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diabetes insipidus [keywords]
- Full mouth rehabilitation in a medically compromised patient with fluorosis. [Journal Article]
- J Clin Diagn Res 2014 Jul; 8(7):ZD22-4.
Severely worn out dentition needs to be given definite attention as it not only affects aesthetics but can also cause psychological distress to the affected individual. It can cause chewing difficulty, temporomandibular joint problems, headaches, pain and facial collapse. Before any attempt to restore severely worn dentition, aetiology of excessive tooth wear should be established. Severe wear can result from chemical cause, mechanical cause or a combination of various causes. Dental fluorosis can also result in severe wear of teeth. Teeth sometimes become extremely porous and friable with a mottled appearance ranging from yellow to brown-black. There occurs loss of tooth substance and anatomic dental deformities resulting in un-aesthetic dentition requiring full mouth rehabilitation. Here a similar case of full mouth rehabilitation of severely worn dentition due to dental fluorosis in a 27-year-old patient is presented. This case report conjointly presents the uncommon association of diabetes insipidus with dental fluorosis. Diabetes insipidus through its characteristic symptom of polydipsia can result in intake of more than permitted dose of fluoride thus causing dental fluorosis. In literature only few cases have been reported of dental fluorosis in association of diabetes insipidus. Full mouth rehabilitation of the patient was successfully accomplished through well-planned systematic approach to simultaneously fulfill aesthetic, occlusal and functional parameters.
- Colorectal cancer manifesting with metastasis to prolactinoma: report of a case involving symptoms mimicking pituitary apoplexy. [Journal Article]
- Intern Med 2014; 53(17):1965-9.
Pituitary metastasis is an uncommon first presentation of systemic malignancy. The most common presenting symptom of pituitary metastasis is diabetes insipidus reflecting involvement of the stalk and/or posterior pituitary. We herein present a unique case of the coexistence of both a functioning pituitary adenoma (prolactinoma) and pituitary metastasis of advanced colorectal cancer with pituitary apoplexy as the first manifestation of underlying malignancy. The present case emphasizes the need to consider pituitary metastasis as a differential diagnosis in patients presenting with pituitary lesions and be aware that tumor-to-tumor metastasis can occur unexpectedly in those with pituitary metastases.
- Significant expressivity of Wolfram syndrome: phenotypic assessment of two known and one novel mutation in the WFS1 gene in three Iranian families. [JOURNAL ARTICLE]
- Mol Biol Rep 2014 Aug 31.
Wolfram syndrome also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness) is a rare neurodegenerative autosomal recessive disorder. There is evidence of variable expressivity both in patients and heterozygous carriers. In this study, we describe three Persian Wolfram syndrome families with differences in the age of onset, signs and symptoms of the disease. We clinically evaluated affected families for verifying WS clinical diagnosis. After linkage analysis via 5 STR markers, molecular analysis for WFS1 was performed by direct sequencing for patients and available family members. Three homozygous mutations were identified including c.1885 C>T, c.2205C>A both in exon 8 and c.460+1G>A in intron 4. The mutation c.2205C>A was found to be novel. We report interesting phenotype-genotype correlations: homozygous c.1885C>T and c.2205C>A variants were correlated with quite different disease severity and onset in the siblings. We report a rare case of WS with homozygous c.1885C>T who is married and has a healthy child. c.460+1G>A showed a possible partial dominant inheritance put forth by a heterozygous parent showing partial WS symptoms while her daughter displayed typical WS symptoms. Due to variable expressivity, detailed clinical examination and molecular diagnostics should be used to confirm WS and a more exact recurrence risk data.
- Initial symptoms of pineal region tumors - comparison to historical control of pre-ct era -. [Journal Article]
- Neuro Oncol 2014 Jul.:iii3.
The initial symptoms of pineal region tumors might vary according to histology and era.The initial symptoms of 39 pineal region tumors who were treated at the International Medical Center, Saitama Medical University and whose initial clinical symptoms were well documented on charts were analyzed. Those symptoms were compared with those of historical control (HC) of 26 "pienalomas" (1), who were treated at the University of Tokyo in pre-CTera (mostly germ cell tumors, but some without histological confirmation).There were 32 germ cell tumors (germinoma 20, non-germinomatous germ cell tumors (NGGCT) 12) and 6 pineal parenchymal tumors (PPT). Increased intracranial pressure (IICP) was observed in 20 cases (51%) which was slightly less than the HC (66.7%) (P = 0.17), The IICP was observed 40% of cases in germinoma, 83.3% in NGCGCT and 33.3% in PPT. Eye movement disorder was observed in 18 of 39 patients (47%) wheres that was only in 12 (33.3%) in the HC (P= 0.26). Abnormality in pupils was observed in 33.3% in the study cohort and in 25% in HC (P = 0.43). Diabetes insipidus, which suggests the presence of multifocal lesion involving hypothalamus was observed in 25% of GCTs of study cohort and in 19.4% in the HC.With the advancement of modern imaging modalities and accessibility to neurosurgical practice, the clinical pictures of pineal region tumors have been slightly changed but not significantly. Current pineal region tumors tend to be found a little earlier than the pre-CT era. (1) Fujimaki T. Ryoikibetsu-shoukougun series, 2000 SECONDARY CATEGORY: Epidemiology & Cancer Control.
- Is environmental temperature related to renal symptoms, serum lithium levels, and other laboratory test results in current lithium users? [Journal Article, Research Support, Non-U.S. Gov't]
- Hum Psychopharmacol 2014 Jul; 29(4):392-6.
