<b><i>Background:</i></b> Copeptin levels reflect vasopressin activity and help classify osmoregulatory disorders. There is limited pediatric experience using copeptin to diagnose and manage diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and bi- or tri-phasic postsurgical osmoregulatory disorders. In this report, we describe serial copeptin levels in an infant who developed transient SIADH after neurosurgery. <b><i>Case Description:</i></b> A 4-month-old infant with no prior pituitary dysfunction underwent endoscopic fenestration of a large arachnoid cyst (3.5 × 4.7 × 3.8 cm). He developed SIADH on postoperative day 4 with seizures, hyponatremia (sodium 121 mmol/L), and concentrated urine (535 mOsm/kg). His initial copeptin level was inappropriately high in the context of his hyponatremia. Copeptin levels decreased as his SIADH resolved. Serial copeptin levels correlated to the infant’s increased ability to dilute urine. <b><i>Conclusion:</i></b> Copeptin levels in this infant are consistent with levels described in adults and older children. Obtaining copeptin levels may improve providers’ ability to quickly diagnose and manage SIADH amongst other heterogeneous causes of hyponatremia. Lastly, trending copeptin levels improved providers’ ability to monitor SIADH progression, and may allow preemptive fluid titration for children with bi- or tri-phasic shifts in osmoregulation after neurological procedures.

Tolosa–Hunt syndrome is an idiopathic, inflammatory condition involving the cavernous sinus and is characterized by unilateral, painful ophthalmoparesis. The condition often begins with retro-orbital pain followed by select cranial nerve involvement. We report the case of a 17-year-old female whose presentation with progressive left-sided headache and ophthalmoparesis culminated in the diagnosis of Tolosa–Hunt syndrome. While many of her signs and symptoms have been previously reported in the rare pediatric cases of Tolosa–Hunt syndrome described in the literature, this case illustrates a unique presentation involving cranial nerves V and VII in addition to the more commonly reported cranial nerve III, IV, and VI palsies.

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The emphasis on increasing diversity within medical schools is not a new trend. At Virginia Commonwealth University School of Medicine, we made a concerted effort to increase the percentage of Hispanic students in each incoming class. In this article, we highlight the experiences, actions, and lessons learned from key stakeholders. We conclude with a set of recommendations for medical school administrators and students who also seek to increase diversity in their enrollment. Resumen El énfasis en incrementar la diversidad en las escuelas de medicina no es un nuevo curso de acción. En la universidad de la Mancomunidad de Virginia la escuela de medicina hizo un esfuerzo organizado para incrementar el porcentage de estudiantes hispanos en nuevas generaciones. En este manuscrito se subrayan las experiencias, acciones, y lecciones aprendidas por los principales interesados. Se concluye con un grupo de recomendaciones para administradores de escuelas de medicina así como estudiantes que buscan incrementar la diversidad de las inscripciones.