Vasopressins

Topics: Blood; Diagnosis, Differential; Extracellular Space; Humans; Hyponatremia; Osmolar Concentration; Syndrome; Urine; Vasopressins

Topics: Child, Preschool; Humans; Male; Medication Errors; Syndrome; Vasopressins; Vinblastine

Topics: Humans; Hyponatremia; Syndrome; Vasopressins

Topics: Arginine Vasopressin; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Syndrome; 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

Topics: Drug Therapy, Combination; Humans; Neoplasm Metastasis; Neoplasms; Syndrome; Vasopressins; Vinblastine

Forty patients suffering from idiopathic oedema were studied. The disturbance in water excretion is characterised by a delay in excretion of a water load (20 ml/kg body weight), an inability to decrease urinary osmolarity below 137 mOsm/1 standing (normal: 60 mOsm +/- 25) and an inability to increase free water clearance: 2.36 +/- 2 ml/mn/1. 73 m2 (normal value: 6.8 ml/mn/1.73 m2) in the upright position. This problem of water excretion related to orthostasis defines and characterises the syndrome, the clinical picture of which is well known. The disturbance suggest a fault in the regulation of anti-diuretic hormone whilst the aldosteronism often described would seem to be inconstant and secondary to diuretic therapy too often prescribed without supervision.

Topics: Adult; Diuresis; Edema; Female; Humans; Male; Middle Aged; Osmolar Concentration; Posture; Syndrome; Vasopressins; Water-Electrolyte Imbalance

The syndrome of inappropriate ADH secretion ("SIADH") was first recognized 1935 by Roth et al. and described in detail 1957 by Schwartz et al. The clinical symptoms (hyponatremia, hypertonicity of urine and inability to excrete a water load) are caused by inadequately elevated ADH secretion under a variety of situations and diseases. Some recent work was focused on the pathogenesis of this syndrome and new clinical findings (low plasma levels of uric acid and potassium) as well as special forms ("SIADH" without elevated vasopressin levels in plasma) are thought to be of relevance. New therapeutical recommendations will be discussed.

Topics: Diuresis; Hormones; Hormones, Ectopic; Humans; Hyponatremia; Osmolar Concentration; Potassium; Syndrome; Uric Acid; 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

The concentration of serum sodium is determined by the external balance of water. Hyponatremia occurs when total body water is in excess of sodium, and hypernatremia develops when body water is relatively decreased in relation to sodium. Both disorders may be present in patients with various disease states in which total body sodium is either decreased, normal or increased. The symptomatology in both disorders is related to the disturbance in central nervous system due to brain edema in patients with hyponatremia and brain dehydration, and cerebrovascular hemorrhages in patients with hypernatremia. The treatment of hypo and hypernatremia is achieved by correcting the abnormalities in body water content.

Topics: Adult; Blood Volume; Edema; Endocrine System Diseases; Humans; Hypernatremia; Hyponatremia; Infant; Kidney Concentrating Ability; Kidney Diseases; Syndrome; Thirst; Vasopressins; Water; Water Loss, Insensible

Nine episodes of the syndrome of inappropriate antidiuretic hormone secretion occurred in five newborn infants following atelectasis or pneumothorax. All infants had pre-existing lung disease and were being treated with positive pressure ventilation. The mean interval between acute atelectasis or pneumothorax and the development of diagnostic hyponatremia, hypo-osmolal serum, hyperosmolal urine, and oliguria was 13.4 hours. Fluid restriction and removal of the triggering event resulted in resolution of the abnormalities within 1.5 to 4 days. Infants who develop atelectasis or pneumothorax should be evaluated for the subsequent occurrence of SIADH; the administration of a water load to them may result in dilutional hyponatremia, for which fluid restriction, not sodium infusion, is the proper therapy.

Topics: Acute Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Osmolar Concentration; Pneumothorax; Pulmonary Atelectasis; Sodium; Syndrome; Vasopressins

The syndrome of inappropriate secretion of antidiuretic hormone is characterized by production of less than maximally dilute urine in the presence of hypotonic plasma. It may be secondary to malignant disease, central nervous system disorders, or pulmonary disease, among other conditions, or it may be idiopathic. Manifestations are those of water intoxication, eg, confusion, fatigue, nausea, headache, and neurologic signs. The pathogenesis is not completely understood. Restriction of fluid intake to obtain a negative water balance is effective treatment.

Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Hyponatremia; Sodium; Syndrome; Urine; Vasopressins

Topics: Haloperidol; Humans; Schizophrenia; Syndrome; Thioridazine; Vasopressins

The threshold of serum osmolality causing release of vasopressin (antidiuretic hormone) was shifted to an abnormally low level (262 mosmol/kg H2O) in a 14-year-old girl with hypertension and signs of hypoplastic corpus callosum. There was a physiologically meaningful control of vasopressin release in response to water restriction and water load. Plasma vasopressin concentrations (range 1.2--11.9 pg/ml) were of the same magnitude as those of healthy adults, being abnormally high only when related to the hypotonicity of serum observed. Plasma concentrations of angiotensin II were higher than expected from the suppressed levels of plasma renin activity. Blood-pressure response to angiotensin II infusion was increased. Resetting of the osmostat and hypertension may both be explained by lesions of the central nervous system.

Topics: Adolescent; Agenesis of Corpus Callosum; Aldosterone; Angiotensin II; Arginine Vasopressin; Blood Pressure; Female; Humans; Hypertension; Osmolar Concentration; Renin; Sodium Chloride; Syndrome; Vasopressins; Water-Electrolyte Balance

A case of a 76-year-old man with the syndrome of inappropriate secretion of antidiuretic hormone (ADH) is discussed. The patient was initially treated with fluid restriction followed by the administration of hypertonic saline. After failure to achieve rapid correction of the condition and continued lethargy and muscle weakness in the patient, a trial with lithium carbonate 300 mg three times daily via nasogastric tube was initiated. This resulted in a prompt reversal of the hyperosmolar state and improvement in electrolyte balance. However, despite the apparent success in treating his inappropriate ADH, the patient expired as a result of a massive cerebral vascular accident. The potential benefit of using lithium in the treatment of the syndrome of inappropriate secretion of ADH, and possible mechanisms of action, are reviewed.

Topics: Aged; Humans; Lithium; Male; Syndrome; Vasopressins; Water-Electrolyte Imbalance

The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary inflammatory diseases. The origin of the hormone in these cases is the neurohypophysis, although the afferent stimulus has not been adequately characterized. A previously unreported association of this syndrome with putrid pulmonary abscess and empyema is documented.

Topics: Empyema; Humans; Lung Abscess; Male; Middle Aged; Syndrome; Vasopressins

Topics: Dehydration; Diagnosis, Differential; Humans; Hyponatremia; Infant, Newborn; Infant, Premature, Diseases; Syndrome; Vasopressins

Three children with diabetes insipidus, diabetes mellitus, optic atrophy, and high-tone deafness were shown to lack vasopressin, indicative of degeneration of the cells of the hypothalamic supraoptic nuclei. The syndrome being due to a single gene defect, inherited as an autosomal recessive, is therefore likely to be the result of an inborn error of metabolism with variable periods of latency in those affected.

Topics: Adolescent; Child; Deafness; Diabetes Insipidus; Diabetes Mellitus, Type 1; Humans; Male; Optic Atrophy; Syndrome; Vasopressins

We observed idiopathic light-chain proteinuria in a patient with multiple abnormalities of proximal-tubule transport mechanisms (Fanconi syndrome), nephrogenic diabetes insipidus, and distal renal tubular acidosis. Seventeen of the 19 urinary amino acid levels measured were elevated. Uric acid and phosphate clearances were greater than 60 per cent and 50 per cent, respectively, of the simultaneous inulin clearance. When water deprivation was coupled with vasopressin administration, the maximum urinary concentration observed was 384 mOsm per kilogram of water. During ammonium-chloride loading, the level of hydrogen-ion concentration in the urine remained less than 100 times that in the blood. Kappa light-chain excretion was 149 mg per 24 hours. It appears that the concurrence of proximal tubular dysfunction, distal tubular dysfunction and light-chain proteinuria represents a distinct syndrome, which we call "combined light-chain nephropathy." Available evidence indicates that excessive light-chain production with subsequent filtration, reabsorption and catabolism, causes the complex tubular dysfunctions observed.

