Disorders of the Posterior Pituitary

Srivatsa, Abhinash; Majzoub, Joseph A.

doi:10.1016/b978-0-323-62520-3.00012-9

Cited by 11 publications

(5 citation statements)

References 429 publications

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“…Hyponatremia has multiple etiologies, but the most common cause, which constitutes 60% of all types, is the syndrome of inappropriate antidiuretic hormone secretion (SIADH) [ 6 ]. The syndrome of inappropriate antidiuretic hormone secretion is a condition in which the antidiuretic hormone level is abnormally high irrespective of low serum osmolarity, causing sodium and water imbalance depicted by hypoosmolar hyponatremia and impairment in urinary water excretion except for kidney disease or other endocrinology influences resulting in antidiuretic hormone (ADH) release [ 7 , 8 ]. It was first described by Schwartz et al in 1957 in two patients with bronchogenic carcinoma with low serum osmolality and concentrated urine (i.e., >100 mOsm/kg H2O) [ 9 ].…”

Section: Reviewmentioning

confidence: 99%

“…The management of hyponatremia (Figure 3 ) depends on the underlying causes associated with volume status [ 8 , 131 ].…”

Section: Reviewmentioning

confidence: 99%

“…The management of hyponatremia (Figure 3) depends on the underlying causes associated with volume status [8,131]. The treatment options for SIADH are numerous; therefore, clinical judgment (based on the chronicity of the hyponatremia and the neurological symptoms) and individualized risk-benefit analysis should guide therapeutic decisions [95].…”

Section: Management Of Hyponatremiamentioning

confidence: 99%

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A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature

Ghosal,

Qadeer,

Nekkanti

et al. 2023

Cureus

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Hyponatremia is the most prevalent electrolyte imbalance encountered among hospitalized patients, athletes, the elderly, patients with chronic ailments, postoperative patients, and a few asymptomatic individuals. Clinical manifestations of hyponatremia can be diverse, with characteristic neurological symptoms. Depending on in-depth medical history, physical examination (including volume status assessment), laboratory investigation, and drug history, patients can be classified broadly as undergoing hypervolemic, euvolemic, or hypovolemic hyponatremia. However, patients with hypervolemic hyponatremia often present with distinctive signs such as edema or ascites, and the clinical presentation of hypovolemic and euvolemic hyponatremia poses significant challenges for clinicians. The convolution in clinical manifestations of patients is due to the varied etiologies of euvolemic hyponatremia, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), adrenocortical insufficiency, hypothyroidism, psychogenic polydipsia, different classes of drugs (chemotherapeutics, antipsychotics, antidepressants), endurance exercise events, and reset osmostat syndrome (ROS). The management of hyponatremia depends on the rate of hyponatremia onset, duration, severity of symptoms, levels of serum sodium, and underlying comorbidities. Over the last decade, the clinical understanding of hyponatremia has been scattered due to the introduction of innovative laboratory markers and new drugs. This article will be a conspectus of all the recent advancements in the field of diagnosis, investigations, management, and associations of hyponatremia, along with traditional clinical practices. Subsequently, a holistic overview has been laid out for the clinicians to better understand and identify knowledge deficiencies on this topic.

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Section: Reviewmentioning

confidence: 99%

“…The management of hyponatremia (Figure 3 ) depends on the underlying causes associated with volume status [ 8 , 131 ].…”

Section: Reviewmentioning

confidence: 99%

Section: Management Of Hyponatremiamentioning

confidence: 99%

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A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature

Ghosal,

Qadeer,

Nekkanti

et al. 2023

Cureus

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“…Measurement of serum copeptin has been shown to be useful in the diagnostic evaluation of adult subjects with the polyuria-polydipsia syndrome (PPS), a condition characterized by large output of hypotonic urine (greater than 50 mL/kg in adults [6] or greater than 2 L/m 2 /day in children [7]) with similarly increased intake of fluids. The differential diagnosis of PPS includes primary polydipsia and central and nephrogenic diabetes insipidus.…”

