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Case Reports 2015; 36(8): 734-736 PubMed PMID: 26921572 Citation  Keywords:  Antidiuretic Agents:therapeutic use, Deamino Arginine Vasopressin:therapeutic use, Female, Hormone Replacement Therapy:methods, Human Growth Hormone:therapeutic use, Humans, Hydrocortisone:therapeutic use, Hypopituitarism:diagnosis, Infant, Newborn, Magne.   

: Turner syndrome (TS) is a congenital disease caused by absence or structural abnormalities of sex chromosomes resulting in gonadal dysgenesis. Spontaneous pregnancies occur in 2-8% of patients, especially with mosaic kariotypes, however they are associated with increased risk of poor outcome both for mother and fetus. We report a 4-day-old male infant delivered by women with mosaic TS who was admitted to the pediatric intensive care unit and presented with severe panhypopituitarism as the early manifestation of pituitary stalk interruption syndrome (PSIS). To the best of our knowledge this is the first report of severe panhypopituitarism in a newborn borne by women with TS....

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Case Reports 2015; 36(5): 410-413 PubMed PMID: 26707038 Citation  Keywords:  Adult, Antidiuretic Agents:therapeutic use, Deamino Arginine Vasopressin:therapeutic use, Diabetes Insipidus:diagnosis, Female, Humans, Pregnancy, Pregnancy Complications:diagnosis,.   

: Gestational diabetes insipidus is a very rare complication. However, undiagnosed and untreated may lead to serious complications in both mother and fetus. In this study, a case of 34-year-old female patient with diabetes insipidus associated with pregnancy was reported. We discussed process of diagnosis and treatment with particular emphasis on the monitoring of water-electrolyte imbalance during labor....

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Clinical Trial 2012; 33(7): 680-683 PubMed PMID: 23391874 Citation  Keywords:  Aged, Arginine Vasopressin:blood, Carbidopa:adverse effects, Catechols:adverse effects, Dopamine Agonists:administration & dosage, Dose-Response Relationship, Drug, Drug Combinations, Drug Therapy, Combination, Female, Humans, Inappropriate ADH Syndrome:c.   

OBJECTIVES: Several cases of syndrome of inappropriate antidiuresis induced by anti-Parkinson agents have been reported. Our previous study demonstrated that pergolide and pramipexole stimulated elevation of plasma arginine vasopressin (AVP) levels in some patients with Parkinson's disease (PD), but that levodopa/carbidopa (300/30 mg/day) did not affect plasma AVP levels in treatment-naïve PD patients. On the basis of the binding profile of ropinirole to monoamine receptors, we hypothesized that ropinirole does not stimulate AVP secretion. The aim of this study was to test this hypothesis.

METHODS: Inclusion criteria were patients with probable PD suffering from a wearing-off phenomenon and who had been treated using levodopa/carbidopa with or without entacapone, but not with other classes of anti-Parkinson agents. Patients were excluded if they had at least one condition that could be associated with high AVP levels. Ropinirole was initiated at 0.5 mg 3 times daily, and daily dosages were increased by 1.5 mg/day on a biweekly basis up to 6 mg/day. Plasma AVP levels were determined every two weeks. Effects of escalating ropinirole dosage on plasma AVP levels were evaluated using a one-way analysis of variance for repeated measures, an a priori Dunnett multiple comparison test, and a regression analysis.

RESULTS: Of 16 patients enrolled, 11 patients (four males and seven females) completed the study. There was no statistically significant dose-response relationship between the ropinirole dosage and plasma AVP levels.

CONCLUSION: A minimal therapeutic dosage of ropinirole did not affect plasma AVP levels in patients with PD taking levodopa....

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Case Reports 2012; 33(2): 107-112 PubMed PMID: 22592189 Citation  Keywords:  Adult, Deamino Arginine Vasopressin:therapeutic use, Diabetes Insipidus:complications, Female, Humans, Pituitary Apoplexy:complications, Pituitary Neoplasms:complications, Postoperative Complications:drug therapy, Pregnancy, Pregnancy Complications, Neopl.   

BACKGROUND: Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).

