Clinical characteristics of central diabetes insipidus in Taiwanese children

Liu, Shih-Yao; Tung, Yung-Liang; Lee, Cheng-Ting; Liu, Hon‐Man; Peng, Steven Shinn-Forng; Wu, Mu-Zon; Kuo, Meng-Fai; Tsai, Wen–Yu

doi:10.1016/j.jfma.2013.06.019

Cited by 21 publications

(12 citation statements)

References 19 publications

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“…In our cohort, the causes of SSR lesions only included GCT, LCH and CP, whose proportions were 74.5, 18.2, and 7.3%, respectively. Liu et al (14) also found that GCT was the most common cause (52.6%) among acquired infiltrative disease or tumor in Taiwanese children with CDI, which was consistent with our results. This might indicate that GCT would be the most likely to invade the hypothalamic- (13), the proportion of GCT among acquire infiltrative disease or tumor was much lower (21.3, 21.1, and 26.7%, respectively).…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies about pediatric CDI mainly focused on etiology and common features, while our study mainly focused on CDI caused by SSR lesions, and summarized the detailed clinical manifestations, tumor markers, radiology characteristics and histopathology about each etiology, trying to offer evidence for diagnosis and differential diagnosis. Acquired infiltrative disease or tumor including CP, GCT, LCH, pituitary adenoma, lymphoma, astrocytoma, and cavernous hemangioma were all the etiology of CDI reported before (9,(11)(12)(13)(14). In our cohort, the causes of SSR lesions only included GCT, LCH and CP, whose proportions were 74.5, 18.2, and 7.3%, respectively.…”

Section: Discussionmentioning

confidence: 70%

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Clinical Characteristics of Pediatric Patients With Sellar and Suprasellar Lesions Who Initially Present With Central Diabetes Insipidus: A Retrospective Study of 55 Cases From a Large Pituitary Center in China

Wang

et al. 2020

Front. Endocrinol.

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Purpose: To increase knowledge for the early differential diagnosis and accurate therapeutic strategies for pediatric patients with sellar or suprasellar region (SSR) lesions who initially present with central diabetes insipidus (CDI).Methods: This is a retrospective review of 55 pediatric patients (≤14 years old) with identified lesions in the SSR who initially presented with CDI at a large pituitary center between 2012 and 2018. The following data were summarized: demographic, clinical, endocrine, and neuroimaging data, intraoperative findings, histopathological findings, treatments, and prognosis.Results: In our group, the etiologies of the SSR lesions included germ cell tumors (GCTs, 74.5%), Langerhans cell histiocytosis (LCH, 18.2%), and craniopharyngioma (CP, 7.3%). Almost all patients (50/55, 90.9%) showed anterior pituitary dysfunction [multiple axes dysfunction (38), and isolated axis dysfunction (14)], while the GH/IGF-I axis was the most affected. Most GCT patients presented with various clinical manifestations besides CDI and had elevated β-HCG, whereas LCH and CP patients mostly presented few non-specific symptoms besides CDI and most had normal level tumor markers. Sellar MRI demonstrated that posterior pituitary bright spot disappearance occurred in all patients, and pituitary stalk thickening was observed in 96.7% of patients. Treatment varied due to the different etiologies of the SSR lesions. After follow-up for 35.4 ± 20.2 months, the proportions of patients who needed AVP (arginine vasopressin) for GCT, LCH, and CP were 86.5, 100, and 75%, respectively, and the proportions of patients who needed HRT were 89.2, 50, and 75%, respectively. Ji et al. Pediatric SSR Lesions With CDIConclusion: For pediatric SSR lesions that first manifest as CDI, we should comprehensively consider clinical characteristics and imaging features to aid in their early differential diagnosis. Tumor markers and surgical histopathology are also great complements for the differential diagnosis. Additionally, various treatment strategies should be adopted according to different causes to improve the child's prognosis and quality of life.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 70%

Clinical Characteristics of Pediatric Patients With Sellar and Suprasellar Lesions Who Initially Present With Central Diabetes Insipidus: A Retrospective Study of 55 Cases From a Large Pituitary Center in China

Wang

et al. 2020

Front. Endocrinol.

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“…Dysfunction of the anterior pituitary can be determined at diagnosis and during the follow-up period of CDI. In the present study, 53.5% of the patients had anterior pituitary hormone deficiency when CDI was diagnosed, which was lower than the 80% reported by Liu et al [ 29 ]. Most of these patients had growth hormone deficiency, not related to etiology.…”

Section: Discussioncontrasting

confidence: 82%

Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus

Wang

Liu

et al. 2016

International Journal of Endocrinology

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Objective. In pediatric central diabetes insipidus (CDI), etiology diagnosis and pituitary function monitoring are usually delayed. This study aimed to illustrate the importance of regular follow-up and pituitary function monitoring in pediatric CDI. Methods. The clinical, hormonal, and neuroradiological characteristics of children with CDI at diagnosis and during 1.5–2-year follow-up were collected and analyzed. Results. The study included 43 CDI patients. The mean interval between initial manifestation and diagnosis was 22.29 ± 3.67 months (range: 2–108 months). The most common complaint was polyuria/polydipsia. Causes included Langerhans cell histiocytosis, germinoma, and craniopharyngioma in 2, 5, and 4 patients; the remaining were idiopathic. No significant changes were found during the 1.5–2 years after CDI diagnosis. Twenty-three of the 43 cases (53.5%) had ≥1 anterior pituitary hormone deficiency. Isolated growth hormone deficiency was the most frequent abnormality (37.5%) and was not associated with pituitary stalk diameter. Multiple pituitary hormone deficiencies were found in 8 cases with pituitary stalk diameter > 4.5 mm. Conclusion. Diagnosis of CDI is usually delayed. CDI with a pituitary stalk diameter > 4.5 mm carries a higher risk of multiple pituitary hormone deficiencies. Long-term MRI and pituitary function follow-ups are necessary for children with idiopathic CDI.

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“…[ 18 ] Germ cell tumors and Langerhans cell histiocytosis (LCH) accounted for 60% of CDI cases in Taiwanese children, and histiocytosis accounted for 18.6% of cases in Indian children. [ 16 19 ] LCH as a cause of CDI has been associated with better survival. [ 17 ]…”

Section: T Ypes Of D Iabetes I mentioning

confidence: 99%

Diabetes insipidus: The other diabetes

Kalra¹,

Zargar²,

Jain³

et al. 2016

Indian J Endocr Metab

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Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefits over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.

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Clinical characteristics of central diabetes insipidus in Taiwanese children

Cited by 21 publications

References 19 publications

Clinical Characteristics of Pediatric Patients With Sellar and Suprasellar Lesions Who Initially Present With Central Diabetes Insipidus: A Retrospective Study of 55 Cases From a Large Pituitary Center in China

Clinical Characteristics of Pediatric Patients With Sellar and Suprasellar Lesions Who Initially Present With Central Diabetes Insipidus: A Retrospective Study of 55 Cases From a Large Pituitary Center in China

Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus

Diabetes insipidus: The other diabetes

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