- [New Diagnostic Standard in Diabetes Insipidus]. [Journal Article]
- DMDtsch Med Wochenschr 2018; 143(24):1739-1744
- 2018 brings new insights into the differential diagnosis of patients with hypotonic polyuria syndrome. Exact localization of the antidiuretic defect in patients with hypotonic polyuria can be challen...
2018 brings new insights into the differential diagnosis of patients with hypotonic polyuria syndrome. Exact localization of the antidiuretic defect in patients with hypotonic polyuria can be challenging, especially the distinction of primary polydipsia from partial pituitary or renal forms of diabetes insipidus. However, diagnostic precision is vital since therapeutic management differs substantially and false treatment may result in serious consequences.A main limitation of the indirect water deprivation test is its limited accuracy to correctly distinguish between the pathophysiologically distinct forms of hypotonic polyuria with a residual antidiuretic capacity. Direct detection of the osmotically-sensitive AVP reserve may be diagnostically superior but is technically difficult and not available for clinical routine, having left indirect diagnostic readouts the only accepted method for differentiating polyuric states, despite a diagnostic accuracy of only 70 %.New data demonstrate that selective measurement of plasma copeptin, a reliable AVP surrogate, not only captures patients with underlying renal defect, but critically improves diagnostic differentiation between primary polydipsia and pituitary forms of central diabetes insipidus.This manuscript presents the novel findings in the field and interprets their clinical consequences.
- Case of Polydipsia. [Journal Article]
- LMLond Med Phys J 1816; 35(205):199-201
- Dr. Domeier, on the Cure of Polydipsia. [Journal Article]
- MPMed Phys J 1800; 4(20):304-306
- Dr. Dyce, on a Case of Polydipsia. [Journal Article]
- MPMed Phys J 1800; 3(16):509-510
- Nephrogenic Diabetes Insipidus. [Review]
- PCPediatr Clin North Am 2019; 66(1):227-234
- Nephrogenic diabetes insipidus (NDI) results from the inability of the late distal tubules and collecting ducts to respond to vasopressin. The lack of ability to concentrate urine results in polyuria...
Nephrogenic diabetes insipidus (NDI) results from the inability of the late distal tubules and collecting ducts to respond to vasopressin. The lack of ability to concentrate urine results in polyuria and polydipsia. Primary and acquired forms of NDI exist in children. Congenital NDI is a result of mutation in AVPR2 or AQP2 genes. Secondary NDI is associated with electrolyte abnormalities, obstructive uropathy, or certain medications. Management of NDI can be difficult with only symptomatic treatment available, using low-solute diet, diuretics, and prostaglandin inhibitors.
- Xanthomatous hypophysitis causing hypogonadotropic hypogonadism resulting in delayed presentation of slipped capital femoral epiphysis. [Journal Article]
- BJBr J Neurosurg 2018 Nov 19; :1-4
- An 18-year-old man who underwent bilateral pinning of his hip joints after a left unstable Slipped Capital Femoral Epiphysis (right pinned prophylactically) was noted to have delayed secondary sexual...
An 18-year-old man who underwent bilateral pinning of his hip joints after a left unstable Slipped Capital Femoral Epiphysis (right pinned prophylactically) was noted to have delayed secondary sexual characteristics and post-operative diabetes insipidus. The patient also described a history of fatigue, headache and polydipsia for the past 4 years. Endocrine investigations revealed reduced androgen levels, hypocortisolism, a borderline normal Serum ACE and secondary hypothyroidism. Magnetic Resonance Imaging of the pituitary gland identified an enhancing mass and a thickened stalk which trans-nasal endoscopic biopsy found to be necrotic with pus. Histology confirmed a diagnosis of Xanthomatous Hypophysitis, an inflammatory condition likely related to a partial rupture of a Rathke cleft cyst. The patient was subsequently commenced on Androgen, Thyroxine, Desmopressin and Hydrocortisone therapy with on-going endocrine follow-up. Although endocrine dysfunction & hypogonadism has been recognised to be a risk factor for SCFE at an atypically older age, due to reduced androgen levels leading to a weakened physeal plate, this is the first known case of a Xanthomatous Hypophysitis resulting in pituitary dysfunction and eventual SCFE. This case highlights that an increased range of pituitary disorders should be considered in late presentations of SCFE; and vice versa the risk of SCFE should be considered in patients with prolonged hypogonadotropic hypogonadism.