Topics: Acidosis, Renal Tubular; Ammonium Chloride; Bence Jones Protein; Diabetes Insipidus; Fanconi Syndrome; Female; Follow-Up Studies; Humans; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Kidney Concentrating Ability; Kidney Diseases; Kidney Tubules; Kidney Tubules, Distal; Middle Aged; Proteinuria; Renal Aminoacidurias; Syndrome; Vasopressins

A few rare syndromes have been delineated in which diabetes mellitus is inherited in association with other conditions. This paper describes five patients, including four siblings in one family, who have diabetes insipidus, diabetes mellitus, optic atrophy and deafness (the DIDMOAD syndrome). The parents of both families are normal but are first cousins. All the patients have insulin-dependent diabetes mellitus with a typical juvenile-onset. The onset of diabetes insipidus was insidious and the symptoms could easily have been ascribed to poor control of diabetes mellitus. The importance of diagnosing diabetes insipidus is that all these patients had dilatation of the urinary tract varying from mild hydroureter to severe hydronephrosis and this improved with treatment of the diabetes insipidus. It is suggested that patients with diabetes mellitus and optic atrophy should have regular screening tests for diabetes insipidus since it is likely that they represent cases of the full syndrome with incomplete clinical expression. The occurrence of this rare syndrome in four siblings of unaffected parents indicates that the syndrome is due to a recessive gene, but the pathogenesis is unknown.

Topics: Adolescent; Adult; Deafness; Diabetes Insipidus; Diabetes Mellitus; Female; Genes, Recessive; Humans; Hydronephrosis; Male; Optic Atrophy; Osmolar Concentration; Pedigree; Syndrome; Urinary Bladder; Urine; Vasopressins; Water Deprivation

Topics: Anemia, Sickle Cell; Child; Female; Humans; Hyponatremia; Syndrome; Vasopressins; Water-Electrolyte Imbalance

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

A study of plasma arginine vasopressin in 17 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with bronchogenic carcinoma, revealed that the arginine vasopressin levels were distinctly elevated in most. In 14 patients with bronchogenic carcinoma, but without overt SIADH, plasma levels of arginine vasopressin were significantly higher than in normal subjects (p less than 0.001). This, together with the finding of a lower than normal plasma osmolality in this group, suggests that inappropriate ADH excess might be much more common in patients with bronchogenic carcinoma than previously thought. The normal positive correlation between plasma osmolality and plasma arginine vasopressin was found to be reversed in SIADH. Seven of nine patients with overt SIADH, studied after fluid deprivation, showed an increase in plasma arginine vasopressin coincident with an increase in plasma osmolality (r = +0.8, p less than 0.01); in one patient, plasma arginine vasopressin returned to the original level following rehydration. The possibility that this might imply a degree of physiologic control to what is generally considered an autonomous secretion is discussed. It is, however, considered more likely that other factors, including changes in plasma volume and glomerular filtration, might explain the increase in plasma levels of arginine vasopressin.

Topics: Adult; Aged; Arginine Vasopressin; Carcinoma, Bronchogenic; Female; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Syndrome; Vasopressins; Water Deprivation

Topics: Aldosterone; Humans; Lithium; Syndrome; Time Factors; Vasopressins

Schwartz-Bartter-syndrome as a consequence of severe cerebral alterations like bacterial and tuberculous meningitis, encephalitis, hydrocephalus and brain haemorrhage has been observed in 7 cases. Massive natriuresis is followed by marked hyponatremia and hypochloremia which may lead to an intracellular brain edema. Sodium administered even in high dosage is lost rapidly through the kidney, and does not normalize the serum level of sodium. The Schwartz-Bartter-syndrome is caused by inadequatly elevated ADH-secretion with consecutive water retention and an increase in plasma volume. Consecutively an increased excretion of sodium takes place causing a substantial loss of bound water. An analogous situation was seen in a child with neurohormonal diabetes insipidus after an overdosage of ADH, which resulted in a hypervolemia, marked hyponatremia and massive natriuresis. The increased excretion of sodium may be the result of reduced reabsorption of sodium in the proximal tubuli of the kidney, caused by a humeral natriuretic factor (the socalled "third factor"). In the serum of one of our patients an increased natriuretic activity could be shown; this is the first time in a child with Schwartz-Bartter-syndrome.

