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Stock A, Calaminus G, Weisthoff M, Serfling J, Pietsch T, Bison B, Pham M, Warmuth-Metz M. Imaging in malignant germ cell tumors involving the hypothalamo-neurohypophyseal axis: the evaluation of the posterior pituitary bright spot is essential. Neuroradiology 2024; 66:1405-1416. [PMID: 38844695 PMCID: PMC11246258 DOI: 10.1007/s00234-024-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Malignant intracranial germ cell tumors (GCTs) are rare diseases in Western countries. They arise in midline structures and diagnosis is often delayed. We evaluated imaging characteristics and early tumor signs of suprasellar and bifocal GCT on MRI. METHODS Patients with the diagnosis of a germinoma or non-germinomatous GCT (NGGCT) who received non-contrast sagittal T1WI on MRI pre-therapy were included. Loss of the posterior pituitary bright spot (PPBS), the expansion and size of the tumor, and the expansion and infiltration of surrounding structures were evaluated. Group comparison for histologies and localizations was performed. RESULTS A total of 102 GCT patients (median age at diagnosis 12.3 years, range 4.4-33.8; 57 males; 67 in suprasellar localization) were enrolled in the study. In the suprasellar cohort, NGGCTs (n = 20) were noticeably larger than germinomas (n = 47; p < .001). Each tumor showed involvement of the posterior lobe or pituitary stalk. A PPBS loss (total n = 98) was observed for each localization and entity in more than 90% and was related to diabetes insipidus. Osseous infiltration was observed exclusively in suprasellar GCT (significantly more frequent in NGGCT; p = .004). Time between the first MRI and therapy start was significantly longer in the suprasellar cohort (p = .005), with an even greater delay in germinoma compared to NGGCT (p = .002). The longest interval to treatment had circumscribed suprasellar germinomas (median 312 days). CONCLUSION A loss of the PPBS is a hint of tumor origin revealing small tumors in the neurohypophysis. Using this sign in children with diabetes insipidus avoids a delay in diagnosis.
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Affiliation(s)
- Annika Stock
- Department of Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, D-97080, Wuerzburg, Germany.
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Mathilda Weisthoff
- Department of Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, D-97080, Wuerzburg, Germany
- Department of Radiology, University Hospital Cologne, Colonge, Germany
| | - Julia Serfling
- Department of Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, D-97080, Wuerzburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg until 2020; Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg Since 2021, Augsburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, D-97080, Wuerzburg, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, D-97080, Wuerzburg, Germany
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Tuli G, Munarin J, De Sanctis L. The diagnostic role of arginine-stimulated copeptin in the differential diagnosis of polyuria-polydipsia syndrome (PPS) in pediatric age. Endocrine 2024; 84:677-682. [PMID: 38155322 DOI: 10.1007/s12020-023-03671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE In recent years, copeptin stimulation through arginine administration has been evaluated as a new potential tool in the differential diagnosis of polyuria-polydipsia syndrome (PPS) in adults; to date very few data, all retrospective, exist in pediatric age. The aim of this prospective study is to evaluate the diagnostic performance of the arginine-stimulation test for copeptin in a cohort of pediatric patients affected by PPS. METHODS All children (<18 years) referred to the Department of Pediatric Endocrinology of the Regina Margherita Children Hospital for polyuria-polydipsia in the period January 2021-June 2023 were enrolled. The Arginine-stimulation test for copeptin was performed in all patients presenting PPS after water deprivation test (WDT). Patients with polyuria-polydipsia were then classified as having primary polyuria (PP), complete and partial central diabetes insipidus (CDI), according to the standardized interpretation. Arginine-stimulation test for copeptin was also performed in a control cohort. RESULTS A significant difference in arginine-stimulated copeptin values was observed at baseline (p = 0.005), at 60 min (p = 0.01), and at 90 min (p = 0.005) in 7 subjects presenting PP, 6 patients affected by CDI and 50 subjects of the control cohort. Plasma osmolality values remained stable at all measurements. The arginine-stimulated copeptin test demonstrated sensitivity and specificity of 100%, whereas the sensitivity of the WDT test was 83.3% and the specificity was 85.7%. CONCLUSION Given the reliability and the minor adverse effects and costs, the copeptin level after arginine administration could replace the WDT in the diagnostic workup of these in pediatric age.
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Affiliation(s)
- Gerdi Tuli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
| | - Jessica Munarin
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
| | - Luisa De Sanctis
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Korkmaz HA, Arya VB, Gönüllü A, Coşkunol F, Ozkan B. Management of Central Diabetes Insipidus in Disabled Children with Diluted Oral Desmopressin Lyophilisate Formulation Administered Through Nasogastric Tube: A Retrospective Case Series. Paediatr Drugs 2023; 25:595-601. [PMID: 37326929 DOI: 10.1007/s40272-023-00578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Experience with nasogastric administration of oral DDAVP [desamino-D-arginine-8-vasopressin] lyophilisate (ODL) for central diabetes insipidus (CDI) in disabled children with swallowing coordination difficulties is limited. OBJECTIVE We aimed to assess the safety and efficacy of nasogastric use of ODL in disabled children with CDI. Time to serum sodium normalisation was compared with that of children with normal intellect and CDI treated with sublingual DDAVP. METHODS Clinical, laboratory and neuroimaging characteristics were evaluated for 12 disabled children with CDI treated with ODL through nasogastric tube at Dr Behcet Uz Children's Hospital, Turkey, between 2012 and 2022. RESULTS Six boys and six girls with a mean (±SD) age of 43 (± 40) months were evaluated. These children (mean [±SD] weight standard deviation score [SDS] - 1.2 ± 1.7; mean [±SD] height SDS - 1.3 ± 1.4) presented with failure to thrive, irritability, prolonged fever, polyuria and hypernatraemia (mean serum sodium 162 [±3.6] mEq/L). At diagnosis, mean serum and urine osmolality were 321 (± 14) mOsm/kg and 105 (± 7.8) mOsm/kg, respectively. Arginine vasopressin (AVP) levels were undetectable (< 0.5 pmol/L) at diagnosis in all patients. Nasogastric tube administration of DDAVP lyophilisate (120 µg/tablet) dissolved in water (10 mL) was commenced at a dose of 1-5 µg/kg/day in two divided doses together with controlled water intake to avoid hyponatraemia. The frequency and dose of DDAVP were titrated based on urine output and serum sodium concentration. Serum sodium declined at a rate of 0.11 ± 0.03 mEq/L/h and reached normal range in a mean duration of 174 ± 46.5 h. Serum sodium declined faster in children with normal intellect and CDI treated with sublingual DDAVP (1.28 ± 0.39 mEq/L/h; p = 0.0003). Three disabled children needed rehospitalisation because of hypernatraemia due to unintentional DDAVP omission by caregivers. No episode of hyponatraemia was observed. Weight gain and growth were normal during the median (± interquartile range) follow-up duration of 32 ± 67 months. CONCLUSIONS Nasogastric administration of oral DDAVP lyophilised formulation was safe and effective in the treatment of CDI in disabled children in this small retrospective series.
