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Endocrine Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Diabetes insipidus can also result from renal tubular resistance to ADH, so-called NDI secondary to interstitial renal disease, hypokalaemia, hypercalcaemia, lithium toxicity (Figure 12.25), and also by mutations of V2R. Diabetes insipidus may result from hypothalamus injury (e.g. from pituitary surgery) and may then be transient and recover spontaneously.
Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Clinical characteristics are polyuria, excessive thirst (polydipsia), and low urinary specific gravity. Diabetes insipidus may be idiopathic, autosomal dominant inheritance, or secondary to trauma or tumor. Fertility is not impaired and fetal outcomes are not adversely affected in patients with diabetes insipidus when the disease is successfully treated (Hime and Richardson, 1978; Jouppila and Vuopala, 1971). Therapy includes hormone replacement. The drug of choice in pregnancy is DDAVP (1-deamino-8-D-arginine vasopressin) given as a nasal spray. Other therapeutic regimens in patients with partial diabetes insipidus are not recommended for use during pregnancy (chlorpropamide, clofibrate, and carbamazepine). Note that DDAVP is not effective for the treatment of nephrogenic diabetes insipidus.
Endocrine Disorders
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Lisa Spence, Nana Adwoa Gletsu Miller, Tamara S. Hannon
Diabetes insipidus is rare in children but can occur due to a genetic abnormality or secondary to hypothalamic or pituitary tumors or following neurosurgery. Unlike diabetes mellitus, blood glucose concentrations are normal in diabetes insipidus. Rather, common symptoms for both conditions are frequent urination (polyuria) and constant thirst (polydipsia). In the case of diabetes insipidus, the urine is dilute and odorless while for diabetes mellitus, the urine is concentrated with glucose. The etiology of diabetes insipidus involves disruption of hormonal regulation of water balance, most often due to abnormal production or function of vasopressin. Vasopressin (also called anti-diuretic hormone) is made in the hypothalamus and its function is to increase fluid balance by reducing the excretion of water from the kidney. Thus, a main complication of diabetes insipidus is dehydration that results from water loss through excessive urination. Treatment of diabetes insipidus aims to address the primary cause, whether a tumor or hormonal. Treatment also focuses on drinking sufficient water to avoid dehydration.
Complete and Uneventful Recovery in a Case of Lymphocytic Hypophysitis Causing a Third Nerve Palsy
Published in Neuro-Ophthalmology, 2023
Jamie M. Nord, Paras P. Shah, Rashmi Verma
The most common symptoms of LH are related to mass effect. Headache is the most reported early symptom, which 60% of patients report on diagnosis.11 These headaches may be severe, generalised, retro-orbital, or bitemporal. Forty percent of patients have visual field deficits due to optic chiasm compression.3 Patients also describe symptoms of adenohypophyseal hypofunction including fatigue, lethargy, loss of libido, amenorrhoea, dizziness, nausea and vomiting. ACTH is the most common hormone deficiency, occurring in 65% of patients.12 Thirty percent of patients experience hyperprolactinaemia, which can result in amenorrhoea or galactorrhoea in women and sexual dysfunction in men.13 However, given that most women present in pregnancy or the postpartum period, these symptoms are difficult to identify. Some patients also have symptoms of neurohypophysis involvement from diabetes insipidus.1,14
Sheehan’s syndrome and sickle cell disease: the story of Natasha*
Published in Neuropsychological Rehabilitation, 2018
Barbara A. Wilson, Anita Rose, Gerhard Florschutz
Treatment for SS consists of hormone replacement such as ovarian, thyroid, and adrenocortical hormones. Synthetic hormones may be used. Oral contraceptives may be used to replace oestrogen/progesterone. There is a risk of diabetes insipidus and this is treated with yet another hormone. Growth hormone replacement therapy (GHRT) is sometimes used and has been shown to lead to increased muscle mass and an improved sense of well-being (Shivaprasad, 2011). Abs et al. (1999) conducted a study comprising 1034 adults with GH deficiency. SS was found to be the sixth most frequent aetiology and was responsible for 3.1% of cases. This contrasted with 53.9% of cases due to a pituitary tumour. There are a number of papers reporting on the treatment of SS with GHRT (for example, Abs et al., 1999; Diri et al., 2016; Kelestimur, et al., 2005; Shivaprasad, 2011). Abs et al. (1999) say that their work confirms earlier findings whereby untreated GH deficiency is associated with a number of clinical problems and that treatment is usually well tolerated. Kelestimur et al. (2005) found that treatment improved quality of life and body composition.
Desmopressin and nocturnal voiding dysfunction: Clinical evidence and safety profile in the treatment of nocturia
Published in Expert Opinion on Pharmacotherapy, 2018
Global polyuria is defined as 24-h urinary output that exceeds 40 ml/kg body weight or above and can result in increased urinary frequency. Disease states such as diabetes mellitus, diabetes insipidus, hypercalcemia, and primary polydipsia can be associated with global polyuria [18]. Diabetes insipidus can be classified as central (neurogenic) due to insufficient antidiuretic hormone (ADH) synthesis by neurosecretory cells, or nephrogenic, in turn due to renal insensitivity to ADH. In contrast, NP is an abnormally large urine volume produced during the night-time, and the ICS defines NP as nocturnal polyuria index (NPI) >20% of daily urine output at night in young individuals and >33% in elderly [3,4,15]. Excessive urine production remains a commonly reported cause of nocturia with up to 93% of elderly patients having NP [19]. Given the difference used in the definition of 24-h polyuria and NP units (based on a 70 kg person of undefined gender voiding more than 40 ml/kg/24 h vs. patient age and urine production per time unit), it can be difficult to compare these two conditions. Patients with fluid overload states such as congestive heart failure, liver disease with hypoalbuminemia, nephrotic syndrome, or lower extremity venous stasis often exhibit NP [16].