Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
diabetes insipidus [keywords]
- Chronic Kidney Disease in Lithium-Treated Older Adults: A Review of Epidemiology, Mechanisms, and Implications for the Treatment of Late-Life Mood Disorders. [JOURNAL ARTICLE]
- Drugs Aging 2014 Dec 18.
Lithium is an important medication in the treatment of mood disorders. However, clinicians are hesitant to use lithium in older adults for fear of its medical effects, particularly kidney disease. This review describes the current understanding of the epidemiology and mechanisms underlying chronic kidney disease (CKD) in older lithium users, with recommendations for using lithium safely in late life. Prevalence estimates of CKD in older lithium users range from 42-50 %, which does not differ greatly from the 37.8 % rates seen in community-dwelling non-lithium using, non-psychiatric populations. Clinical and pre-clinical data suggest a variety of synergistic mechanisms contributing to CKD in older lithium users, including aging, cardiovascular factors, oxidative stress, inflammation, nephrogenic diabetes insipidus, acute kidney injury, and medication interactions. With regards to CKD, lithium can be used safely in many older adults with mood disorders. Compared to patients with pre-existing CKD, those with an estimated glomerular filtration rate >60 mL/min/1.73 m(2) are probably not as susceptible to lithium-associated renal decline. Using lithium concentrations <0.8 mmol/L; monitoring lithium concentrations and renal function every 3-6 months; being vigilant about concurrent medication use (e.g., diuretics, anti-inflammatories); as well as preventing/treating acute kidney injury, nephrogenic diabetes insipidus, diabetes mellitus, hypertension, smoking, and coronary artery disease can all help prevent CKD and further renal decline in older lithium users.
- Clinical experiences and success rates of acromegaly treatment: the single center results of 62 patients. [JOURNAL ARTICLE]
- BMC Endocr Disord 2014 Dec 16; 14(1):97.
This study aimed to report the clinical and outcome data from a large cohort of patients diagnosed with acromegaly and treated at our institution over a 20-year period.Sixty-two acromegaly patients (32 women and 30 men) treated and monitored at the endocrinology polyclinic between 1984 and 2013 were enrolled in this retrospective study. Clinical features and patients' treatment outcomes were evaluated. A level of growth hormone (GH) of <2.5 ng/ml was considered as the criterion for remission, and the normal insulin-like growth factor (IGF) range was based on gender and age. The mean age at the time of diagnosis was 38.8 +/- 1.4 years, the time to diagnosis was 4.5 +/- 0.3 years, and the follow-up duration was 7.3 +/- 0.8 years.Among patients' symptoms, growth in hands and feet and typical facial dysmorphism were the most prominent (92%). The number of patients with diabetes mellitus, hypertension and hyperprolactinemia were 22 (35%), 13 (21%) and 13 (21%), respectively. Microadenomas and macroadenomas were found in eight and 54 patients, respectively. A significant correlation was found between the initial tumor diameters and GH levels (p = 0.002). The mean GH and IGF-1 levels were 39.18 +/- 6.1 ng/ml and 993.5 +/- 79 ng/ml, respectively. Visual field defect was found in 16 patients (32%). Thirty-one patients were treated by transsphenoidal surgery. Four of these were cured, 10 patients developed postoperative anterior pituitary hormone deficiency, and one patient developed diabetes insipidus. Twenty patients were treated by transcranial surgery, of which two were cured, while 17 patients developed postoperative anterior pituitary hormone deficiency. In total, five of the patients who were not cured after surgery were given conventional radiotherapy, of which two were cured. Four of 15 patients, on whom Gamma Knife radiosurgery was performed, were cured. Biochemical remission was achieved in 32 of 52 patients who received octreotide treatment, and in two of five patients who received lanreotide treatment.The rate of surgical success in our patients was found to be low. This could be explained by an absence of experienced pituitary surgical centers or surgeons in our region, and the fact that most patients presented late at the macroadenoma stage.
- Successful treatment of pituitary abscess with intravenous antibiotics: a case report and literature review. [Journal Article]
- Genet Mol Res 2014; 13(4):10523-8.
Pituitary abscess is a rare intrasellar infectious disease. It is usually treated with a combination of surgical drainage and intravenous antibiotics. We describe the case of a 38-year-old man with headache, fever, left earache, subsequent diabetes insipidus, and anterior pituitary insufficiency due to pituitary abscess, which was confirmed on the basis of clinical symptoms, laboratory examination results, and magnetic resonance imaging features. He was treated nonsurgically with intravenous antibiotics, with complete resolution of the pituitary abscess and recovery of pituitary function. Nonsurgical treatment may be an option for pituitary abscess.