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Affiliation(s)
- Hüseyin Anıl Korkmaz
- Division of Pediatric Endocrinology, Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey.
| | - Ved Bhushan Arya
- Division of Pediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Medicine and Life Science, King's College London, London, UK
| | - Ahmet Gönüllü
- Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fulya Coşkunol
- Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Behzat Ozkan
- Division of Pediatric Endocrinology, Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Claude F, Ubertini G, Szinnai G. Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1617. [PMID: 36360345 PMCID: PMC9688119 DOI: 10.3390/children9111617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. CONCLUSION Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.
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Affiliation(s)
- Fabien Claude
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Graziamaria Ubertini
- Department of Pediatric Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, 4056 Basel, Switzerland
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Morana G, Shaw D, MacDonald SM, Alapetite C, Ajithkumar T, Bhatia A, Brisse H, Jaimes C, Czech T, Dhall G, Fangusaro J, Faure-Conter C, Fouladi M, Hargrave D, Harreld JH, Mitra D, Nicholson JC, Souweidane M, Timmermann B, Calaminus G, Bartels U, Bison B, Murray MJ. Imaging response assessment for CNS germ cell tumours: consensus recommendations from the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group. Lancet Oncol 2022; 23:e218-e228. [PMID: 35489353 DOI: 10.1016/s1470-2045(22)00063-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
Homogeneous and common objective disease assessments and standardised response criteria are important for better international clinical trials for CNS germ cell tumours. Currently, European protocols differ from those of North America (the USA and Canada) in terms of criteria to assess radiological disease response. An international working group of the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group was therefore established to review existing literature and current practices, identify major challenges regarding imaging assessment, and develop consensus recommendations for imaging response assessment for patients with CNS germ cell tumours. New clinical imaging standards were defined for the most common sites of CNS germ cell tumour and for the definition of locoregional extension. These new standards will allow the evaluation of response to therapy in patients with CNS germ cell tumours to be more consistent, and facilitate direct comparison of treatment outcomes across international studies.
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Affiliation(s)
- Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin, Italy
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Alapetite
- Department of Radiation Oncology and Proton Center, Institut Curie, Paris, France
| | - Thankamma Ajithkumar
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hervé Brisse
- Department of Imaging, Institut Curie, Paris, France
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital and Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Girish Dhall
- Division of Pediatric Hematology and Oncology, Department of Pediatrics School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Maryam Fouladi
- Department of Pediatric Hematology and Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Darren Hargrave
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie H Harreld
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Souweidane
- Department of Neurosurgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital, Essen, Germany; West German Proton Therapy Centre, Essen, Germany; West German Cancer Center, Essen, Germany
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Ute Bartels
- Pediatric Brain Tumour Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK.
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Patti G, Napoli F, Fava D, Casalini E, Di Iorgi N, Maghnie M. Approach to the Pediatric Patient: Central Diabetes Insipidus. J Clin Endocrinol Metab 2022; 107:1407-1416. [PMID: 34993537 DOI: 10.1210/clinem/dgab930] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 11/19/2022]
Abstract
Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of disorders affecting the hypothalamic-posterior pituitary network. The differential diagnosis is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies, and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating congenital or acquired cerebral and pituitary stalk lesions. Pituitary stalk size at presentation could be normal, but it may change over time, depending on the underlying condition, while other brain areas or organs may become involved during follow-up. Early diagnosis and treatment are crucial to avoid central nervous system damage and germ cell tumor dissemination and to minimize complications of multiple pituitary hormone defects. We provide a practical update on the diagnosis and management of patients with CDI and highlight several pitfalls that may complicate the differential diagnosis of conditions presenting with polyuria and polydipsia. The need for a careful and close follow-up of patients with apparently idiopathic CDI is particularly emphasized because the underlying condition may be recognized over time. The clinical scenario that we outline at the beginning of this article represents the basis for the discussion about how the etiological diagnosis of CDI can be overlooked and demonstrates how a water intake and urine output improvement can be a sign of progressive damage of both hypothalamus and anterior pituitary gland with associated pituitary hormonal deficiencies.
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Emilio Casalini
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Variability in Oral Desmopressin Dose Requirements in Children with Central Diabetes Insipidus. J Pediatr 2021; 239:228-230. [PMID: 34487771 DOI: 10.1016/j.jpeds.2021.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
There is inconsistency in the amount of oral desmopressin that children with central diabetes insipidus require. We investigated whether clinical characteristics influenced desmopressin dose requirements in 100 children with central diabetes insipidus. Extremely large doses were associated with acquired etiology (P = .04), greater body mass index z score, intact thirst, and additional pituitary hormone deficiencies (P < .001).