Topics: Blood Volume; Brain Diseases; Brain Edema; Cerebral Hemorrhage; Child; Chlorides; Encephalitis; Female; Humans; Hydrocephalus; Hyponatremia; Infant; Infant, Newborn; Male; Meningitis; Natriuresis; Osmolar Concentration; Syndrome; Tuberculosis, Meningeal; Vasopressins

A clinical and investigative study is reported of 19 patients with 'idiopathic oedema of women'. The resons for defining this as a specific syndrome unrelated to the menstrual cycle are given, and the clinical features reviewed. During a forced water diuresis the flow and composition of the urine and the plasma volume were studied on tilting from the supine to the upright position seven premenopausal and four postmenopausal patients with this disorder. No differences were found in the results obtained in the follicular and luteal phases of the menstrual cycle or in the pre- and post-menopausal patients. The reductions in urinary volume and electrolyte excretion on upright tilting were greater than those observed under similar circumstances during the luteal phase of the menstrual cycle in normal female controls, and attributed to increased proximal renal tubular reabsorption. The rate of loss of isotopically labelled albumin from the intravascular compartment was greater in patients with idiopathic oedema than in control subjects. A reduction in blood volume on tilting occurred in control subjects and patients with idiopathic oedema, but was greater in the latter; and the larger the fall, the greater were the reductions in urinary flow and electrolyte excretion. The effect of administering 9-alpha-fluorohydrocortisone was studied in nine patients with idiopathic oedema. One patient failed to 'escape' from the sodium-retaining action of this mineralocorticoid and developed pulmonary oedema; the others 'escaped' normally. The pathophysiological disturbance in this condition is related to increased loss of fluid from the vascular compartment but the precise aetiological mechanism remains unknown.

Topics: Adult; Age Factors; Blood Volume Determination; Body Water; Diuretics; Edema; Female; Fludrocortisone; Follicular Phase; Hematocrit; Humans; Luteal Phase; Male; Middle Aged; Plasma Volume; Posture; Psychology; Serum Albumin; Sodium; Syndrome; Vasopressins; Water-Electrolyte Balance

A patient with Shy-Drager syndrome exhibited a partial defect in antidiuretic hormone (ADH) release, and cluster breathing, an indication of pontomedullary respiratory center damage, with a normal CO2 response curve. This extends the spectrum of abnormalities associated with the degenerative disease of the central nervous system. The presence of a pontomedullary respiratory pattern without an impaired CO2 response curve suggests that neurons that determine respiratory rhythm function independently from those that function as chemoreceptors.

Topics: Apnea; Blood Pressure; Carbon Dioxide; Central Nervous System Diseases; Gliosis; Humans; Male; Medulla Oblongata; Middle Aged; Olivary Nucleus; Pons; Respiration; Reticular Formation; Sleep; Syndrome; Vasopressins; Wakefulness

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Neurologic Manifestations; Syndrome; Vasopressins; Water Intoxication

Topics: Female; Humans; Middle Aged; Subarachnoid Hemorrhage; Syndrome; Vasopressins

Topics: Adenylyl Cyclases; Animals; Carbonates; Cyclic AMP; Diabetes Insipidus; Humans; Hyperthyroidism; Hyponatremia; Lithium; Osmolar Concentration; Rats; Sodium; Syndrome; Thyrotropin; Vasopressins

Topics: Carcinoma, Small Cell; Demeclocycline; Diuresis; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Syndrome; Vasopressins

We have studied the effects of demeclocycline on the water metabolism of a patient with the syndrome of inappropriate antidiuretic hormone (ADH) secretion who presented with a serum sodium concentration of 110 meq/litre. Free water clearance was studied before, during, and after treatment with demeclocycline. This study shows that demeclocycline (900 mg/day) can at least partially inhibit the action of ADH in the setting of tumor-induced ADH secretion, with the production of a reversible, partial nephrogenic diabetes insipidus, and with few or no side effects. Demeclocycline may be useful in the treatment of chronic inappropriate ADH secretion.