CASE PRESENTATION: A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.

CONCLUSION: Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion....

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Journal Article 2012; 33(1): 34-36 PubMed PMID: 22467109 Citation  Keywords:  Arginine Vasopressin:blood, Carbidopa, Controlled Before-After Studies, Humans, Levodopa, Parkinson Disease:drug therapy,.   

OBJECTIVE: Several cases of syndrome of inappropriate antidiuresis (SIAD) induced by antiparkinson agents have been reported. Our previous study demonstrated that in some patients with Parkinson's disease (PD), pergolide and pramipexole stimulate elevations of plasma arginine vasopressin (AVP) levels even at doses that are lower than the ordinary maintenance dose. Although mean plasma AVP levels are significantly higher in treated PD patients than in treatment-naïve patients, neither disease severity nor levodopa/carbidopa dosage (range, 300/30-850/85 mg) correlates with plasma AVP levels. However, the effects of levodopa/carbidopa monotherapy on plasma AVP levels in older patients remain unknown. To address this issue, a 14-day before-after study was conducted.

METHODS: Subjects in this study were consecutive treatment-naïve patients with a diagnosis of possible PD who visited our clinic from November 2008 to September 2009. Patients had no conditions that could be associated with high plasma AVP levels. Twenty-five patients were treated with levodopa/carbidopa (100/10 mg) 3 times a day. A paired t-test was used to compare plasma AVP levels before and 14 days after initiation of treatment.

RESULTS: Five patients dropped out of this study. In the remaining 20 patients (8 males and 12 females), no significant differences were observed between mean plasma AVP levels before and during treatment with levodopa/carbidopa.

CONCLUSION: Monotherapy with levodopa/carbidopa (300/30 mg/day) does not affect plasma AVP levels in older PD patients and seems less likely to cause SIAD....

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Journal Article 2011; 32(1): 39-43 PubMed PMID: 21407160 Citation  Keywords:  Aged, Arginine Vasopressin:blood, Benzothiazoles:therapeutic use, Carbidopa:therapeutic use, Dopamine Agonists:therapeutic use, Female, Humans, Levodopa:therapeutic use, Male, Middle Aged, Parkinson Disease:drug therapy, Pergolide:therapeutic use,.   

OBJECTIVE: Several cases of syndrome of inappropriate antidiuresis induced by antiparkinson agents have been previously reported. However, the effect of antiparkinson agents on plasma arginine vasopressin (AVP) levels remains unknown in Parkinson's disease (PD) patients. The aim of the present study is to determine plasma AVP levels in PD patients and the effects of antiparkinson agents on these levels.

METHODS: PD patients who visited our clinic between November 2008 and September 2009 were included in this study. Patients were excluded if they had at least one condition that could be associated with high AVP levels. PD patients who had been treated with antiparkinson agents participated in this study (treated PD group, n=76). De novo PD patients were also included (n=25).

RESULTS: Mean plasma AVP levels were significantly higher in treated PD patients than those in treatment-naïve patients. Neither disease severity nor L-dopa dosage correlated with plasma AVP levels. Multiple linear regression analysis identified the male gender and pergolide dosage as weak independent predictors of high plasma AVP levels. While no difference in plasma AVP levels between genders in treatment-naïve patients was observed, mean plasma AVP levels were significantly higher in male patients than in female patients administered antiparkinson agents. Mean plasma AVP levels in pergolide users were significantly higher than those in dopamine agonist nonusers with corresponding disease duration and L-dopa/carbidopa dosage. In some patients, plasma AVP levels appeared to be dependent on pramipexole dosage.

CONCLUSION: Dopamine agonists may cause increased plasma AVP levels in some PD patients....

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Case Reports 2010; 31(5): 588-593 PubMed PMID: 21173753 Citation  Keywords:  Adolescent, Antidiuretic Agents:therapeutic use, Arginine Vasopressin:agonists, Deamino Arginine Vasopressin:therapeutic use, Diabetes Insipidus, Neurogenic:blood, Diagnosis, Differential, Drinking, Humans, Hypernatremia:blood, Male, Osmolar Concentration.   