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Abstract
Diabetes insipidus (DI) is a disorder characterized by a high hypotonic urinary output of more than 50ml per kg body weight per 24 hours, with associated polydipsia of more than 3 liters a day [1,2]. Central DI results from inadequate secretion and usually deficient synthesis of Arginine vasopressin (AVP) in the hypothalamus or pituitary gland. Besides central DI further underlying etiologies of DI can be due to other primary forms (renal origin) or secondary forms of polyuria (resulting from primary polydipsia). All these forms belong to the Polyuria Polydipsia Syndrom (PPS). In most cases central and nephrogenic DI are acquired, but there are also congenital forms caused by genetic mutations of the AVP gene (central DI) [3] or by mutations in the gene for the AVP V2R or the AQP2 water channel (nephrogenic DI) [4]. Primary polydipsia (PP) as secondary form of polyuria includes an excessive intake of large amounts of fluid leading to polyuria in the presence of intact AVP secretion and appropriate antidiuretic renal response. Differentiation between the three mentioned entities is difficult [5], especially in patients with Primary polydipsia or partial, mild forms of DI [1,6], but different tests for differential diagnosis, most recently based on measurement of copeptin, and a thorough medical history mostly lead to the correct diagnosis. This is important since treatment strategies vary and application of the wrong treatment can be dangerous [7]. Treatment of central DI consists of fluid management and drug therapy with the synthetic AVP analogue Desmopressin (DDAVP), that is used as nasal or oral preparation in most cases. Main side effect can be dilutional hyponatremia [8]. In this review we will focus on central diabetes insipidus and describe the prevalence, the clinical manifestations, the etiology as well as the differential diagnosis and management of central diabetes insipidus in the out- and inpatient setting.
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Yasuda T, Murakami T, Yasoda A, Sone M, Harada N, Ogura M, Inagaki N. Clinical Practice Changes After Post-Market Safety Reports on Desmopressin Orally Disintegrating Tablet in Japan: A Single-Center Retrospective Study. J Clin Med Res 2021; 13:92-100. [PMID: 33747323 PMCID: PMC7935623 DOI: 10.14740/jocmr4399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 11/11/2022] Open
Abstract
Background Desmopressin orally disintegrating tablet (ODT) was approved in March 2012 in Japan; the post-market safety reports, which warned about adequate initial dose of desmopressin ODT, were published in 2014. However, it is unclear how the warning affected physician and patient behavior. Methods We performed a retrospective single-center study to compare the clinical situation of Japanese central diabetes insipidus patients before and after the report. Results Thirty-four patients before October 2014 and 16 patients after November 2014 switched from intranasal desmopressin to desmopressin ODT. The mean follow-up period after the switch to desmopressin ODT was 38 ± 3 months. Patients switching after November 2014 tended to have lower ratios of oral to nasal desmopressin dose at switching and 3 months after the switch (at switching; P = 0.20, 3 months; P = 0.42, respectively), and higher ratios from 6 to 12 months than before October 2014 (6 months; P = 0.93, 9 months; P = 0.52, 12 months; P = 0.80, respectively). Relative doses per initial desmopressin ODT at 9 and 12 months were significantly higher in patients switching after November 2014 than in patients switching before October 2014 (9 months; P = 0.02, 12 months; P = 0.04, respectively). Moreover, logistic regression analysis revealed that the incidence of hyponatremia was dependent on the ratio of nasal to oral desmopressin dose (P = 0.02). In addition, in four out of six patients who had serum sodium level reduced below 130 mEq/L, hyponatremia occurred within 1 month after the switch. Conclusions A more gradual dose titration after the safety reports was performed, which involved the long-term safety of desmopressin ODT use. Vigilance of hyponatremia in early phase of desmopressin ODT use should be noted.
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Affiliation(s)
- Takuma Yasuda
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,The first two authors (T.Y. and T.M.) contributed equally to this work
| | - Takaaki Murakami
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,The first two authors (T.Y. and T.M.) contributed equally to this work
| | - Akihiro Yasoda
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Norio Harada
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahito Ogura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Binder G, Schnabel D, Reinehr T, Pfäffle R, Dörr HG, Bettendorf M, Hauffa B, Woelfle J. Evolving pituitary hormone deficits in primarily isolated GHD: a review and experts' consensus. Mol Cell Pediatr 2020; 7:16. [PMID: 33140249 PMCID: PMC7606365 DOI: 10.1186/s40348-020-00108-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
Isolated growth hormone deficiency (GHD) is defined by growth failure in combination with retarded bone age, low serum insulin-like growth factor-1, and insufficient GH peaks in two independent GH stimulation tests. Congenital GHD can present at any age and can be associated with significant malformations of the pituitary-hypothalamic region or the midline of the brain. In rare instances, genetic analysis reveals germline mutations of transcription factors involved in embryogenesis of the pituitary gland and the hypothalamus. Acquired GHD is caused by radiation, inflammation, or tumor growth. In contrast to organic GHD, idiopathic forms are more frequent and remain unexplained.There is a risk of progression from isolated GHD to combined pituitary hormone deficiency (> 5% for the total group), which is clearly increased in children with organic GHD, especially with significant malformation of the pituitary gland. Therefore, it is prudent to exclude additional pituitary hormone deficiencies in the follow-up of children with isolated GHD by clinical and radiological observations and endocrine baseline tests. In contrast to primary disorders of endocrine glands, secondary deficiency is frequently milder in its clinical manifestation. The pituitary hormone deficiencies can develop over time from mild insufficiency to severe deficiency. This review summarizes the current knowledge on diagnostics and therapy of additional pituitary hormone deficits occurring during rhGH treatment in children initially diagnosed with isolated GHD. Although risk factors are known, there are no absolute criteria enabling exclusion of children without any risk of progress to combined pituitary hormone deficiency. Lifelong monitoring of the endocrine function of the pituitary gland is recommended in humans with organic GHD. This paper is the essence of a workshop of pediatric endocrinologists who screened the literature for evidence with respect to evolving pituitary deficits in initially isolated GHD, their diagnosis and treatment.