Topics: Carcinoma, Small Cell; Demeclocycline; Diabetes Insipidus; Humans; Hyponatremia; Kidney Diseases; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Syndrome; Urine; Vasopressins

Lithium, an established inhibitor of antidiuretic hormone action, was used (as the carbonate salt) to treat a patient with the syndrome of inappropriate secreation of antidiuretic hormone. The patient was studied by balance technics, and after a stablized hyponatremic state developed, 0.9 g of lithium carbonate was administered daily. A prompt water diuresis ensued, with correctionof hyponatremia in two days. Discontinuation of the drug resulted in a gradual return of the hyponatremic state. No change in urinary cyclic AMP occurred during the period of lithium effect. Lithium carbonate may be an effective treatment for both the acute and the chronic forms of the syndrome.

Topics: Administration, Oral; Blood; Carbonates; Humans; Hyponatremia; Lithium; Male; Middle Aged; Osmolar Concentration; Sodium; Syndrome; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Animals; Dogs; Humans; Hyponatremia; Isoproterenol; Osmolar Concentration; Oxytocin; Rats; Syndrome; Vasopressins

Topics: Aged; Amitriptyline; Cognition Disorders; Depression; Female; Humans; Hyponatremia; Syndrome; Vasopressins

Topics: Biopsy; Humans; Hyponatremia; Male; Middle Aged; Osmolar Concentration; Syndrome; Thymoma; Thymus Neoplasms; Vasopressins

The authors describe three postmenopausal women with agitated psychotic depression, increased water ingestion, and electrolyte values consistent with the syndrome of inappropriate antidiuretic hormone (ADH) secretion. They hypothesize that this clinical triad represents a syndrome reflecting underlying dysfunction of the hypothalamus and limbic system of the brain. The diagnosis of inappropriate ADH in one of the patients was directly confirmed by a recently developed serum radioimmunoassay.

Topics: Acute Disease; Adult; Drinking; Female; Humans; Hypothalamus; Limbic System; Middle Aged; Psychotic Disorders; Radioimmunoassay; Syndrome; Vasopressins

The syndrome of inappropriate ADH secretion was diagnosed on the basis of the cardinal features described by Bartter and Schwartz in 3 patients: one neonate with bacterial meningitis and two children respectively under Vincristin and Cyclophosphamide treatment. Treatment with fluid restriction and infusions of hypertonic saline led to a slow excretion of the water excess and to the restoration of both the body fluid volume and serum sodium concentration. The urinary excretion of aldosterone was found to be in the normal range or slightly increased during the development of the syndrome and at the beginning of the therapy. In the phase of recovery there was decreased urinary aldosterone.

Topics: Aldosterone; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Metabolic Diseases; Syndrome; Vasopressins

Topics: Diagnosis, Differential; Humans; Hyponatremia; Kidney Function Tests; Osmolar Concentration; Syndrome; Vasopressins

Topics: Adrenal Insufficiency; Humans; Hyperglycemia; Hyperlipidemias; Hyponatremia; Pituitary Gland, Posterior; Syndrome; Vasopressins; Water Intoxication; Water-Electrolyte Balance

A radioimmunoassay for [8-arginine]-vasopressin (AVP), previously described (Czernichow et al. 1975) has been used for the determination of antidiuretic hormone in a 4 ml urine sample. AVP is extracted from acidified urine with a cation exchanger (Amberlite CG 50) with an overall recovery of 72%. The blank value measured in extracted samples of urine was 0.29 pg/ml +/- 0.21 (SEM) and calculated by extrapolation of the regression line of the recovery experiment was 0.49 pg/ml. The coefficient of variation within-assay was 13% and between-assay 18%. Addition of the amounts of AVP found in each specimen of urine voided gave results nearly identical to those of the amounts found in 24 h pool of urine, indicating that the assay was not affected by changes in concentration of the other urinary components during the day. The daily urinary excretion of AVP measured in 34 subjects was found to be 34 ng in 17 women and 70 ng in 17 men, a significant difference. Urinary concentration and excretion rate of AVP rose during thirst test and during Carter-Robbins test performed in 13 healthy subjects. In the latter test it was observed that the women displayed a strikingly more pronounced AVP elevation after the osmolar stimulus than the men. In both sexes a significant correlation was found between AVP excretion rate and plasma osmolality as well as free water clearance. Three cases of complete or incomplete diabetes insipidus and potomania could be clearly differentiated according to the total output of AVP during the thirst test. Extremely high values of AVP were found in the urine of 5 subjects with Schwartz-Bartter syndrome associated with bronchogenic tumours.