Section: Introductionmentioning

confidence: 99%

Combined Arginine and Insulin Stimulation Elicits a Robust and Consistent Copeptin Response in Short Children

et al. 2022

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Introduction: Copeptin, co-secreted with arginine-vasopressin, is regulated by osmotic and volume stimuli but also responds to intravenous arginine and insulin-induced hypoglycemia. The serum copeptin response to the latter agents has been studied in adults, but only to a limited extent in children. The objective of this study was to describe the copeptin response to combined arginine and insulin in children with normal posterior pituitary function. Methods: We conducted a prospective, single-arm assessment of serum copeptin concentrations in children (age 7-16 years, n=38) undergoing growth hormone stimulation testing with an arginine-insulin tolerance test (AITT) for short stature or growth deceleration in a tertiary referral center. After overnight fasting, arginine (500 mg/kg) was administered between 0-30 minutes intravenously (IV) followed by insulin (0.1 units/kg IV) at 60 minutes. Copeptin serum concentrations were measured at baseline (0 minutes), at the post-arginine peak (60 minutes), and at the post-insulin peak (90 minutes; 30 minutes post-insulin), respectively. The main outcome was the peak copeptin concentration. Results: Mean±SD copeptin concentrations increased from 9.9±5.0 pmol/L at 0 minutes to 13.2±5.8 pmol/L at 60 minutes (p<0.0001 vs. 0 minutes) and 27.7±14.2 pmol/L at 90 minutes (p<0.0001 vs 0 and 60 minutes). There was no significant correlation between copeptin concentrations and age, BMI, pubertal status, cortisol, growth hormone, or glucose concentrations. Discussion/Conclusion: Arginine and insulin appear to have an additive and consistent effect resulting in significant stimulation of copeptin secretion in children. The AITT may be a useful tool to evaluate for normal posterior pituitary function in this age group, with potential implications for the evaluation of polyuria-polydipsia syndrome.

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“…In otherwise healthy individuals with DI, the thirst system can maintain plasma osmolality in the near-normal range despite relative AVP deficiency or decreased action [ 4 ]. In patients with DI who have normal cognition and free access to water, true hypernatremia (plasma sodium concentration >150 mmol/L) should not occur given that the initial water loss stimulates thirst, resulting in increased water consumption that matches urinary losses [ 5 , 6 ]. However, in cases where DI presents with adipsia, cognitive impairment, or restricted access to water, true hypernatremia can occur, leading to severe morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Adipsic Diabetes Insipidus in Children: A Case Report and Practical Guide

2021

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Patient: Male, 2-year-old Final Diagnosis: Adipsic diabetes insipidus Symptoms: Dehydration • polyuria Medication: Desmopressin Clinical Procedure: Fluid replacement Specialty: Pediatrics and Neonatology • Endocrine and Metabolic Objective: Rare coexistence of disease or pathology Background: Diabetes insipidus (DI) is a clinical syndrome characterized by polyuria and polydipsia that result from a deficiency of antidiuretic hormone (ADH), central DI, or resistance to ADH, nephrogenic DI. In otherwise healthy patients with DI, normal thirst mechanism, and free access to water, the thirst system can maintain plasma osmolality in the near-normal range. However, in cases where DI presents with adipsia, cognitive impairment, or restricted access to water, true hypernatremia may occur, leading to severe morbidity and mortality. Case Report: We report a case of a 2-year-old boy who had global developmental delay and post-brain debulking surgery involving the hypothalamic region, which resulted in central DI and thirst center dysfunction. We describe the clinical presentation, the current understanding of adipsic DI, and a new practical approach for management. The main guidelines of treatment include (1) fixed desmopressin dosing that allows minimal urinary breakthroughs in-between the doses; (2) timely diaper weight-based replacement of water; (3) bodyweight-based fluid correction 2 times a day, and (4) providing the nutritional and water requirements in a way similar to any healthy child but at fixed time intervals. Conclusions: This plan of management showed good effectiveness in controlling plasma sodium level and volume status of a child with adipsic DI without interfering with his average growth. This home treatment method is practical and readily available, provided that the family remains very adherent.

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Disorders of the Posterior Pituitary

Cited by 11 publications

References 429 publications

A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature

A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature

Combined Arginine and Insulin Stimulation Elicits a Robust and Consistent Copeptin Response in Short Children

Adipsic Diabetes Insipidus in Children: A Case Report and Practical Guide

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