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Affiliation(s)
- Gerhard Binder
- University Children's Hospital, Pediatric Endocrinology, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
| | - Dirk Schnabel
- Center for Chronic Sick Children, Pediatric Endocrinology, Charité, University Medicine Berlin, Berlin, Germany
| | - Thomas Reinehr
- Vestische Children's Hospital, Pediatric Endocrinology, Diabetes and Nutrition Medicine, University of Witten/Herdecke, 45711, Datteln, Germany
| | - Roland Pfäffle
- University Children's Hospital Leipzig, Pediatric Endocrinology, University of Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Helmuth-Günther Dörr
- University Children's Hospital, Pediatric Endocrinology, 91301, Erlangen, Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Berthold Hauffa
- University Children's Hospital, Pediatric Endocrinology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Joachim Woelfle
- University Children's Hospital, Pediatric Endocrinology, Loschgestr. 15, 91054, Erlangen, Germany
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Bianco D, Napoli F, Morana G, Pistorio A, Allegri AEM, Fava D, Schiavone M, Thiabat HF, Crocco M, Camia T, Lezzi M, Calandrino A, Tortora D, Severino M, Patti G, Ibba A, Rossi A, Di Iorgi N, Maghnie M. Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging "Mismatch Pattern". J Clin Endocrinol Metab 2020; 105:5892808. [PMID: 32797230 DOI: 10.1210/clinem/dgaa540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. OBJECTIVE To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. METHODS We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. RESULTS Seventeen of 29 patients (58.6%) with idiopathic CDI displayed "mismatch pattern," consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while "mismatch" appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). CONCLUSIONS The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up.
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Affiliation(s)
- Deborah Bianco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maurizio Schiavone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Hanan F Thiabat
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marco Crocco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Camia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marilea Lezzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico Tortora
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Azienda Ospedaliera Brotzu, SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Andrea Rossi
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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12
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Hussain A, Baier RJ, Mehrem AA, Soylu H, Fraser D, Elsayed Y. Central Diabetes Insipidus in a Preterm Neonate Unresponsive to Intranasal Desmopressin. Neonatal Netw 2020; 39:339-346. [PMID: 33318230 DOI: 10.1891/0730-0832/11-t-679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 06/12/2023]
Abstract
Central or neurogenic diabetes insipidus (DI) is uncommon in the pediatric age group and rarely occurs in neonates. It should be suspected in any neonate presenting with excessive urine output and hypernatremia that persists despite increased fluid administration. Diabetes insipidus may be secondary to asphyxia, intraventricular hemorrhage, infection, and structural abnormalities or may be idiopathic or genetic. Diagnosis includes a careful history, laboratory testing, and magnetic resonance imaging. Management of neonatal DI involves a careful balance between fluid intake and pharmacologic treatment. In this article we report a case of an extremely low birth weight infant presenting with central DI possibly caused by abnormality of the pituitary gland. Persistent hypernatremia was the initial presentation. Increased fluids were given initially but were only partially helpful. Eventually subcutaneous desmopressin (DDAVP) was required. The infant was unresponsive to intranasal DDAVP and required subcutaneous DDAVP upon discharge.
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13
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Peinado Barraso MC, García García E. Monitorización domiciliaria de sodio en niños con diabetes insípida y adipsia. An Pediatr (Barc) 2020; 93:262-264. [DOI: 10.1016/j.anpedi.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022] Open
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14
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Home monitoring of sodium in children with adipsic diabetes insipidus. An Pediatr (Barc) 2020; 93:262-264. [DOI: 10.1016/j.anpede.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022] Open
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15
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Liu JS, Huang H, Jin JY, Du R, Wang CY, Fan LL. Identification of a Novel Arginine Vasopressin Receptor 2 Mutation (p.V183M) in a Chinese Family with Nephrogenic Diabetes Insipidus. Mol Syndromol 2020; 11:130-134. [PMID: 32903920 DOI: 10.1159/000507035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 11/19/2022] Open
Abstract
Loss of function of arginine vasopressin receptor 2 (AVPR2) may affect the recognition and binding of arginine vasopressin (AVP) which, in turn, may prevent the activation of Gs/adenylate cyclase and reduce the reabsorption of water by renal tubules and combined tubes. Finally, the organism may suffer from nephrogenic diabetes insipidus (NDI), a kind of kidney disorder featured by polyuria and polydipsia, due to a break of water homeostasis. In this study, we enrolled a Chinese family with polyuria and polydipsia. The proband presented abnormal fluid intake and excessive urine output. A water deprivation and AVP stimulation test further indicated that this patient had NDI. By sequencing known causative genes for diabetes insipidus, we identified a novel mutation in AVPR2 (c.547G>A; p.V183M) in the family. This mutation, located in a conserved site of AVPR2 and predicted to be disease-causing by informatics programs, was absent in our 200 controls and other public databases. Our study not only further confirms the clinical diagnosis, but also expands the spectrum of AVPR2 mutations and contributes to genetic diagnosis and counseling of patients with NDI.
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Affiliation(s)
- Ji-Shi Liu
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hao Huang
- Department of Cell Biology, The School of Life Sciences, Central South University, Changsha, China
| | - Jie-Yuan Jin
- Department of Cell Biology, The School of Life Sciences, Central South University, Changsha, China
| | - Ran Du
- Department of Cell Biology, The School of Life Sciences, Central South University, Changsha, China
| | - Chen-Yu Wang
- Department of Cell Biology, The School of Life Sciences, Central South University, Changsha, China
| | - Liang-Liang Fan
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, China.,Department of Cell Biology, The School of Life Sciences, Central South University, Changsha, China
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16
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Patti G, Ibba A, Morana G, Napoli F, Fava D, di Iorgi N, Maghnie M. Central diabetes insipidus in children: Diagnosis and management. Best Pract Res Clin Endocrinol Metab 2020; 34:101440. [PMID: 32646670 DOI: 10.1016/j.beem.2020.101440] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of conditions (genetic, congenital, inflammatory, neoplastic, traumatic) that arise mainly from the hypothalamus. The differential diagnosis between diseases presenting with polyuria and polydipsia is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating the sellar-suprasellar region in CDI. Pituitary stalk size at presentation is variable and can change over time, depending on the underlying condition, and other brain areas or other organs - in specific diseases - may become involved during follow up. An early diagnosis and treatment are preferable in order to avoid central nervous system damage and the risk of dissemination of germ cell tumor, or progression of Langerhans Cell Histiocytosis, and in order to start treatment of additional pituitary defects without further delay. This review focuses on current diagnostic work-up and on the role of neuroimaging in the differential diagnosis of CDI in children and adolescents. It provides an update on the best approach for diagnosis - including novel biochemical markers such as copeptin - treatment and follow up of children and adolescents with CDI; it also describes the best approach to challenging situations such as post-surgical patients, adipsic patients, patients undergoing chemotherapy and/or in critical care.