Lithium continues to be an important mood disorder treatment. Although patients exposed to higher environmental temperatures may have serum lithium level elevations due to dehydration, there is conflicting data in the literature. In addition, no study has assessed the association between temperature and other renal laboratory tests and symptoms in lithium users.This is a cross-sectional analysis of 63 current lithium users who participated in the McGill Geriatric Lithium-induced Diabetes Insipidus Clinical Study. The relationship between mean daily temperature with diabetes insipidus symptoms, glomerular filtration rate, urine osmolality, serum sodium, lithium level, and lithium dose-level ratio was assessed.Although a higher temperature on the day of laboratory testing trended toward being independently associated with a lower lithium dose-level ratio (Beta = -0.17, p = 0.08), this was not found when using a dichotomous measure of temperature (T > 20°C). No association was observed between temperature and other renal parameters.The association of temperature with lithium levels, renal symptoms, and laboratory tests appears to be of relatively little clinical importance in lithium users in temperate climates. However, future research should re-examine patients living in climates with extreme temperatures (e.g., >40°C), who may theoretically be at higher risk.
- Paediatric endocrine disorders at the university college hospital, ibadan: 2002 - 2009. [Journal Article]
- Ann Ib Postgrad Med 2013 Dec; 11(2):96-101.
Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis.This study aims at defining the burden of paediatric endocrine disorders in Ibadan.A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out.During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders were present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period.Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.
- Visceral disseminated varicella zoster virus infection after rituximab treatment for granulomatosis with polyangiitis. [JOURNAL ARTICLE]
- Mod Rheumatol 2014 Aug 27.:1-7.
We report on a 30-year-old Japanese woman with granulomatosis with polyangiitis (GPA) complicated by pituitary diabetes insipidus and multiple lung granulomas. The granulomas disappeared with prednisolone (50 mg/day) and rituximab, although continuous nasal desmopressin was needed to control diabetes insipidus after immunosuppressive therapies. At the time of presentation, the patient had abdominal pain and disseminated intravascular coagulation but no rash. She died of continuous hemorrhage from her skin of neck, mucosa of her pharynx, and small intestine. At autopsy, varicella zoster virus (VZV)-DNA detected in serum and VZV antigens detected in tissues of her pharynx, esophagus, and liver led to a diagnosis of visceral disseminated VZV infection (VD-VZV). She also complicated cytomegalovirus infection in her stomach and ovaries. Her posterior pituitary gland had been replaced by foamy macrophages. In 38 reported cases of VD-VZV, rash appeared following the onset of abdominal pain (mean interval, 6.5 days) but was lacking in 11% of cases. The mortality rate associated with VD-VZV was as high as 29% and survived cases were treated with antivirals earlier than mortal cases. A quick diagnosis with detection of VZV-DNA or VZV antigens in sera or tissues using PCR or immunohistochemistry examination and early empirical treatment with antivirals are important.
- IgG4-related disease that presented cranial, cervical, lumbar and sacral hypertrophic pachymeningitis associated with infundibulo-hypophysitis. [Journal Article]
- Rinsho Shinkeigaku 2014; 54(8):664-7.
We report a patient of 32-year-old female with central IgG4-related disease. She developed headache and visual disturbance. On examination, she revealed diabetes insipidus, retrobulbar neuritis, hyperreflexia and limb weakness. Her laboratory findings showed serum IgG4 elevation, pleocytosis and protein elevation in cerebrospinal fluid. Chest CT showed a nodular lesion in the S8 of the left lung. Cranial and spinal magnetic resonance images with gadolinium contrast material showed cranial, cervical and lumbosacral hypertrophic pachymeningitis associated with infundibulo-hypophysitis. Pathological findings of the left frontal dura mater revealed lymphoplasmacytic inflammatory cell infiltrate with dense fibrosis. IgG4 immunohistochemistry showed no IgG4 + plasma cells within the inflammatory infiltrate. During treatment with intravenous pulse methylprednisolone followed by oral prednisolone, she revealed recovery of visual acuity with improvement of hypertrophic pachymeningitis and normalization of serum IgG4. This is a first report of IgG4-related hypertrophic pachymeningitis which involved cranial, cervical and lumbosacral regions as well as infundibulo-hypophysitis in a young female.
- A novel method for managing water and electrolyte balance after transsphenoidal surgery: preliminary study of moderate water intake restriction. [Journal Article]
- Nagoya J Med Sci 2014 Feb; 76(1-2):73-82.
Hyponatremia is a common and potentially serious complication of transsphenoidal surgery (TSS). Since September 2009, we have implemented moderate water intake restriction (< 2500 mL/day) after TSS in an attempt to prevent this complication. The aim of this study was to investigate the efficacy of a combination of moderate restriction of water intake plus antidiuretic hormone (arginine vasopressin [AVP]) replacement therapy in patients with diabetes insipidus (DI) for reducing the incidence of delayed hyponatremia after TSS. Patients treated from September 2005 to August 2009 were allowed to drink water freely after surgery (the control group), while patients treated from September 2009 to June 2012 were restricted to less than 2500 mL water per day (the water restriction group). To reduce the occurrence of hypernatremia, AVP replacement therapy was provided immediately after the development of DI. We retrospectively analyzed the incidence of hyponatremia, DI, and hypernatremia in patients following TSS. Hyponatremia incidence was significantly lower in the water restriction group (P = 0.017); however, there were no significant differences in DI incidence and hypernatremia incidence between the 2 groups. Under DI control with AVP replacement therapy, the water restriction group showed no significant difference in the daily self-rated thirst level for the patients with and without DI. Moderate water intake restriction in addition to AVP replacement therapy significantly decreases the incidence of hyponatremia without patient discomfort (extreme thirst) and other complications. However, further studies are required to determine the most effective amount of water and the optimal duration of postoperative water restriction.