- PREGNANCY MAY FAVOUR THE DEVELOPMENT OF SEVERE AUTOIMMUNE CENTRAL DIABETES INSIPIDUS IN WOMEN WITH VASOPRESSIN-CELL ANTIBODIES: DESCRIPTION OF TWO CASES. [JOURNAL ARTICLE]
- Eur J Endocrinol 2014 Dec 10.
OBJECTIVE Recently, an increased incidence of central diabetes insipidus in pregnancy and less frequently in post-partum period has been reported, likely favoured by some conditions occurring in pregnancy, DESIGN To investigate the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity, we studied longitudinally the overtime behavior of vasopressin-cell antibodies (AVPcAb) and post pituitary function in two young women with positive history of autoimmune diseases and presence of AVPcAb but without clinical central diabetes insipidus (CDI), became pregnant 5 and 7 months after our first observation, respectively. METHODS The behavior of post-pituitary function and AVPcAb (by immunofluorescence) were evaluated at baseline, during pregnancy and for 2 years after delivery. RESULTS AVPcAb, present at low/middle titres at baseline in both patients, showed a titre increase during the pregnancy in one and after delivery in the other, with development of clinically overt CDI. The start of therapy with 1-deamino-8-D-arginine-vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month of post partum period, respectively, when AVPcAb disappeared accompanied by post- pituitary function recovery, persisting until the end of the follow- up. CONCLUSION To search for AVPcAb is advisable in patients with autoimmune diseases when planning their pregnancy, because they may be considered good predictive markers of gestational or postpartum autoimmune CDI . The monitoring of AVPcAb titre and post-pituitary function during pregnancy in these patients may allow an early diagnosis and an early replacement therapy, which could be able to induce the disappearance of these antibodies with consequent complete remission of CDI.
- Effects of chronic lithium administration on renal acid excretion in humans and rats. [Journal Article]
- Physiol Rep 2014 Dec 1; 2(12)
Lithium therapy's most common side effects affecting the kidney are nephrogenic diabetes insipidus (NDI) and chronic kidney disease. Lithium may also induce a distal renal tubular acidosis. This study investigated the effect of chronic lithium exposure on renal acid-base homeostasis, with emphasis on ammonia and citrate excretion. We compared 11 individuals on long-term lithium therapy with six healthy individuals. Under basal conditions, lithium-treated individuals excreted significantly more urinary ammonia than did control subjects. Following an acute acid load, urinary ammonia excretion increased approximately twofold above basal rates in both lithium-treated and control humans. There were no significant differences between lithium-treated and control subjects in urinary pH or urinary citrate excretion. To elucidate possible mechanisms, rats were randomized to diets containing lithium or regular diet for 6 months. Similar to humans, basal ammonia excretion was significantly higher in lithium-treated rats; in addition, urinary citrate excretion was also significantly greater. There were no differences in urinary pH. Expression of the critical ammonia transporter, Rhesus C Glycoprotein (Rhcg), was substantially greater in lithium-treated rats than in control rats. We conclude that chronic lithium exposure increases renal ammonia excretion through mechanisms independent of urinary pH and likely to involve increased collecting duct ammonia secretion via the ammonia transporter, Rhcg.
- Endoscopic Endonasal Surgery for Nonadenomatous Sellar/Parasellar Lesions. [REVIEW]
- World Neurosurg 2014 Dec; 82(6S):S138-S146.
This article demonstrates the experience with endoscopic transphenoidal anterior skull base surgery for lesions other than pituitary adenomas. The spectrum of lesions, results, and complications are presented.This series includes patients with 102 lesions other than pituitary adenomas operated upon using the endoscopic approach. The results and complications were reviewed retrospectively.The most common lesions treated were Rathke Cleft Cysts (n = 39) and craniopharyngiomas (n = 18) in a total of 82 tumors. There were 8 patients with inflammatory lesions, and the remainder had a variety of unusual pathologies. Complications other than diabetes insipidus (n = 12) were uncommon, with 6 postoperative cerebrospinal fluid leaks.The endoscopic anterior skull base approach is highly effective in treating a large variety of lesions other than pituitary adenomas. The adoption of the nasoseptal flap for closure has markedly reduced the incidence of spinal fluid leaks, and is used routinely for lesions that violate the intracranial compartment.
- Clinical profile and outcome of renal tubular disorders in children: A single center experience. [Journal Article]
- Indian J Nephrol 2014 Nov; 24(6):362-6.
Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT) in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA) (44%), Bartter-like (Bartter's and Gitelman) syndromes (22%) followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome) (13%) and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11) years. Growth failure was the presenting feature in 86% of children followed by polyuria (60%) and bone deformities (47%). In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD) within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well.
- Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas. [JOURNAL ARTICLE]
- J Craniofac Surg 2014 Dec 2.
The objective of this study was to report the efficacy, safety, and outcomes of endoscopic endonasal transsphenoidal techniques for pituitary adenomas.A retrospective data analysis of 32 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma between February 2011 and December 2013 was performed. The patients' demographic data, clinical presentations, radiologic findings, recurrence rates, and complications were analyzed.There were 14 men and 18 women with age ranging from 23 to 74 years (mean age, 48.6 y). Functioning and nonfunctioning tumors were present in 22 (68.8%) and 10 patients (31.2%), respectively. Among the functioning adenomas, 8 patients (25%) had growth hormone-secreting adenomas, 6 patients (18.8%) had prolactinomas, 5 patients (15.6%) had adrenocorticotropic hormone-secreting adenomas, 2 patients (6.2%) had follicle-stimulating hormone/luteinizing hormone-secreting adenomas, and 1 patient (3.1%) had thyroid-stimulating hormone-secreting adenomas. Of the 32 patients, 20 (62.5%) had pituitary macroadenomas and 12 patients (37.5%) had microadenomas. Total-subtotal tumor resection was achieved in 75% and 45% of the microadenomas and macroadenomas, respectively. Radiologically, 60% of the macroadenomas had suprasellar and carvenous sinus extension. Postoperative cerebrospinal fluid leaks occurred in 3 patients. Two patients developed temporary diabetes insipidus.Endoscopic transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in these patients.
- Endoscopic endonasal resection of skull base meningiomas: the significance of a "cortical cuff" and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection. [Journal Article]
- Neurosurg Focus 2014 Oct; 37(4):E7.
Object This paper describes a consecutive series of skull base meningiomas resected using an endoscopic endonasal approach through various corridors at a single institution over 7 years. The impact of case selection and experience, the presence of a cortical cuff between the tumor and surrounding vessels, and brain edema on morbidity and rates of gross-total resection (GTR) were examined. Methods A retrospective review of a series of 46 skull base meningiomas from a prospective database was conducted. The series of cases were divided by location: olfactory groove (n = 15), tuberculum and planum (n = 20), sellar/cavernous (n = 9) and petroclival (n = 2). Gross-total resection was never intended in the sellar/cavernous tumors, which generally invaded the cavernous sinus. Clinical charts, volumetric imaging, and pathology were reviewed to assess the extent of resection and complications. Cases were divided based on a time point in which surgical technique and case selection improved into Group 1 (surgery prior to June 2008; n = 21) and Group 2 (surgery after June 2008; n = 25) and into those with and without a cortical cuff and with and without brain edema. Results Improved case selection had the greatest impact on extent of resection. For the entire cohort, rates of GTR went from 38% to 76% (p = 0.02), and for cases in which GTR was the intent, the rates went from 63% to 84% (not significant), which was mostly driven by the planum and tuberculum meningiomas, which went from 75% to 91.7 % (nonsignificant difference). The presence of a cortical cuff and brain edema had no impact on outcomes. There were 3 CSF leaks (6.5%) but all were in Group 1. Hence, CSF leak improved from 14.2% to 0% with surgical experience. Lessons learned for optimal case selection are discussed. Conclusions Surgical outcome for endonasal endoscopic resection of skull base meningiomas depends mostly on careful case selection and surgical experience. Imaging criteria such as the presence of a cortical cuff or brain edema are less important.
- Folding and stability of the aquaglyceroporin GlpF: Implications for human aqua(glycero)porin diseases. [REVIEW]
- Biochim Biophys Acta 2014 Nov 20; 1848(2):622-633.
Aquaporins are highly selective polytopic transmembrane channel proteins that facilitate the permeation of water across cellular membranes in a large diversity of organisms. Defects in aquaporin function are associated with common diseases, such as nephrogenic diabetes insipidus, congenital cataract and certain types of cancer. In general, aquaporins have a highly conserved structure; from prokaryotes to humans. The conserved structure, together with structural dynamics and the structural framework for substrate selectivity is discussed. The folding pathway of aquaporins has been a topic of several studies in recent years. These studies revealed that a conserved protein structure can be reached by following different folding pathways. Based on the available data, we suggest a complex folding pathway for aquaporins, starting from the insertion of individual helices up to the formation of the tetrameric aquaporin structure. The consequences of some known mutations in human aquaporin-encoding genes, which most likely affect the folding and stability of human aquaporins, are discussed.