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MESH Headings
- Adolescent
- Age of Onset
- Biomarkers/analysis
- Brain/diagnostic imaging
- Brain/pathology
- Child
- Diabetes Insipidus, Neurogenic/diagnosis
- Diabetes Insipidus, Neurogenic/epidemiology
- Diabetes Insipidus, Neurogenic/etiology
- Diabetes Insipidus, Neurogenic/therapy
- Diagnosis, Differential
- Diagnostic Imaging/methods
- Diagnostic Imaging/trends
- Diagnostic Techniques, Endocrine/trends
- Histiocytosis, Langerhans-Cell/complications
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/epidemiology
- Histiocytosis, Langerhans-Cell/therapy
- Humans
- Magnetic Resonance Imaging
- Polydipsia/diagnosis
- Polydipsia/epidemiology
- Polydipsia/etiology
- Polydipsia/therapy
- Polyuria/diagnosis
- Polyuria/epidemiology
- Polyuria/etiology
- Polyuria/therapy
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy; Department of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Natascia di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
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17
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Hardacker DM, Myung KS, Hardacker KD, Dammann ER. Acute onset of central diabetes insipidus during adolescent idiopathic scoliosis surgery. Spine Deform 2020; 9:293-295. [PMID: 32827088 DOI: 10.1007/s43390-020-00187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
This is a case report of a 12-year-old female with idiopathic scoliosis undergoing posterior scoliosis reconstruction that developed an acute onset of central diabetes insipidus (CDI) during surgery. The diagnosis was made as a result of an intraoperative increase in urine output to 6.82 ml/kg/hour (550 ml), a serum sodium increase from 139 to 147 mmol/L, a serum osmolality of 299 mOsmol/kg, a rapid response to vasopressin administration and a low vasopressin level of < 0.5 picograms/ml (normal, 1-5 picograms/ml). This is the first reported case of CDI with a documented low vasopressin level that has occurred in a pediatric scoliosis surgical patient.
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Affiliation(s)
| | - Karen S Myung
- Indiana University School of Medicine, Indianapolis, USA
| | - Kyle D Hardacker
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Erin R Dammann
- Indiana University School of Medicine, Indianapolis, USA
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18
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Tuli G, Matarazzo P, de Sanctis L. Clinical Approach to Sodium Homeostasis Disorders in Children with Pituitary-Suprasellar Tumors. Neuroendocrinology 2020; 110:161-171. [PMID: 31401632 DOI: 10.1159/000502609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Abstract
Children with pituitary-suprasellar tumors are at high risk of developing sodium metabolism disorders since the tumoral mass itself or surgical and medical treatment can damage AVP release circuits. Additional risk factors are represented by the use of hypotonic fluids, the young age, total parenteral nutrition, and obstructive hydrocephalus secondary to tumor pathology. The most frequent hyponatremic disorders related to AVP in these patients are the syndrome of inappropriate ADH secretion and the cerebral/renal salt wasting syndrome, while hypernatremic conditions include central diabetes insipidus (CDI) and adipsic CDI. The main challenge in the management of these patients is to promptly distinguish the AVP release disorder at the base of the sodium imbalance and treat it correctly by avoiding rapid sodium fluctuations. These disorders can coexist or follow each other in a few hours or days; therefore, careful clinical and biochemical monitoring is necessary, especially during surgery, the use of chemotherapeutic agents, or radiotherapy. This monitoring should be performed by experienced healthcare professionals and should be multidisciplinary, including pediatric endocrinologists, neurosurgeons, and oncologists since maintaining sodium homeostasis also plays a prognostic role in terms of disease survival, therapeutic response, hospitalization rate, and mortality. In this review, we analyze the management of sodium homeostasis disorders in children with pituitary-suprasellar tumors and discuss the main challenges in the diagnosis and treatment of these conditions based on literature data and over 30 years of clinical experience at our Department of Pediatric Endocrinology.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy,
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy,
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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19
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Howell JC, Rose SR. Pituitary disease in pediatric brain tumor survivors. Expert Rev Endocrinol Metab 2019; 14:283-291. [PMID: 31131647 DOI: 10.1080/17446651.2019.1620599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Treatment of childhood brain tumors, including surgical resection and especially external beam radiation, often results in endocrine complications manifested by hypopituitarism, which can involve growth hormone deficiency, hypothyroidism, adrenal insufficiency, disorders of puberty, diabetes insipidus, and hypothalamic obesity. AREAS COVERED A comprehensive literature search was conducted on Medline (publications from the 1990s to 01/2019) including systematic reviews, meta-analyses, longitudinal controlled studies, retrospective cohort studies, and case reports. Herein, we present an up-to-date review of the current literature regarding endocrine sequellae of childhood brain tumor survivors. EXPERT OPINION Late endocrine sequellae can arise many years after the initial treatment of tumor, so at least annual surveillance of growth, puberty, weight, development, and endocrine status is recommended for at least 10 years after tumor therapy. This follow up should encompass childhood and adulthood among survivors. If found early, outcomes of endocrinopathies are favorable when treated appropriately. Newer tumor therapy modalities, such as proton beam radiation, offer the potential for fewer endocrine complications, but such benefit has yet to be demonstrated, and more research into short- and long-term outcomes is needed.
