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Li K, Feng Z, Xiong Z, Pan J, Zhou M, Li W, Ou Y, Wu G, Che M, Gong H, Peng J, Wang X, Qi S, Peng J. Growth hormone promotes the reconstruction of injured axons in the hypothalamo-neurohypophyseal system. Neural Regen Res 2024; 19:2249-2258. [PMID: 38488559 PMCID: PMC11034602 DOI: 10.4103/1673-5374.389358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 04/24/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202410000-00026/figure1/v/2024-02-06T055622Z/r/image-tiff Previous studies have shown that growth hormone can regulate hypothalamic energy metabolism, stress, and hormone release. Therefore, growth hormone has great potential for treating hypothalamic injury. In this study, we established a specific hypothalamic axon injury model by inducing hypothalamic pituitary stalk electric lesions in male mice. We then treated mice by intraperitoneal administration of growth hormone. Our results showed that growth hormone increased the expression of insulin-like growth factor 1 and its receptors, and promoted the survival of hypothalamic neurons, axonal regeneration, and vascular reconstruction from the median eminence through the posterior pituitary. Altogether, this alleviated hypothalamic injury-caused central diabetes insipidus and anxiety. These results suggest that growth hormone can promote axonal reconstruction after hypothalamic injury by regulating the growth hormone-insulin-like growth factor 1 axis.
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Affiliation(s)
- Kai Li
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhanpeng Feng
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhiwei Xiong
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jun Pan
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Mingfeng Zhou
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Weizhao Li
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yichao Ou
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Guangsen Wu
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Mengjie Che
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Haodong Gong
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Junjie Peng
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xingqin Wang
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Songtao Qi
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Junxiang Peng
- Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Varaldo E, Sibilla M, Prencipe N, Berton AM, Cuboni D, Aversa LS, Mocellini F, Bioletto F, Ghigo E, Gasco V, Grottoli S. Desmopressin dose requirements in patients with permanent arginine vasopressin deficiency: a tertiary center experience. Pituitary 2024:10.1007/s11102-024-01454-4. [PMID: 39266909 DOI: 10.1007/s11102-024-01454-4] [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] [Accepted: 08/24/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE The desmopressin daily dose requirement is highly variable among patients with arginine vasopressin (AVP) deficiency (i.e. central diabetes insipidus) and few studies to date have evaluated this topic, with often inconclusive results. The aim of our study was to identify clinical and biochemical predictors of such dose requirements in a cohort of patients with a confirmed diagnosis of permanent AVP deficiency who have good and stable control under substitutive treatment. METHODS We retrospectively analyzed data of all patients with permanent AVP deficiency undergoing regular follow-up at our Division. Inclusion criteria were the presence of stable disease under therapy for at least 12 months and in good biochemical and clinical control. Patients with AVP deficiency who lacked intact thirst or had a disease duration of less than 12 months were excluded from the analysis. RESULTS Out of the 132 patients initially screened, 96 patients (M/F 44/52; age 51 [37-63] years) met the inclusion criteria. Patients on nasal spray therapy (n = 8) had a significantly longer disease duration (p = 0.002) than patients treated with oral lyophilizate (n = 88). In the bivariate analysis, considering only patients treated with the sublingual formulation, the drug dose was correlated positively with estimated glomerular filtration rate (eGFR) and weight (r = 0.410, p < 0.001; r = 0.224, p = 0.036, respectively) and negatively with age (r = - 0.433, p < 0.001). In the multivariate regression analysis taking into account age, weight, and eGFR, only age emerged as a significant predictor of the required sublingual desmopressin dose (β = - 1.426, p = 0.044). CONCLUSION Our data suggest that patient age appears to be the primary factor associated with the daily sublingual desmopressin dose required to achieve adequate clinical and biochemical control in patients with permanent AVP deficiency.
