Diabetes insipidus secondary to sellar/parasellar lesions

Angelousi, Anna; Mytareli, Chrysoula; Xekouki, Paraskevi; Kassi, Eva; Barkas, Konstantinos; Grossman, Ashley; Kaltsas, Gregory

doi:10.1111/jne.12954

Cited by 10 publications

(14 citation statements)

References 94 publications

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“…This highlights the importance of a long-term endocrine follow-up in these patients [ 33 – 36 ], for which is essential to personalize glucocorticoid replacement therapy [ 37 ]. The risk of developing CDI was higher in patients with non-endocrine lesions, as already reported [ 38 ].…”

Section: Discussionsupporting

confidence: 82%

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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Background Sellar/parasellar lesions have been studied in the adult and paediatric age range, but during the transition age their epidemiology, clinical manifestations, management and treatment outcomes have been poorly investigated. Materials and methods An Italian multicentre cohort study, in which hospital records of patients with diagnosis of sellar/parasellar lesions during the transition age and young adulthood (15–25 years), were reviewed in terms of prevalence, clinical and hormonal features at diagnosis, and outcomes where available. Both pituitary neuroendocrine tumours (pituitary tumours, Group A) and non-endocrine lesions (Group B) were included. Results Among Group A (n = 170, 46.5% macroadenomas), the most frequent were prolactin and GH-secreting tumours, with a female predominance. Among Group B (n = 28), germinomas and Rathke cells cysts were the most common. In Group A, the most frequent hormonal deficiency was gonadal dysfunction. Galactorrhoea and amenorrhoea were relatively common in female patients with prolactinomas. Pre-surgical diabetes insipidus was only seen in Group B, in which also hormone deficiencies were more frequent and numerous. Larger lesions were more likely to be seen in Group B. Patients in Group B were more frequently male, younger, and leaner than those of Group A, whereas at last follow-up they showed more obesity and dyslipidaemia. In our cohort, the percentage of patients with at least one pituitary deficiency increased slightly after surgery. Conclusions The management of sellar/parasellar lesions is challenging in the transition age, requiring an integrated and multidisciplinary approach. Hormone and metabolic disorders can occur many years after treatment, therefore long-term follow-up is mandatory.

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Section: Discussionsupporting

confidence: 82%

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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“…In Mena s series [40], neuroimaging did not identify abnormalities in the hypothalamus or pituitary glands. The loss of a high signal in the posterior pituitary gland in T1-weighted images has been reported in the majority of cases of central DI [99], but normal magnetic resonance imaging in children with primary central DI has been reported as well [100]. Although mild cases may have gone underdiagnosed, the lack of further reports in the literature calls into question the association between cCMV and central DI.…”

Section: Discussionmentioning

confidence: 99%

Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review

Ríos-Barnés¹,

Fortuny

Alarcón

et al. 2021

Microorganisms

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Background: Congenital cytomegalovirus (cCMV) infection is the most frequent mother-to-child transmitted infection worldwide and a prevalent cause of neonatal disease and long-term morbidity. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Nonetheless, kidney disease has rarely been reported in cCMV-infected patients. Objective: We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels. Methods: A systematic search was performed in the MEDLINE/PubMed, SCOPUS, and Cochrane databases. Studies describing any renal involvement in fetuses or neonates aged ≤3 weeks at diagnosis of microbiologically confirmed cCMV infection were eligible. Results: Twenty-four articles were included, with a very low level of evidence. Pathologic findings in autopsy studies universally described CMV typical inclusion bodies in tubular cells. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations. Congenital nephrotic syndrome was the most common clinical condition associated with cCMV, but a causal relationship cannot be established. Conclusions: Typical pathological features of cCMV infection are very common in renal tissue, but they do not seem to entail significant consequences at the anatomical or clinical levels.

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“…Although pituitary adenomas account for 90% of all sellar/ parasellar lesions, they seldom produce DI even when relatively large. 16 In one recent study, only 0.6% of 160 patients (i.e., a single patient) with NFPAs presented with pre-operative CDI. 18 The most common pathologies of sellar/parasellar lesions presenting with CDI are non-adenomatous lesions, whereas the highest prevalence of CDI was found in less commonly encountered pathologies such as germ-cell tumours (76.7%).…”

Section: Benign or Malignant Neoplasms Of The Hypothalamic-pituitary ...mentioning

confidence: 97%

“…New-onset postoperative DI was found in 27.8% of patients with nonadenomatous sellar/parasellar lesions undergoing eTSS. 16 The incidence of CDI after eTSS removal of pituitary adenomas limited to the sella varies from 11% to 22%, whereas, in very large tumours, it can occur in up to 60%-80% of cases, being transient in 1%-4%. 16,17 A new diagnosis of post-operative CDI was made in 7.5% of 160 patients with non-functioning pituitary adenomas (NFPAs)…”

Section: Neurosurgery or Traumamentioning

confidence: 99%

“…Other mostly non-neoplastic pathologies include lymphocytic hypophysitis, Langerhans cell histiocystosis (LCH), abscesses and neurosarcoidosis. 16,27 Additional infiltrative disorders include granulomatosis with polyangiitis, 28 and immunoglobulin (Ig)G4-related hypophysitis. 29,30 Most of these cases also present with concomitant anterior pituitary hormonal deficiencies.…”

Section: Systemic And/or Infiltrative Disordersmentioning

confidence: 99%

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New developments and concepts in the diagnosis and management of diabetes insipidus (AVP‐deficiency and resistance)

Angelousi

Alexandraki

Mytareli

et al. 2023

J Neuroendocrinology

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Diabetes insipidus (DI) is a disorder characterised by the excretion of large amounts of hypotonic urine, with a prevalence of 1 per 25,000 population. Central DI (CDI), better now referred to as arginine vasopressin (AVP)‐deficiency, is the most common form of DI resulting from deficiency of the hormone AVP from the pituitary. The less common nephrogenic DI (NDI) or AVP‐resistance develops secondary to AVP resistance in the kidneys. The majority of causes of DI are acquired, with CDI developing when more than 80% of AVP‐secreting neurons are damaged. Inherited/familial CDI causes account for approximately 1% of cases. Although the pathogenesis of NDI is unclear, more than 280 disease‐causing mutations affecting the AVP2 protein or AVP V2 receptor, as well as in aquaporin 2 (AQP2), have been described. Although the cAMP/protein kinase A pathway remains the major regulatory pathway of AVP/AQP2 action, in vitro data have also revealed additional cAMP independent pathways of NDI pathogenesis. Diagnosing partial forms of DI, and distinguishing them from primary polydipsia, can be challenging, previously necessitating the use of the water deprivation test. However, measurements of circulating copeptin levels, especially after stimulation, are increasingly replacing the classical tests in clinical practice because of their ease of use and high sensitivity and specificity. The treatment of CDI relies on desmopressin administration, whereas NDI requires the management of any underlying diseases, removal of offending drugs and, in some cases, administration of diuretics. A better understanding of the pathophysiology of DI has led to novel evolving therapeutic agents that are under clinical trial.

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Diabetes insipidus secondary to sellar/parasellar lesions

Cited by 10 publications

References 94 publications

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review

New developments and concepts in the diagnosis and management of diabetes insipidus (AVP‐deficiency and resistance)

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