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Affiliation(s)
- Jonathan C Howell
- a Division of Pediatric Endocrinology , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Susan R Rose
- a Division of Pediatric Endocrinology , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , OH , USA
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20
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Biset A, Claris O. Idiopathic central diabetes insipidus in an extreme premature infant: A case report. Arch Pediatr 2018; 25:480-484. [PMID: 30361085 DOI: 10.1016/j.arcped.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/14/2018] [Accepted: 09/23/2018] [Indexed: 02/08/2023]
Abstract
CONTEXT Central diabetes insipidus (CDI) is a rare disease during the neonatal period, making it diagnosis difficult and delaying medical treatment. CASE REPORT We report here a case of a premature infant born at 26 weeks gestation who, during his 1st month of life, presented persistent hypernatremia with polyuria despite increased fluid supply and low sodium intake. CDI diagnosis was suspected and then confirmed by the therapeutic test with vasopressin analog, in its oral form. Electrolyte disorders were normalized after treatment, which allowed normal weight and height growth with standard fluid supply. Biological and radiological tests were all normal; this CDI was considered idiopathic. CONCLUSION Persistent hypernatremia with excessive diuresis should alert to CDI diagnosis.
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Affiliation(s)
- A Biset
- Department of neonatology, Hôpital Femme-Mère-Enfant, hospices Civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France.
| | - O Claris
- Department of neonatology, Hôpital Femme-Mère-Enfant, hospices Civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France; EA4128, université Claude Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France
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21
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Godano E, Morana G, Di Iorgi N, Pistorio A, Allegri AEM, Napoli F, Gastaldi R, Calcagno A, Patti G, Gallizia A, Notarnicola S, Giaccardi M, Noli S, Severino M, Tortora D, Rossi A, Maghnie M. Role of MRI T2-DRIVE in the assessment of pituitary stalk abnormalities without gadolinium in pituitary diseases. Eur J Endocrinol 2018; 178:613-622. [PMID: 29650689 DOI: 10.1530/eje-18-0094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/11/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the role of T2-DRIVE MRI sequence in the accurate measurement of pituitary stalk (PS) size and the identification of PS abnormalities in patients with hypothalamic-pituitary disorders without the use of gadolinium. DESIGN This was a retrospective study conducted on 242 patients who underwent MRI due to pituitary dysfunction between 2006 and 2015. Among 135 eligible patients, 102 showed eutopic posterior pituitary (PP) gland and 33 showed 'ectopic' PP (EPP). METHODS Two readers independently measured the size of PS in patients with eutopic PP at the proximal, midpoint and distal levels on pre- and post-contrast T1-weighted as well as T2-DRIVE images; PS visibility was assessed on pre-contrast T1 and T2-DRIVE sequences in those with EPP. The length, height, width and volume of the anterior pituitary (AP), PP height and length and PP area were analyzed. RESULTS Significant agreement between the two readers was obtained for T2-DRIVE PS measurements in patients with 'eutopic' PP; a significant difference was demonstrated between the intraclass correlation coefficient calculated on the T2-DRIVE and the T1-pre- and post-contrast sequences. The percentage of PS identified by T2-DRIVE in EPP patients was 72.7% compared to 30.3% of T1 pre-contrast sequences. A significant association was found between the visibility of PS on T2-DRIVE and the height of AP. CONCLUSION T2-DRIVE sequence is extremely precise and reliable for the evaluation of PS size and the recognition of PS abnormalities; the use of gadolinium-based contrast media does not add significant information and may thus be avoided.
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Affiliation(s)
- Elisabetta Godano
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Giovanni Morana
- Pediatric Neuroradiology UnitIstituto Giannina Gaslini, Genoa, Italy
| | - Natascia Di Iorgi
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics UnitIstituto Giannina Gaslini, Genoa, Italy
| | | | - Flavia Napoli
- Department of PediatricsIstituto Giannina Gaslini, Genoa, Italy
| | | | | | - Giuseppa Patti
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Annalisa Gallizia
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Sara Notarnicola
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marta Giaccardi
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Serena Noli
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | | | - Domenico Tortora
- Pediatric Neuroradiology UnitIstituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Pediatric Neuroradiology UnitIstituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of PediatricsIstituto Giannina Gaslini, University of Genoa, Genoa, Italy
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22
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Tuli G, Tessaris D, Einaudi S, Matarazzo P, De Sanctis L. Copeptin role in polyuria-polydipsia syndrome differential diagnosis and reference range in paediatric age. Clin Endocrinol (Oxf) 2018; 88:873-879. [PMID: 29464737 DOI: 10.1111/cen.13583] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Plasma arginine-vasopressin (AVP) analysis can help in the differential diagnosis of the polyuria-polydipsia syndrome (PPS), even if such investigation is hampered by technical difficulties, conversely to its surrogate copeptin. This study aims to enlarge the existing data on normal copeptin levels in childhood, to evaluate the correlation between copeptin, serum sodium and plasma and urine osmolality, and to assess the utility of the copeptin analysis in the diagnostic work-up of PPS in the paediatric age. PATIENTS AND METHODS Plasma copeptin levels were evaluated in 53 children without AVP disorders (control population), in 12 hypopituitaric children and in 15 patients with PPS after water deprivation test (WDT). RESULTS Mean basal copeptin levels were 5.2 ± 1.56 (range 2.4-8.6 pmol/L) in the control population, 2.61 ± 0.49 pmol/L in the hypopituitaric children with complete diabetes insipidus (CDI) (P = .04) and 6.21 ± 1.17 pmol/L in the hypopituitaric patients without DI (P = .02). After WDT, among 15 naïve polyuric/polydipsic children, copeptin values greater than 20 pmol/L allowed to identify nephrogenic diabetes insipidus (NDI), concentrations below 2.2 pmol/L complete central DI (CCDI) and between 5 and 20 pmol/L primary polydipsia (PP). Copeptin cut-off level of 3.5 pmol/L distinguished CDI from PP, with a sensitivity and specificity of 75% and 83.3%, respectively. CONCLUSION Copeptin evaluation holds promises as a diagnostic tool in paediatric PPS; its interpretation might be useful to promptly distinguish NDI, even avoiding the WDT need.