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Affiliation(s)
- Emanuele Varaldo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy.
| | - Michela Sibilla
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Nunzia Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Alessandro Maria Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Daniela Cuboni
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Luigi Simone Aversa
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Francesca Mocellini
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Fabio Bioletto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Valentina Gasco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Silvia Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
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Fuse S, Fujisawa H, Murao N, Iwata N, Watanabe T, Seino Y, Takeuchi H, Suzuki A, Sugimura Y. Effects of hypernatremia on the microglia. Peptides 2024; 179:171267. [PMID: 38908517 DOI: 10.1016/j.peptides.2024.171267] [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: 02/26/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Signs and symptoms of hypernatremia largely indicate central nervous system dysfunction. Acute hypernatremia can cause demyelinating lesions similar to that observed in osmotic demyelination syndrome (ODS). We have previously demonstrated that microglia accumulate in ODS lesions and minocycline protects against ODS by inhibiting microglial activation. However, the direct effect of rapid rise in the sodium concentrations on microglia is largely unknown. In addition, the effect of chronic hypernatremia on microglia also remains elusive. Here, we investigated the effects of acute (6 or 24 h) and chronic (the extracellular sodium concentration was increased gradually for at least 7 days) high sodium concentrations on microglia using the microglial cell line, BV-2. We found that both acute and chronic high sodium concentrations increase NOS2 expression and nitric oxide (NO) production. We also demonstrated that the expression of nuclear factor of activated T-cells-5 (NFAT5) is increased by high sodium concentrations. Furthermore, NFAT5 knockdown suppressed NOS2 expression and NO production. We also demonstrated that high sodium concentrations decreased intracellular Ca2+ concentration and an inhibitor of Na+/Ca2+ exchanger, NCX, suppressed a decrease in intracellular Ca2+ concentrations and NOS2 expression and NO production induced by high sodium concentrations. Furthermore, minocycline inhibited NOS2 expression and NO production induced by high sodium concentrations. These in vitro data suggest that microglial activity in response to high sodium concentrations is regulated by NFAT5 and Ca2+ efflux through NCX and is suppressed by minocycline.
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Affiliation(s)
- Sachiho Fuse
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Haruki Fujisawa
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Naoya Murao
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Naoko Iwata
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Takashi Watanabe
- Division of Gene Regulation, Oncology Innovation Center, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yusuke Seino
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan; Department of Neurology, Graduate School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8686, Japan; Center for Intractable Neurological Diseases and Dementia, International University of Health and Welfare Atami Hospital, Atami, Shizuoka 413-0012, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan.
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Shu X, Cai F, Li W, Shen H. Copeptin as a diagnostic and prognostic biomarker in pediatric diseases. Clin Chem Lab Med 2024; 0:cclm-2024-0839. [PMID: 39165044 DOI: 10.1515/cclm-2024-0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/09/2024] [Indexed: 08/22/2024]
Abstract
Arginine vasopressin (AVP) plays a main role in maintaining the homeostasis of fluid balance and vascular tone and in regulating the endocrine stress response in response to osmotic, hemodynamic and stress stimuli. However, the difficulty in measuring AVP limits its clinical application. Copeptin, the C-terminal part of the AVP precursor, is released in an equimolar concentration mode with AVP from the pituitary but is more stable and simple to measure. Therefore, copeptin has emerged as a promising surrogate marker of AVP with excellent potential for the diagnosis, differentiation and prognosis of various diseases in recent decades. However, its application requires further validation, especially in the pediatric population. This review focuses on the clinical value of copeptin in different pediatric diseases and the prospects for its application as a potential biomarker.
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Affiliation(s)
- Xiaoli Shu
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Fengqing Cai
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Hongqiang Shen
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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Atila C, Refardt J, Christ-Crain M. Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency. Nat Rev Endocrinol 2024; 20:487-500. [PMID: 38693275 DOI: 10.1038/s41574-024-00985-x] [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: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Polyuria-polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name 'central diabetes insipidus' was changed in 2022 to arginine vasopressin (AVP) deficiency and 'nephrogenic diabetes insipidus' was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria-polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland.
