Objective We are reporting a case of adipsic diabetes insipidus (ADI) post astrocytoma resection. Method Clinical and laboratory data are presented Results 16-year-old female with a history of incompletely resected hypothalamic astrocytoma admitted with headache. Head MRI showed interval increase in suprasellar lesion with extension to the third ventricle. Following second stage resection, she developed increased urine output with diluted urine resulting in negative fluid balance, however, she was unable to sense thirst. Blood tests showed serum sodium of 155 mEq/dl (136–145), serum osmolality at 321 mOs/kg ( 285–295 ) and urine osmolality of 128 mOsm/kg (300–1600 ). Serum creatinine and potassium were normal. Pituitary hormone profile were normal : Growth Hormone 0.171 ng/ml (0.123–8.05), LH 3.44 miu/ml (7.59–89.08), FSH 5.60 miu/ml (2.55–16.69) TSH 2.9 miu/ml (0.35–4.94), Free Thyroxine 0.92 ng/dl (0.7–1.48), ACTH 19.56 pg/ml (7.2–63.3) and Prolactin 7.25 ng/ml (5.18–26.53). The patient was treated with Desmopressin Acetate 120 mcg tablets twice daily with a fixed fluid intake of 1.5 to 2.0 liters/day with closed monitoring of fluid intake, output and body weight. Response was good with gradual reduction of serum sodium level of around 7–9 mEq/L/Day. Conclusions Adipsic diabetes insipidus is a rare entity of central diabetes insipidus, where the absence of polydipsia can be challenging in diagnosing and managing the condition. Cases of ADI are likely under reported and clinicians need to be aware of this condition

Objective Isolated ACTH deficiency is characterized by loss of adrenocorticotropic hormone and resulting in adrenal insufficiency, which can lead to life threatening severe hypoglycemia. We are reporting a case of isolated ACTH deficiency with emphases on presentation , common etiologies , diagnosis and management. Method The clinical course in addition to laboratory and imaging results are presented. These include : Cortisol level , ACTH, other pituitary hormones, insulin tolerance test , Pituitary antibodies and pituitary Magnetic resonance imaging. Results A 19-year-old male was brough by ambulance to the Emergency department with loss of consciousness and with a random blood sugar (RBS) of 30 mg/dl Our patient had barely detectable plasma ACTH repeatedly and cortisol <1 ug/dl .There was no involvement of other pituitary hormones. Steroid replacement therapy led to resolution of all symptoms and prevented further episodes of hypoglycemia. Conclusion isolated ACTH deficiency is a rare condition that is challenging to diagnose and can lead to serious life-threatening problems if unrecognized. Proper management can be achieved with appropriate hydrocortisone supplementation to mimic the normal secretion under both normal conditions and during state of stress.

BackgroundObstructive sleep apnea (OSA) is a prevalent disease that is associated with an increased incidence of type II diabetes mellitus (DM) if left untreated. We aimed to determine the association between glycosylated hemoglobin (HbA1c) levels and both nocturnal hypoxemia and apnea-hypopnea index (AHI) among a Saudi patients with OSA.MethodsA cross-sectional study that enrolled 103 adult patients diagnosed with DM and confirmed to have OSA by full night attended polysomnography between 2018 and 2021. Those who presented with acute illness, chronic obstructive pulmonary disease (COPD)/restrictive lung diseases causing sleep-related hypoxemia, or no available HbA1c level within 6 months before polysomnography were excluded from the study. Univariate and multivariate linear regression analyses between HbA1c levels and parameters of interest were tested.ResultsSixty-seven (65%) of the studied population had uncontrolled DM (HbA1c ≥7%). In univariate regression analysis, there was a significant positive association between HbA1c, and sleep time spent with an oxygen saturation below 90% (T90), female gender, and body mass index (BMI) (p&lt;0.05) but not AHI, or associated comorbidities (p&gt;0.05). In the multivariate analysis, HbA1c was positively associated with increasing T90 (p&lt;0.05), and ODI (p&lt;0.05), but not with AHI (p&gt;0.05).ConclusionNocturnal hypoxemia could be an important factor affecting glycemic control in patients with OSA suffering from DM irrespective of the severity of both diseases.