OBJECTIVES: Essential hypernatremia is very rare in clinical practice and the pathogenesis is unclear. We performed a set of clinical tests to a patient with chronic and sustained hypernatremia as well as absence of thirst in order to investigate the clinical characteristics and make the diagnosis, yet most importantly to analyze the possible pathogenesis and explore a possible therapy regime.

METHODS: Water deprivation test and acute water intravenous loading test were performed to observe the changes of urinary osmolality, plasma osmolality and plasma sodium. Free water clearance (C(H₂O) was calculated. Osmolality was detected using the method of freezing point depression, and thirst grade using visual analogue scales. Desmopressin acetate (0.05-0.1 mg/d) was administered to the patient in order to observe the therapeutic effects to his disorder.

RESULTS: The patient had sustained hypernatremia over a long period of time, decreased thirst, normal renal function, as well as absence of clinical hypovoluemia. The plasma sodium was 160-190 mmol/L and plasma osmolality was 330-370 mOsm/L without any thirst perception which could not be corrected by water intake. An 18-hour period of water deprivation increased the urinary osmolality from 368 mOsm/L to 420 mOsm/L with plasma osmolality increasing from 362 mOsm/L to 369 mOsm/L and rising further to 857 mOsm/L after an injection of 5 u vasopresin. With the infusion of 1 250 ml 5%-glucose during 2 hours in an acute water loading test setting, plasma osmolality decreased from 350 mOsm/L to 334 mOsm/L associated with a plasma sodium decrease from 164.7 mmol/L to 155 mmol/L urinary osmolality dropped from a maximum of 632 mOsm/L to 135 mOsm/L urinary volume from 0.25 ml/min to 2.33 ml/min and C(H₂O) from -0.18 ml/min to 1.19 ml/min after acute water loading with 1 250 ml glucose dissolved in water. Our results reveal that treatment of the patient with Desmopressin acetate relieved the adypsia, hypernatremia and hyperosmolality effectively.

CONCLUSIONS: The patient was considered as suffering from essential hypernatremia which was associated with partial central diabetes insipidus and adypsia. Desmopressin acetate as a common therapeutic agent of central diabetes insipidus proved to be an effective treatment for essential hypernatremia....

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Journal Article 2008; 29(3): 341-346 PubMed PMID: 18580851 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Adult, Biomarkers, Body Mass Index, Cohort Studies, Female, Glycopeptides:analysis, Humans, Hydrocortisone:blood, Hypothalamus:metabolism, Male, Middle Aged, Sex Characteristics, Stress, Psychological:metabolism, Vasopre.   

BACKGROUND: During stress, vasopressin is a potent synergistic factor of CRH as a hypothalamic stimulator of the HPA axis. The measurements of CRH and vasopressin levels are cumbersome because of their instability and short half-life. Copeptin is a more stable peptide stoichiometrically released from the same precursor molecule. The aim of our study was to compare copeptin and cortisol levels in different stress situations.

METHODS: Three groups of patients with increasing stress levels were investigated: a) healthy controls without apparent stress (n=20), b) hospitalized medical patients with moderate stress (n=25) and c) surgical patients 30 minutes after extubation, with maximal stress (n=29). In all patients we assessed cortisol and copeptin levels. Copeptin levels were measured with a new sandwich immunoassay.

RESULTS: Cortisol levels in controls were (median, IQ range, 486 [397-588] nmol/L), not significantly different as compared to medical patients (438 [371-612] nmol/L, p=0.69). Cortisol levels in surgical patients after extubation were higher (744 [645-1062] nmol/L p<0.01 vs controls and medical patients). Copeptin levels in controls were 4.3 [3.2-5.5] pmol/L, which was lower as compared to medical patients (17.5 [6.4-24.1], p<0.001) and surgical patients after extubation (67.5 [37.8-110.0] pmol/L, p<0.001). The correlation between copeptin levels and cortisol was r=0.46, p<0.001.

CONCLUSION: Copeptin is a novel marker of the individual stress level. It more subtly mirrors moderate stress as compared to cortisol values....

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