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Clarke L, Gesundheit N, Sherr EH, Hardan AY, Parker KJ. Vasopressin deficiency: a hypothesized driver of both social impairment and fluid imbalance in autism spectrum disorder. Mol Psychiatry 2024; 29:2568-2570. [PMID: 38454082 PMCID: PMC11380037 DOI: 10.1038/s41380-024-02497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Lauren Clarke
- 401 Quarry Road, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Neil Gesundheit
- 1265 Welch Road, Department of Medicine, Division of Endocrinology, Stanford University, Stanford, CA, 94305, USA
| | - Elliott H Sherr
- 675 Nelson Rising Lane, Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - Antonio Y Hardan
- 401 Quarry Road, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Karen J Parker
- 401 Quarry Road, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- 300 Pasteur Drive, Department of Comparative Medicine, Stanford University, Stanford, CA, 94305, USA.
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7
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Choy KW, Wijeratne N, Chiang C, Don-Wauchope A. Copeptin as a surrogate marker for arginine vasopressin: analytical insights, current utility, and emerging applications. Crit Rev Clin Lab Sci 2024:1-21. [PMID: 39086073 DOI: 10.1080/10408363.2024.2383899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
Copeptin is a 39-amino-acid long glycosylated peptide with a leucine-rich core segment in the C-terminal part of pre-pro-vasopressin. It exhibits a rapid response comparable to arginine vasopressin (AVP) in response to osmotic, hemodynamic, and nonspecific stress-related stimuli. This similarity can be attributed to equimolar production of copeptin alongside AVP. However, there are markedly different decay kinetics for both peptides, with an estimated initial half-life of copeptin being approximately two times longer than that of AVP. Like AVP, copeptin correlates strongly over a wide osmolality range in healthy individuals, making it a useful alternative to AVP measurement. While copeptin does not appear to be significantly affected by food intake, small amounts of oral fluid intake may result in a significant decrease in copeptin levels. Compared to AVP, copeptin is considerably more stable in vitro. An automated immunofluorescent assay is now available and has been used in recent landmark trials. However, separate validation studies are required before copeptin thresholds from these studies are applied to other assays. The biological variation of copeptin in presumably healthy subjects has been recently reported, which could assist in defining analytical performance specifications for this measurand. An established diagnostic utility of copeptin is in the investigation of polyuria-polydipsia syndrome and copeptin-based testing protocols have been explored in recent years. A single baseline plasma copeptin >21.4 pmol/L differentiates AVP resistance (formerly known as nephrogenic diabetes insipidus) from other causes with 100% sensitivity and specificity, rendering water deprivation testing unnecessary in such cases. In a recent study among adult patients with polyuria-polydipsia syndrome, AVP deficiency (formerly known as central diabetes insipidus) was more accurately diagnosed with hypertonic saline-stimulated copeptin than with arginine-stimulated copeptin. Glucagon-stimulated copeptin has been proposed as a potentially safe and precise test in the investigation of polyuria-polydipsia syndrome. Furthermore, copeptin could reliably identify those with AVP deficiency among patients with severe hypernatremia, though its diagnostic utility is reportedly limited in the differential diagnosis of profound hyponatremia. Copeptin measurement may be a useful tool for early goal-directed management of post-operative AVP deficiency. Additionally, the potential prognostic utility of copeptin has been explored in other diseases. There is an interest in examining the role of the AVP system (with copeptin as a marker) in the pathogenesis of insulin resistance and diabetes mellitus. Copeptin has been found to be independently associated with an increased risk of incident stroke and cardiovascular disease mortality in men with diabetes mellitus. Increased levels of copeptin have been reported to be independently predictive of a decline in estimated glomerular filtration rate and a greater risk of new-onset chronic kidney disease. Furthermore, copeptin is associated with disease severity in patients with autosomal dominant polycystic kidney disease. Copeptin predicts the development of coronary artery disease and cardiovascular mortality in the older population. Moreover, the predictive value of copeptin was found to be comparable with that of N-terminal pro-brain natriuretic peptide for all-cause mortality in patients with heart failure. Whether the measurement of copeptin in these conditions alters clinical management remains to be demonstrated in future studies.
