Chronic Posttraumatic Stress
Rolland S. Parker in Concussive Brain Trauma, 2016
Diabetes insipidus (vasopressin deficiency syndrome) is a complication of closed head injury in children and adults due to posterior pituitary stalk lesion or hypothalamic damage with loss of vasopressin (Molitch, 2001; Robinson, 2004). The sensing system for water level (osmostat) is in a small area of the hypothalamus just anterior to the third ventricle. Hormone synthesis and regulation is high in the hypothalamus; thus, local trauma (e.g., severing the pituitary stalk) or surgery traumatizes only the axon terminals (Ramsey, 1986). Survival of even 10% of vasopressin neurons may be sufficient to maintain homeostasis without symptoms. Alerting symptoms are polyuria, polydipsia, and thirst (Ganong & Kappy, 1993). These can develop from hypothalamic lesions or the destruction of vasopressin-containing neural fibers that terminate in the posterior pituitary. Diabetes insipidus (DI) is associated with reduced levels of vasopressin after severe head trauma, but may also occur after minor head trauma (hypothalamus; hypophysectomy; retrograde degeneration of axons into the supraoptic and paraventricular hypothalamic nuclei) (Kern & Meislin, 1984; Robertson, 1996). Permanent ADH insufficiency is expected with delayed onset (Hadani et al., 1985). Diabetes insipidus is a condition characterized by excretion of large volumes of urine that is hypotonic, dilute, and tasteless (insipid). This is a common disorder after closed head trauma (CHI), but does not seem to be recognized in later clinical contacts. This writer remembers one patient who, during a long examination, had to excuse himself repeatedly to urinate. This condition was posttraumatic and had never been studied by his physicians. It is associated with head injury (e.g., MVA) and panhypopituitarism (hypothyroidism and adrenal insufficiency). The trauma involved are hypothalamic or posterior pituitary (neurohypophysis) injury (Robinson & Verbalis, 2003). Dehydration creates thirst, and perhaps a desire for cold liquids as well. The writer has seen some patients who did not suffer such severe head trauma as to be unaware that their posttraumatic water ingestion and frequent urination followed their head injury.
Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
True diabetes insipidus (DI) in pregnancy is extremely rare in pregnancy, and occurs in an estimated three per 100,000 pregnancies (Hime and Richardson, 1978). Diabetes insipidus (of hypothalamic or neurogenic origin) is an unusually infrequent disorder caused by deficient arginine vasopressin (AVP) release from the posterior pituitary in response to normal physiologic stimuli. This results in low blood levels of AVP and impaired renal conservation of water. 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. The frequency of birth defects in 157 infants exposed to DDAVP (desmopressin) was not increased in the Swedish Birth Defects Registry (Kallen, 2019). An earlier study on birth defects in 29 infants who were exposed to desmopressin or vasopressin found one birth defect (Kallen et al., 1995). In a published literature review, 49 infants exposed to desmopressin (DDAVP) during organogenesis were found, and three had one had a major birth defect, and unrelated chromosomal abnormalities (trisomy 21) (Ray, 1998). A recent literature review reported that among 35 infants in 32 different studies exposed to desmopressin during the first trimester, no birth defects occurred. However, the C-section rate was 54 percent (Kyriakos et al., 2021).
