Transient Central Diabetes Insipidus after Discontinuation of Vasopressin

Carman, Nathaniel; Kay, Carl; Petersen, Abigail; Kravchenko, Maria; Tate, Joshua

doi:10.1155/2019/4189525

Cited by 7 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conversely, additional treatment with surgery, stable vision status following surgery, transient DI, increased MIB-1/Ki-67 labeling index percentage, low preoperative cortisol axis, and a preoperative diagnosis of acromegaly were shown to increase the odds of a suboptimal outcome. Transient DI is a known complication of pituitary surgery and has been shown to be proportional to the degree of damage to the pituitary gland [31,32]. As a result, more aggressive tumors with a high likelihood of recurrence or progression may require increased margins of resection, thus increasing the rates of transient DI.…”

Section: Discussionmentioning

confidence: 99%

Neural network modeling for prediction of recurrence, progression, and hormonal non-remission in patients following resection of functional pituitary adenomas

et al. 2021

View full text Add to dashboard Cite

Purpose Functional pituitary adenomas (FPAs) cause severe neuro-endocrinopathies including Cushing's disease (CD) and acromegaly. While many are effectively cured following FPA resection, some encounter disease recurrence/progression or hormonal non-remission requiring adjuvant treatment. Identification of risk factors for suboptimal postoperative outcomes may guide initiation of adjuvant multimodal therapies. Methods Patients undergoing endonasal transsphenoidal resection for CD, acromegaly, and mammosomatotroph adenomas between 1992 and 2019 were identified. Good outcomes were defined as hormonal remission without imaging/biochemical evidence of disease recurrence/progression, while suboptimal outcomes were defined as hormonal non-remission or MRI evidence of recurrence/progression despite adjuvant treatment. Multivariate regression modeling and multilayered neural networks (NN) were implemented. The training sets randomly sampled 60% of all FPA patients, and validation/testing sets were 20% samples each. Results 348 patients with mean age of 41.7 years were identified. Eighty-one patients (23.3%) reported suboptimal outcomes. Variables predictive of suboptimal outcomes included: Requirement for additional surgery in patients who previously had surgery and continue to have functionally active tumor (p = 0.0069; OR = 1.51, 95%CI 1.12-2.04), Preoperative visual deficit not improved after surgery (p = 0.0033; OR = 1.12, 95%CI 1.04-1.20), Transient diabetes insipidus (p = 0.013; OR = 1.27, 95%CI 1.05-1.52), Higher MIB-1/Ki-67 labeling index (p = 0.038; OR = 1.08, 95%CI 1.01-1.15), and preoperative low cortisol axis (p = 0.040; OR = 2.72, 95%CI 1.06-7.01). The NN had overall accuracy of 87.1%, sensitivity of 89.5%, specificity of 76.9%, positive predictive value of 94.4%, and negative predictive value of 62.5%. NNs for all FPAs were more robust than for CD or acromegaly/mammosomatotroph alone. Conclusion We demonstrate capability of predicting suboptimal postoperative outcomes with high accuracy. NNs may aid in stratifying patients for risk of suboptimal outcomes, thereby guiding implementation of adjuvant treatment in high-risk patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Neural network modeling for prediction of recurrence, progression, and hormonal non-remission in patients following resection of functional pituitary adenomas

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Until 2019 and the COVID19 pandemic, several case reports and two case series described 47 patients who developed a clinical course of DI after vasopressin discontinuation. Not all reports include urine osmolarity results, but all reports described patients with polyuria and increased plasma sodium level (or its increment during polyuria) [ 7 , 14 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. Of these 47 patients, only 6 were treated with ECMO.…”

Section: Discussionmentioning

confidence: 99%

Transient diabetes insipidus in critically ill COVID19 patients

Statlender¹,

Fishman²,

Hellerman³

et al. 2023

Journal of Critical Care

View full text Add to dashboard Cite

“…However, data are emerging that suggest vasopressin may cause transient diabetes insipidus (DI) when discontinued. To date, there have been 14 case reports ( 4 – 12 ) describing this occurrence. With the use of vasopressin now standard in ICU practice, it is reasonable to expect further reports of this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Why So Salty? Transient Diabetes Insipidus After Discontinuation of Vasopressin

et al. 2022

View full text Add to dashboard Cite

In recent years, vasopressin has been increasingly used as an early treatment of vasopressor-refractory septic shock. In this article, we describe 2 episodes of transient diabetes insipidus after vasopressin for the treatment of septic shock was discontinued, which adds to a modest number of case studies reporting the same phenomenon. With the anticipated continued use of vasopressin in intensive care units, it can be expected that this adverse effect will occur with some frequency. Awareness and early recognition of this phenomenon can lead to prompt diagnosis and treatment.

show abstract

Transient Central Diabetes Insipidus after Discontinuation of Vasopressin

Cited by 7 publications

References 11 publications

Neural network modeling for prediction of recurrence, progression, and hormonal non-remission in patients following resection of functional pituitary adenomas

Neural network modeling for prediction of recurrence, progression, and hormonal non-remission in patients following resection of functional pituitary adenomas

Transient diabetes insipidus in critically ill COVID19 patients

Why So Salty? Transient Diabetes Insipidus After Discontinuation of Vasopressin

Contact Info

Product

Resources

About