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Affiliation(s)
- Kay Weng Choy
- Department of Pathology, Northern Health, Epping, Australia
| | - Nilika Wijeratne
- Eastern Health Pathology, Eastern Health, Box Hill, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Cherie Chiang
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Don-Wauchope
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Laverty Pathology, North Ryde, Australia
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Jacobsen C, Jüppner H, Mitchell DM. Case 21-2024: A 10-Month-Old Boy with Vomiting and Hypercalcemia. N Engl J Med 2024; 391:167-176. [PMID: 38986061 DOI: 10.1056/nejmcpc2402485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Christina Jacobsen
- From the Department of Pediatrics, Boston Children's Hospital (C.J.), the Department of Pediatrics, Massachusetts General Hospital (D.M.M., H.J.), and the Department of Pediatrics, Harvard Medical School (C.J., D.M.M., H.J.) - all in Boston
| | - Harald Jüppner
- From the Department of Pediatrics, Boston Children's Hospital (C.J.), the Department of Pediatrics, Massachusetts General Hospital (D.M.M., H.J.), and the Department of Pediatrics, Harvard Medical School (C.J., D.M.M., H.J.) - all in Boston
| | - Deborah M Mitchell
- From the Department of Pediatrics, Boston Children's Hospital (C.J.), the Department of Pediatrics, Massachusetts General Hospital (D.M.M., H.J.), and the Department of Pediatrics, Harvard Medical School (C.J., D.M.M., H.J.) - all in Boston
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Fountas A, Coulden A, Fernández-García S, Tsermoulas G, Allotey J, Karavitaki N. Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis. Eur J Endocrinol 2024; 191:S1-S13. [PMID: 38996052 DOI: 10.1093/ejendo/lvae084] [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: 03/07/2024] [Revised: 05/19/2024] [Accepted: 07/11/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Central diabetes insipidus or vasopressin deficiency (AVP-D) is the most frequent water balance disorder after transsphenoidal surgery (TSS) with variable prevalence amongst studies. We aimed to determine rates of newly developed transient or permanent AVP-D in patients with pituitary tumours treated with TSS. DESIGN AND METHODS We performed systematic review of Medline, Embase, and Cochrane Library between January 1, 2000 and January 31, 2021 for studies reporting on outcomes for pituitary adenoma, craniopharyngioma, and Rathke's cleft cyst (RCC) after TSS and providing definition of post-operative AVP-D. We pooled the results as proportions with 95% confidence intervals (CIs) using Freeman-Tukey transformation random effects meta-analysis. RESULTS From 11 694 studies, 51 were included. Rates of transient or permanent AVP-D were: 17% (95% CI, 13-21) and 3% (95% CI, 2-5) in total group, 16% (95% CI, 12-21) and 2% (95% CI, 2-3) in pituitary adenomas, 31% (95% CI, 24-39) and 30% (95% CI, 22-39) in craniopharyngiomas, and 35% (95% CI, 16-57) and 14% (95% CI, 6-23) in RCCs, respectively. Based on diagnostic criteria, rates of transient or permanent AVP-D were: For hypotonic polyuria, 14% (95% CI, 8-22) and 3% (95% CI, 1-4), for hypotonic polyuria and hypernatraemia, 21% (95% CI, 13-29) and 5% (95% CI, 2-11), and for desmopressin administration, 22% (95% CI, 15-29) and 9% (95% CI, 0-30), respectively. CONCLUSIONS Following TSS, a small proportion of patients with pituitary adenoma have permanent AVP-D (2%), but prevalence reaches 30% in ones with craniopharyngioma and 14% in those with RCC. Diagnostic criteria for post-operative AVP-D remain variable affecting reported rates of this condition.
