pituitrin and Tuberculosis--Meningeal

In tuberculous meningitis there is a disturbance of control involving hyponatraemia and increased urinary elimination of antidiuretic hormone resulting in hypersecretion of vasopressin. This inappropriate secretion of antidiuretic hormone should not be confused with the Schwartz-Bartter syndrome, which is reserved for paraneoplastic syndromes. The pathophysiology remains poorly understood but its recognition in cases of lymphocytic meningitis is improved as the correct diagnosis has precise therapeutic implications.

Topics: Aged; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Tuberculosis, Meningeal; Vasopressins

To evaluate serum antidiuretic hormone (ADH), its receptors, and renin levels in cerebral salt wasting (CSW) in tuberculous meningitis (TBM).. Patients diagnosed with definite (n = 30) or probable TBM (n = 47) who developed hyponatremia (CSW, SIADH, or miscellaneous causes) were included. Sequential measurement of serum ADH, ADH-R, and renin activity by enzyme-linked immunosorbent assay was done and correlated with serum sodium level, urinary output, and fluid balance.. Out of 79 TBM patients, CSW was observed in 36, SIADH in four, and miscellaneous hyponatremia in eight patients. CSW patients had a longer hospital stay (P < 0.001), lower GCS score (P < 0.007), higher MRC grade (P < 0.007), and a lower serum Na (P < 0.001) compared to non-CSW TBM patients. In severe CSW patients, serum ADH and ADH-R were correlated with hyponatremia and returned to baseline on correction; however, serum renin levels remained elevated. Serum ADH was related to hyponatremia but ADH-R and renin were not. ADH-R and renin levels did not significantly differ in CSW and SIADH.. CSW is the commonest cause of hyponatremia in TBM and correlates with disease severity. ADH is related to hyponatremia, but ADH receptor and renin are not.

Topics: Humans; Hyponatremia; Inappropriate ADH Syndrome; Renin; Tuberculosis, Meningeal; Vasopressins

Nine children with Schwartz-Bartter-syndrome are described. Seven suffered from severe diseases of the CNS, 2 developed the syndrome during treatment with vincristine, the damaging action of which on the CNS is known. The main symptoms of the syndrome are: hyponatremia with consecutive hypotonia of the extracellular space caused by excessive urinary sodium loss. The plasma volume is not diminished. Therapeutically administered NaCl appears in the urine which is hyperosmolar in spite of the hypoosmolarity of the plasma. The increased secretion of ADH which Schwartz et al. postulated to be the cause of the syndrome has been confirmed in recent years. The organism attempts to excrete the increased fluid volume which is retained by ADH, probably by means of a natriuretic hormone, so-called third factor. Enhanced activity of such a factor was assessed in one of our cases.

Topics: Brain Diseases; Brain Injuries; Cerebrospinal Fluid Shunts; Child; Cysts; Female; Humans; Inappropriate ADH Syndrome; Infant; Male; Tuberculosis, Meningeal; Vasopressins; Vincristine

Topics: Adult; Ethanol; Female; Humans; Inappropriate ADH Syndrome; Pituitary Gland; Pregnancy; Pregnancy Complications; Tuberculosis, Meningeal; 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

Topics: Female; Humans; Hyponatremia; Infant; Tuberculosis, Meningeal; Vasopressins

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

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

Topics: Hormones, Ectopic; Humans; Hyponatremia; Liver Cirrhosis; Male; Middle Aged; Tuberculosis, Meningeal; Tuberculosis, Pulmonary; Vasopressins

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

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

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Aged; Cerebrovascular Disorders; Circadian Rhythm; Creatinine; Diffuse Cerebral Sclerosis of Schilder; Encephalitis; Female; Humans; Middle Aged; Potassium; Sodium; Tuberculosis, Meningeal; Urination Disorders; Vasopressins; Water-Electrolyte Balance