- Highlighting the importance of early diagnosis in progressive multi-organ involvement of IgG4-related disease: A case report and review of literature. [Journal Article]
- WJWorld J Clin Cases 2018 Nov 06; 6(13):707-715
- IgG4-related disease (IgG4-RD) is an increasingly recognized pathological entity that tends to involve multiple organs with an elevated level of serum IgG4, which is easily misdiagnosed owing to shar...
IgG4-related disease (IgG4-RD) is an increasingly recognized pathological entity that tends to involve multiple organs with an elevated level of serum IgG4, which is easily misdiagnosed owing to sharing common clinical features with a variety of other diseases. Here, we report an interesting IgG4-RD case of a woman with progressive multi-organ involvement for over 19 years, started with swollen eyelids, dry eye and mouth, and polydipsia and hydruria. Imaging diagnosis revealed diffuse enlargement of the parotid glands, enlargement of the head of the pancreas, pulmonary infection and interstitial lung. Serological tests showed a remarkable elevation of the serum IgG4, and cytological analysis further revealed a large amount of lymphoplasmacytic infiltration into the focal lobule, and IgG4-positive cell infiltration in bladder mucosa. Therapeutically, the patient responded well to steroid therapy, and thus, she was diagnosed as IgG4-RD suspicious. This report highlights the importance of an early diagnosis in this autoimmune disease and suggests that patients with a clinically unclear cause of inflammation, swelling and refractory glands, rhinitis, pancreatitis, hypophysitis, and/or interstitial pneumonia should be considered for IgG4-RD. The plasma IgG4 level and lymphoplasmacytic infiltration may be useful indexes for screening, and a low dose of steroid maintaining therapy may offer benefits for patients with IgG4-RD.
- Cerebral tuberculomas in a 6-year-old girl causing central diabetes insipidus. [Journal Article]
- BCBMJ Case Rep 2018 Nov 12; 2018
- A 6-year-old girl presented acutely with worsening frontal headaches. She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. A chest X-ray showed a left ...
A 6-year-old girl presented acutely with worsening frontal headaches. She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. A chest X-ray showed a left upper lobe consolidation, and a CT head showed multiple enhancing lesions with significant surrounding oedema in both cerebral hemispheres. Due to the strong suspicion of tuberculosis (TB), she was admitted and treated with anti-TB therapy and steroids. Following this, pulmonary infection with Mycobacterium tuberculosis was confirmed by a positive PCR from induced sputum. Cerebral spinal fluid (CSF) analysis was normal and tested negative for M. tuberculosis on PCR. During her first week of treatment, she developed polyuria, nocturia and polydipsia and was diagnosed with central diabetes insipidus. She was started on desmopressin which rapidly improved her symptoms, and she was continued on desmopressin for 3 months. Currently, she remains well and has shown a good response to TB treatment.
- Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine pituitary pars intermedia dysfunction. [Journal Article]
- EVEquine Vet J 2018 Nov 12
- CONCLUSIONS: PPID can present with variable signs at different latitudes and climates, and ID should be investigated in equids diagnosed with PPID. Adequate body condition and administration of pergolide are fundamental in PPID management. This article is protected by copyright. All rights reserved.
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- Anti-PD-1 pembrolizumab induced autoimmune diabetes in Chinese patient: A case report. [Case Reports]
- MMedicine (Baltimore) 2018; 97(45):e12907
- CONCLUSIONS: Autoimmune diabetes induced by anti-programmed cell death-1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) therapy is a rare, but life threatening immune-related side effect. Physicians should closely monitor diabetes-related indexes of patients who have been undergoing the treatment of anti-PD-1/PD-L1 therapy.