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Affiliation(s)
- Athanasios Fountas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
| | - Amy Coulden
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
| | - Silvia Fernández-García
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Georgios Tsermoulas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
| | - John Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham B15 2TH, United Kingdom
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
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Chasseloup F, Tabarin A, Chanson P. Diabetes insipidus: Vasopressin deficiency…. ANNALES D'ENDOCRINOLOGIE 2024; 85:294-299. [PMID: 38316255 DOI: 10.1016/j.ando.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 02/07/2024]
Abstract
Diabetes insipidus is a disorder characterized by hypo-osmotic polyuria secondary to abnormal synthesis, regulation, or renal action of antidiuretic hormone. Recently, an expert group, with the support of patient associations, proposed that diabetes insipidus be renamed to avoid confusion with diabetes mellitus. The most common form of diabetes insipidus is secondary to a dysfunction of the neurohypophysis (central diabetes insipidus) and would be therefore named 'vasopressin deficiency'. The rarer form, which is linked to renal vasopressin resistance (nephrogenic diabetes insipidus), would then be named 'vasopressin resistance'. The etiology of diabetes insipidus is sometimes clear, in the case of a neurohypophyseal cause (tumoral or infiltrative damage) or a renal origin, but in some cases diabetes insipidus can be difficult to distinguish from primary polydipsia, which is characterized by consumption of excessive quantities of water without any abnormality in regulation or action of antidiuretic hormone. Apart from patients' medical history, physical examination, and imaging of the hypothalamic-pituitary region, functional tests such as water deprivation or stimulation of copeptin by hyperosmolarity (induced by infusion of hypertonic saline) can be proposed in order to distinguish between these different etiologies. The treatment of diabetes insipidus depends on the underlying etiology, and in the case of a central etiology, is based on the administration of desmopressin which improves patient symptoms but does not always result in an optimal quality of life. The cause of this altered quality of life may be oxytocin deficiency, oxytocin being also secreted from the neurohypophysis, though this has not been fully established. The possibility of a new test using stimulation of oxytocin to identify alterations in oxytocin synthesis is of interest and would allow confirmation of a deficiency in those patients presenting with diabetes insipidus linked to neurohypophyseal dysfunction.
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Affiliation(s)
- Fanny Chasseloup
- Service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse, université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, France.
| | - Antoine Tabarin
- Service d'endocrinologie, diabète et nutrition, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, Pessac, France
| | - Philippe Chanson
- Service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse, université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, France
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11
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Kharin A, Klussmann E. Many kinases for controlling the water channel aquaporin-2. J Physiol 2024; 602:3025-3039. [PMID: 37440212 DOI: 10.1113/jp284100] [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: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
Aquaporin-2 (AQP2) is a member of the aquaporin water channel family. In the kidney, AQP2 is expressed in collecting duct principal cells where it facilitates water reabsorption in response to antidiuretic hormone (arginine vasopressin, AVP). AVP induces the redistribution of AQP2 from intracellular vesicles and its incorporation into the plasma membrane. The plasma membrane insertion of AQP2 represents the crucial step in AVP-mediated water reabsorption. Dysregulation of the system preventing the AQP2 plasma membrane insertion causes diabetes insipidus (DI), a disease characterised by an impaired urine concentrating ability and polydipsia. There is no satisfactory treatment of DI available. This review discusses kinases that control the localisation of AQP2 and points out potential kinase-directed targets for the treatment of DI.