Topics: Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Lung Neoplasms; Male; Osmolar Concentration; Radioimmunoassay; Sex Factors; Syndrome; Thirst; Vasopressins

Topics: Biological Transport, Active; Cell Membrane Permeability; Cells; Diffusion; Extracellular Space; Humans; Hyponatremia; Ion Exchange; Osmolar Concentration; Sodium; Syndrome; Vasopressins; Water-Electrolyte Balance

Topics: Calcitonin; Carcinoma, Small Cell; Hormones, Ectopic; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Paraneoplastic Endocrine Syndromes; Sodium; Syndrome; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Aged; Aldosterone; Angiotensin II; Diet, Sodium-Restricted; Hormones, Ectopic; Humans; Hydrocortisone; Male; Middle Aged; Natriuresis; Potassium; Radioimmunoassay; Renin; Sodium; Spironolactone; Syndrome; Vasopressins; Water Deprivation

Topics: Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Diagnosis, Differential; Female; Follicle Stimulating Hormone; Growth Hormone; Hormones, Ectopic; Humans; Hyperthyroidism; Hypocalcemia; Hypoglycemia; Hyponatremia; Insulin; Luteinizing Hormone; Mediastinal Neoplasms; Middle Aged; Osmolar Concentration; Parathyroid Hormone; Pigmentation Disorders; Syndrome; Thymus Neoplasms; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Adrenal Gland Neoplasms; Autopsy; Bone Neoplasms; Bronchial Neoplasms; Calcitonin; Carcinoma; Carcinoma, Small Cell; Humans; Hyponatremia; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Osmolar Concentration; Paraneoplastic Endocrine Syndromes; Syndrome; Vasopressins

Topics: Chronic Disease; Cyanosis; Humans; Inflammation; Lung Diseases; Male; Middle Aged; Osteoarthropathy, Secondary Hypertrophic; Penicillins; Pneumoconiosis; Smoking; Syndrome; Tetracycline; Tomography, X-Ray; Vasopressins

Topics: Adult; Hormones, Ectopic; Humans; Hyponatremia; Male; Syndrome; Tuberculosis, Pulmonary; Vasopressins

Topics: Body Weight; Chemical Phenomena; Chemistry; Humans; Hyponatremia; Male; Middle Aged; Natriuresis; Osmolar Concentration; Schizophrenia; Syndrome; Thiothixene; Vasopressins; Water

Topics: Administration, Intranasal; Adult; Amenorrhea; Female; Follicle Stimulating Hormone; Humans; Lactation Disorders; Pregnancy; Syndrome; Vasopressins

Topics: Adult; Bronchial Neoplasms; Carcinoma; Diagnosis, Differential; Humans; Hyponatremia; Lung Neoplasms; Male; Muscular Diseases; Muscular Dystrophies; Osmolar Concentration; Syndrome; Vasopressins

Topics: Body Water; Humans; Infant; Male; Pituitary Gland; Syndrome; Vasopressins; Vincristine; Water-Electrolyte Balance

Topics: Child, Preschool; Humans; Hyponatremia; Infant; Leukemia, Myeloid, Acute; Male; Syndrome; Vasopressins; Vincristine

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: Amitriptyline; Cognition Disorders; Fatigue; Female; Humans; Hyponatremia; Middle Aged; Osmolar Concentration; Sodium; Syndrome; Vasopressins

Topics: Adolescent; Chlorpropamide; Diabetes Insipidus; Drinking; Female; Humans; Hydrochlorothiazide; Hypernatremia; Nicotine; Potassium; Sodium; Sodium Chloride; Spironolactone; Syndrome; Thirst; Urination; Vasopressins; Water Deprivation

Topics: Female; Humans; Infant; Meningitis, Haemophilus; Syndrome; Vasopressins

Topics: Humans; Sodium; Syndrome; Vasopressins

Five dysautonomic patients with the Shy-Drager syndrome were studied to determine the basis of their nocturnal polyuria. The results indicated excessive postural modification of renal function in dysautonomic patients. This may, in fact, relate to excessive release of ADH while these patients are up and about, and excessive inhibition while they are recumbent. Treatment with vasopressin produced an inconsistent response.