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Affiliation(s)
- Gerdi Tuli
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Daniele Tessaris
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Silvia Einaudi
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Patrizia Matarazzo
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Luisa De Sanctis
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
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Feng Z, Ou Y, Zhou M, Wu G, Ma L, Bao Y, Qiu B, Qi S. A rat model for pituitary stalk electric lesion-induced central diabetes insipidus: application of 3D printing and further outcome assessments. Exp Anim 2018; 67:383-392. [PMID: 29681579 PMCID: PMC6083024 DOI: 10.1538/expanim.18-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A stable and reproducible rat injury model is not currently available to study central
diabetes insipidus (CDI) and the neurohypophyseal system. In addition, a system is needed
to assess the severity of CDI and measure the accompanying neurobiological alterations. In
the present study, a 3D-printed lesion knife with a curved head was designed to fit into
the stereotaxic instrument. The neuro-anatomical features of the brain injury were
determined by in vivo magnetic resonance imaging (MRI) and arginine
vasopressin (AVP) immunostaining on brain sections. Rats that underwent pituitary stalk
electrical lesion (PEL) exhibited a tri-phasic pattern of CDI. MRI revealed that the
hyperintenseT1-weighted signal of the pituitary stalk was interrupted, and the brain
sections showed an enlarged end proximal to the injury site after PEL. In addition, the
number of AVP-positive cells in supraoptic nucleus (SON) and paraventricular nucleus (PVN)
decreased after PEL, which confirmed the success of the CDI model. Unlike hand-made tools,
the 3D-printed lesion knives were stable and reproducible. Next, we used an ordinal
clustering method for staging and the k-means’ clustering method to construct a CDI index
to evaluate the severity and recovery of CDI that could be used in other multiple animals,
even in clinical research. In conclusion, we established a standard PEL model with a
3D-printed knife tool and proposed a CDI index that will greatly facilitate further
research on CDI.
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Affiliation(s)
- Zhanpeng Feng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
| | - Yichao Ou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
| | - Mingfeng Zhou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
| | - Guangsen Wu
- The First School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, P.R. China
| | - Linzi Ma
- The First School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, P.R. China
| | - Yun Bao
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
| | - Binghui Qiu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, No. 1038, North Guangzhou Avenue, Baiyun District, Guangzhou 510515, P.R. China
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Monteiro AM, Marques O, Martins S, Antunes A. Iatrogenic water intoxication in a female adolescent with hypopituitarism. BMJ Case Rep 2018. [DOI: 10.1136/bcr-2017-223021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Morana G, Alves CA, Tortora D, Finlay JL, Severino M, Nozza P, Ravegnani M, Pavanello M, Milanaccio C, Maghnie M, Rossi A, Garrè ML. T2*-based MR imaging (gradient echo or susceptibility-weighted imaging) in midline and off-midline intracranial germ cell tumors: a pilot study. Neuroradiology 2017; 60:89-99. [PMID: 29128947 DOI: 10.1007/s00234-017-1947-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The role of T2*-based MR imaging in intracranial germ cell tumors (GCTs) has not been fully elucidated. The aim of this study was to evaluate the susceptibility-weighted imaging (SWI) or T2* gradient echo (GRE) features of germinomas and non-germinomatous germ cell tumors (NGGCTs) in midline and off-midline locations. METHODS We retrospectively evaluated all consecutive pediatric patients referred to our institution between 2005 and 2016, for newly diagnosed, treatment-naïve intracranial GCT, who underwent MRI, including T2*-based MR imaging (T2* GRE sequences or SWI). Standard pre- and post-contrast T1- and T2-weighted imaging characteristics along with T2*-based MR imaging features of all lesions were evaluated. Diagnosis was performed in accordance with the SIOP CNS GCT protocol criteria. RESULTS Twenty-four subjects met the inclusion criteria (17 males and 7 females). There were 17 patients with germinomas, including 5 basal ganglia primaries, and 7 patients with secreting NGGCT. All off-midline germinomas presented with SWI or GRE hypointensity; among midline GCT, all NGGCTs showed SWI or GRE hypointensity whereas all but one pure germinoma were isointense or hyperintense to normal parenchyma. A significant difference emerged on T2*-based MR imaging among midline germinomas, NGGCTs, and off-midline germinomas (p < 0.001). CONCLUSION Assessment of the SWI or GRE characteristics of intracranial GCT may potentially assist in differentiating pure germinomas from NGGCT and in the characterization of basal ganglia involvement. T2*-based MR imaging is recommended in case of suspected intracranial GCT.
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Affiliation(s)
- Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.