ENTRIES A–Z
Philip Winn in Dictionary of Biological Psychology, 2003
Dexedrine is the D-ISOMER of AMPHETAMINE: D-amphetamine (or dextroamphetamine): dexedrine is the trade name for it. It is more potent than the L- isomer. The slang name, 'dexys', is of course derived from dexedrine. dextral(from Latin, dexter: right; dextra: right hand)Right-handed (see HANDEDNESS) or on the right side (as with an ISOMER). See also: sinistraldiabetesA condition marked by excessive THIRST and the passage of excessive quantities of dilute urine. There are two distinct diseases: diabetes mellitus (from Greek, mel: honey) is a disorder of CARBOHYDRATE metabolism, the patient's urine being rich in unburnt GLUCOSE while diabetes insipidus (from Latin, insipidus: weak) is due to impaired kidney function, the urine being unduly dilute. Diabetes insipidus may result from intrinsic kidney disease (nephrogenic diabetes insipidus) but is more commonly due to a deficiency of VASOPRESSIN (known also as antidiuretic hormone). This is a peptide synthesized in the supraoptic and paraventricular nuclei of the posterior HYPOTHALAMUS, especially in response to increased plasma osmotic pressure or decreased blood volume. The peptide is carried by axonal transport to the posterior PITUITARY GLAND (neurohypophysis) where it enters the bloodstream. On reaching the kidney it serves to increase the concentration of the urine by promoting the resorption of water from the renal filtrate (see OSMOREGULATION). Vasopressin also promotes VASOCONSTRICTION and haemostasis and has been assigned a number of more dubious cognitive functions. In the absence of vasopressin, urine output may exceed 10 litres daily but revert to normal with replacement therapy, administered by injection or intranasal spray. Diabetes mellitus (or simply, diabetes) is due to deficient production of pancreatic INSULIN, or a defective response to it, associated with retinal, renal, neurological and vascular complications. Raised blood glucose (HYPERGLYCAEMIA) in the fasting subject, and glucose in the urine (glycosuria) are diagnostic. The disease has two forms. The classical young, thin diabetic lacks insulin, commonly as a result of autoimmune destruction of the insulin-secreting pancreatic yS-cells. This condition can be controlled by daily replacement therapy.
Exacerbation of pre-existing diabetes insipidus during pregnancy, mechanisms and management
Published in Acta Clinica Belgica, 2017
Lloyd J.W. Tack, Guy T’Sjoen, Bruno Lapauw
During pregnancy, physiological changes in osmotic homeostasis cause water retention. If excessive, this can cause gestational diabetes insipidus (DI), particularly in patients with already impaired vasopressin secretion. We present the case of a 34-year-old patient with pre-existing hypopituitarism who experienced a transient exacerbation of her DI during a twin pregnancy. In contrast to typical gestational DI, polyuria and polydipsia occurred during the first trimester and remained stable thereafter. This case highlights a challenging clinical entity of which pathophysiology, diagnostic approach and treatment will be discussed.
Interstitial nephritis and nephrogenic diabetes insipidus in a patient treated with pemetrexed
Published in Renal Failure, 2010
Aristeidis Stavroulopoulos, Lydia Nakopoulou, Antonios M. Xydakis, Vasiliki Aresti, Aggeliki Nikolakopoulou, Georgios Klouvas
We present a case of interstitial nephritis and nephrogenic diabetes insipidus (NDI) in a patient treated with pemetrexed (500 mg/m2) for non-small cell lung cancer. Renal impairment and diabetes insipidus appeared after the first treatment cycle while he totally received four cycles of chemotherapy. There was not any significant myelosuppression and the patient was on regular supplementation with folic acid and vitamin B12. He was not on any other medications and he did not receive any nephrotoxic agents. Kidney biopsy showed acute tubular necrosis together with interstitial inflammatory infiltrate of mononuclear cells and interstitial fibrosis occupying 25% of the cortex. There was not any improvement of renal function after a 2-week trial of oral prednisone. In the present case report, we review the literature for pemetrexed-induced renal toxicity and the possible mechanisms involved.
Encephalopathy, Chiasmal Compression, Ophthalmoplegia, and Diabetes Insipidus in Pituitary Apoplexy
Published in Neuro-Ophthalmology, 2014
Meghan Berkenstock, Alexander Szeles, Jessica Ackert
Pituitary apoplexy with haemorrhage is a potentially life-threatening condition, and a rare cause of third nerve palsies. The range of vision loss and ophthalmoplegia seen in cases of apoplexy reflects the variability of cranial structures compressed by mass effect. The pathophysiology of extraocular muscle limitation and facial paraesthesia occurs with compression of the cavernous sinus, which contains cranial nerves III, IV, VI, and the ophthalmic branch of V. Blood supply to adjacent structures may be also compromised, causing additional loss of function. This case report of a patient with diabetes insipidus and a third nerve palsy illustrates the anatomic basis of the presenting signs of pituitary apoplexy, and the necessity for prompt neuroimaging if it is suspected.
Related Knowledge Centers
- Kidney Diseases
- Neurohypophysis
- Pituitary Diseases
- Pregnancy
- Optic Chiasm
- Didmoad
- Head Trauma