Topics: Aged; Circadian Rhythm; Dysautonomia, Familial; Evaluation Studies as Topic; Fecal Incontinence; Female; Humans; Hydrocortisone; Hypotension, Orthostatic; Kidney; Male; Middle Aged; Nervous System Diseases; Osmolar Concentration; Parkinson Disease; Posture; Potassium; Sodium; Syndrome; Urinary Incontinence; Vasopressins; Water Deprivation

Topics: Child, Preschool; Diabetes Insipidus; Humans; Kidney Tubules; Male; Mikulicz' Disease; Polyuria; Syndrome; Vasopressins

Topics: Adult; Body Water; Body Weight; Diuresis; Epilepsy, Tonic-Clonic; Female; Furosemide; Humans; Hypertonic Solutions; Hyponatremia; Injections, Intravenous; Male; Osmolar Concentration; Potassium; Potassium Chloride; Sodium; Sodium Chloride; Syndrome; Urine; Vasopressins

Topics: Aldosterone; Alkalosis; Angiotensin II; Biopsy; Blood Pressure; Child, Preschool; Diet Therapy; Female; Follow-Up Studies; Growth Disorders; Humans; Hyperaldosteronism; Hyperplasia; Hypertrophy; Hypokalemia; Juxtaglomerular Apparatus; Kidney Concentrating Ability; Kidney Diseases; Norepinephrine; Potassium; Renin; Secretory Rate; Sodium Chloride; Spironolactone; Syndrome; Vasopressins

Topics: Adolescent; Female; Humans; Hyponatremia; Porphyrias; Pregnancy; Pregnancy Complications; Sodium; Syndrome; Vasopressins

Topics: Adrenal Gland Neoplasms; Carcinoma; Female; Humans; Hyponatremia; Middle Aged; Neoplasm Metastasis; Osmolar Concentration; Sodium; Syndrome; Vasopressins

Topics: Age Factors; Aged; Chlorpropamide; Cyclic AMP; Humans; Hyponatremia; Syndrome; Tolbutamide; Vasopressins

Topics: Adult; Aged; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diuresis; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neurophysins; Protein Binding; Radioimmunoassay; Syndrome; Tongue Neoplasms; Vasopressins

Topics: Carcinoma, Small Cell; Diabetes Insipidus; Hormones, Ectopic; Humans; Hyponatremia; Lung Neoplasms; Osmolar Concentration; Plasma Volume; Polyuria; Radioimmunoassay; Syndrome; Vasopressins

Topics: Aged; Central Nervous System Diseases; Chlorpropamide; Diabetes Mellitus; Female; Humans; Hyponatremia; Natriuresis; Osmolar Concentration; Syndrome; Time Factors; Urination Disorders; Vasopressins

Topics: Acromegaly; Edema; Endocrine System Diseases; Humans; Hyperaldosteronism; Hyperthyroidism; Hyponatremia; Hypothyroidism; Syndrome; Vasopressins

Topics: Eclampsia; Female; Headache; Humans; Hypertension; Methylergonovine; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Syndrome; Vasopressins

Topics: Acute Disease; Adult; Humans; Hyponatremia; Male; Middle Aged; Porphyrias; Syndrome; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Arginine Vasopressin; Brain Edema; Drug Therapy; Humans; Neurosurgery; Neurosurgical Procedures; Oxytocin; Physiology; Syndrome; Vasopressins

Topics: Chlorothiazide; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diagnosis; Diagnosis, Differential; Diuretics; Humans; Hydrochlorothiazide; Physiology; Polyuria; Syndrome; Thirst; 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

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: Diabetes Insipidus; Humans; Polydipsia, Psychogenic; Syndrome; Thirst; Vasopressins

Topics: Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Humans; Polyuria; Syndrome; Thirst; Vasopressins

Topics: Addison Disease; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diuresis; Diuretics; Humans; Hyperglycemia; Kidney Tubules; Osmosis; Physiology; Polyuria; Syndrome; Vasopressins

Topics: Humans; Hyponatremia; Kidney; Sodium; Sodium, Dietary; Syndrome; Vasopressins