| | | | | | - Jonathan L Finlay
- Division of Hematology, Oncology and BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | | | - Paolo Nozza
- Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | | - Mohamad Maghnie
- Pediatric Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
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Di Iorgi N, Morana G, Allegri AEM, Napoli F, Gastaldi R, Calcagno A, Patti G, Loche S, Maghnie M. Classical and non-classical causes of GH deficiency in the paediatric age. Best Pract Res Clin Endocrinol Metab 2016; 30:705-736. [PMID: 27974186 DOI: 10.1016/j.beem.2016.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Growth hormone deficiency (GHD) may result from a failure of hypothalamic GHRH production or release, from congenital disorders of pituitary development, or from central nervous system insults including tumors, surgery, trauma, radiation or infiltration from inflammatory diseases. Idiopathic, isolated GHD is the most common sporadic form of hypopituitarism. GHD may also occur in combination with other pituitary hormone deficiencies, and is often referred to as hypopituitarism, combined pituitary hormone deficiency (CPHD), multiple pituitary hormone deficiency (MPHD) or panhypopituitarism. Children without any identifiable cause of their GHD are commonly labeled as having idiopathic hypopituitarism. MRI imaging is the technique of choice in the diagnosis of children with hypopituitarism. Marked differences in MRI pituitary gland morphology suggest different etiologies of GHD and different prognoses. Pituitary stalk agenesis and ectopic posterior pituitary (EPP) are specific markers of permanent GHD, and patients with these MRI findings show a different clinical and endocrine outcome compared to those with normal pituitary anatomy or hypoplastic pituitary alone. Furthermore, the classic triad of ectopic posterior pituitary gland, pituitary stalk hypoplasia/agenesis, and anterior pituitary gland hypoplasia is generally associated with permanent GHD. T2 DRIVE images aid in the identification of pituitary stalk without the use of contrast medium administration. Future developments in imaging techniques will undoubtedly reveal additional insights. Mutations in a number of genes encoding transcription factors - such as HESX1, SOX2, SOX3, LHX3, LHX4, PROP1, POU1F1, PITX, GLI3, GLI2, OTX2, ARNT2, IGSF1, FGF8, FGFR1, PROKR2, PROK2, CHD7, WDR11, NFKB2, PAX6, TCF7L1, IFT72, GPR161 and CDON - have been associated with pituitary dysfunction and abnormal pituitary gland development; the correlation of genetic mutations to endocrine and MRI phenotypes has improved our knowledge of pituitary development and management of patients with hypopituitarism, both in terms of possible genetic counseling, and of early diagnosis of evolving anterior pituitary hormone deficiencies.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Anna Elsa Maria Allegri
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Annalisa Calcagno
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Sandro Loche
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
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Abstract
Diabetes insipidus, the inability to concentrate urine resulting in polyuria and polydipsia, can have different manifestations and management considerations in infants and children compared to adults. Central diabetes insipidus, secondary to lack of vasopressin production, is more common in children than is nephrogenic diabetes insipidus, the inability to respond appropriately to vasopressin. The goal of treatment in both forms of diabetes insipidus is to decrease urine output and thirst while allowing for appropriate fluid balance, normonatremia and ensuring an acceptable quality of life for each patient. An infant's obligate need to consume calories as liquid and the need for readjustment of medication dosing in growing children both present unique challenges for diabetes insipidus management in the pediatric population. Treatment modalities typically include vasopressin or thiazide diuretics. Special consideration must be given when managing diabetes insipidus in the adipsic patient, post-surgical patient, and in those undergoing chemotherapy or receiving medications that alter free water clearance.
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Affiliation(s)
- Elizabeth Dabrowski
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA.
| | - Rachel Kadakia
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA.
| | - Donald Zimmerman
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA.
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Djermane A, Elmaleh M, Simon D, Poidvin A, Carel JC, Léger J. Central Diabetes Insipidus in Infancy With or Without Hypothalamic Adipsic Hypernatremia Syndrome: Early Identification and Outcome. J Clin Endocrinol Metab 2016; 101:635-43. [PMID: 26588450 DOI: 10.1210/jc.2015-3108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Neonatal central diabetes insipidus (CDI) with or without adipsia is a very rare complication of various complex hypothalamic disorders. It is associated with greater morbidity and a high risk of developing both hypernatremia and hyponatremia, due to the condition itself or secondary to treatment with vasopressin analogs or fluid administration. Its outcomes have yet to be evaluated. OBJECTIVE To investigate the clinical outcomes of patients with neonatal-onset CDI or adipsic CDI with hypernatremia. DESIGN, SETTING, AND PARTICIPANTS All patients diagnosed with neonatal CDI in a university hospital-based observational study and followed between 2005 and 2015 were included and analyzed retrospectively. MAIN OUTCOME MEASURES The various causes of CDI were grouped. Clinical outcome and comorbidities were analyzed. RESULTS Ten of the 12 patients had an underlying condition with brain malformations: optic nerve hypoplasia (n = 3), septo-optic dysplasia (n = 2), semilobar holoprosencephaly (n = 1), ectopic neurohypophysis (n = 3), and unilateral absence of the internal carotid artery (n = 1). The other two were idiopathic cases. During the median follow-up period of 7.8 (4.9-16.8) years, all but one patient displayed anterior pituitary deficiency. Transient CDI was found in three (25%) patients for whom a posterior pituitary hyperintense signal was observed with (n = 2) and without (n = 1) structural hypothalamic pituitary abnormalities, and with no other underlying cerebral malformations. Patients with permanent CDI with persistent adipsia (n = 4) and without adipsia (n = 5) required adequate fluid intake and various doses of desamino-D-arginine-8-vasopressin. Those with adipsia were more likely to develop hypernatremia (45 vs 33%), hyponatremia (16 vs 4%) (P < .0001), and severe neurodevelopmental delay (P < .05) than those without adipsia. Comorbidities were common. The underlying cause remains unknown at the age of 23 years for one patient with CDI and normal thirst. CONCLUSION Neonatal CDI may be transient or permanent. These vulnerable patients have high rates of comorbidity and require careful monitoring.
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Affiliation(s)
- Adel Djermane
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
| | - Monique Elmaleh
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
| | - Dominique Simon
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
| | - Amélie Poidvin
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
| | - Jean-Claude Carel
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
| | - Juliane Léger
- Assistance Publique-Hôpitaux de Paris (A.D., D.S., A.P., J.-C.C., J.L.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Radiology Department (M.E.), Université Paris Diderot (A.P., J.-C.C., J.L.), Sorbonne Paris Cité, F-75019 Paris, France; and Inserm, Unité 1141 (J.-C.C., J.L.), DHU Protect, F-75019 Paris, France
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29
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Adams PS, Cassara A. Dexmedetomidine-related polyuria in a pediatric patient. J Anesth 2015; 30:352-5. [DOI: 10.1007/s00540-015-2101-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
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30
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Abstract
Central diabetes insipidus is a very common disorder after brain surgery or/trauma or even in the presence of brain inflammatory diseases. Polyuria and polydipsia are the clinical markers, but sometimes clinical situations are presenting with no thirst. These are not frequent but are life-treating conditions. Diagnosis is not easy, and for this reason some cases are treated late. We describe here a very infrequent oncological case of dangerous adipsic diabetes insipidus in a young girl who survived.
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Affiliation(s)
| | - Margarida M Vieira
- Endocrinology and Neurology Department, Portuguese Cancer Institute, Lisbon, Portugal
| | - Joana Simões Pereira
- Endocrinology and Neurology Department, Portuguese Cancer Institute, Lisbon, Portugal
| | - Duarte Salgado
- Endocrinology and Neurology Department, Portuguese Cancer Institute, Lisbon, Portugal
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