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Affiliation(s)
- Andrii Kharin
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Enno Klussmann
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
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12
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Atila C, Mekkattu S, Murugesu R, Gaisl O, Varghese N, Eckert A, Christ-Crain M. Plasma oxytocin levels in response to glucagon in patients with arginine vasopressin deficiency (central diabetes insipidus) and healthy controls. Endocrine 2024:10.1007/s12020-024-03920-2. [PMID: 38935296 DOI: 10.1007/s12020-024-03920-2] [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: 11/27/2023] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE We recently demonstrated an additional oxytocin (OT) deficiency in patients with arginine vasopressin (AVP) deficiency (central diabetes insipidus) by using 3,4-methylenedioxy-methamphetamine (MDMA) as a novel provocation test. However, the implication of the MDMA provocation test in clinical practice might be challenging. Glucagon effectively stimulates vasopressinergic neurons with a strong increase in plasma copeptin. We therefore hypothesized that this provocation test might also stimulate OT. METHODS This is a predefined secondary analysis of a prospective double-blind, randomised, placebo-controlled cross-over trial involving ten patients with AVP deficiency and ten sex- and body-mass index-matched healthy participants at the University Hospital Basel, Switzerland. Each participant underwent the glucagon test (s.c. injection of 1 mg glucagon) and placebo test (s.c. injection of 0.9% normal saline). Plasma OT levels were measured at baseline, 60, 120 and 180 min after injection. The primary objective was to determine whether glucagon stimulates OT and whether OT levels differ between patients with AVP deficiency and healthy participants. The primary outcome (maximum change in OT within 180 min) was compared between groups and conditions using a linear mixed effects model. RESULTS In healthy participants, the median OT at baseline was 82.7 pg/ml [62.3-94.3] and slightly increased to a maximum of 93.3 pg/ml [87.2-121.1] after injection of glucagon, resulting in a change increase of 24.9 pg/ml [5.1-27.8]. Similarly, in patients with AVP deficiency, the median OT at baseline was 73.9 pg/ml [65.3-81.6] and slightly increased after glucagon injection to 114.9 pg/ml [70.9-140.9], resulting in a change increase of 36.8 pg/ml [-2.2 to 51.2]. The results from the mixed model showed no effect between glucagon compared to placebo on OT (difference: -0.5 pg/ml; 95%-CI [-25, 24]; p = 0.97) and no significant treatment-by-group interaction effect between patients compared to healthy participants (interaction: 28 pg/ml; 95%-CI [-7, 62]; p = 0.13). CONCLUSION We found no effect of glucagon on plasma OT levels and no difference between patients with AVP deficiency and healthy participants.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Shalini Mekkattu
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rakithan Murugesu
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Odile Gaisl
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Research Cluster, Molecular & Cognitive Neuroscience, Division of Neurobiology, University of Basel, 4002, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Research Cluster, Molecular & Cognitive Neuroscience, Division of Neurobiology, University of Basel, 4002, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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13
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Fleseriu M, Christ-Crain M, Langlois F, Gadelha M, Melmed S. Hypopituitarism. Lancet 2024; 403:2632-2648. [PMID: 38735295 DOI: 10.1016/s0140-6736(24)00342-8] [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] [Received: 10/25/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 05/14/2024]
Abstract
Partial or complete deficiency of anterior or posterior pituitary hormone production leads to central hypoadrenalism, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency, or arginine vasopressin deficiency depending on the hormones affected. Hypopituitarism is rare and likely to be underdiagnosed, with an unknown but rising incidence and prevalence. The most common cause is compressive growth or ablation of a pituitary or hypothalamic mass. Less common causes include genetic mutations, hypophysitis (especially in the context of cancer immunotherapy), infiltrative and infectious disease, and traumatic brain injury. Clinical features vary with timing of onset, cause, and number of pituitary axes disrupted. Diagnosis requires measurement of basal circulating hormone concentrations and confirmatory hormone stimulation testing as needed. Treatment is aimed at replacement of deficient hormones. Increased mortality might persist despite treatment, particularly in younger patients, females, and those with arginine vasopressin deficiency. Patients with complex diagnoses, pregnant patients, and adolescent pituitary-deficient patients transitioning to adulthood should ideally be managed at a pituitary tumour centre of excellence.
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Affiliation(s)
- Maria Fleseriu
- Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, OR, USA; Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USA; Pituitary Center, Oregon Health and Science University, Portland, OR, USA.
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabienne Langlois
- Department of Medicine, Division of Endocrinology, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mônica Gadelha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Shlomo Melmed
- Department of Medicine and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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14
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Luo W, Zhang J, Luo Y, Wu Q, Chen L, Liu C, Lin M. Factors associated with glycemic control in patients with T2DM: evidence from a cross-sectional study in China. BMC Endocr Disord 2024; 24:77. [PMID: 38831300 PMCID: PMC11149194 DOI: 10.1186/s12902-024-01605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/19/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE This study aimed to analyze the factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS Baseline data, encompassing basic information, lifestyle habits, and treatment of 305 T2DM patients from March 2021 to January 2023, were collected and analyzed using SPSS 26.0 software. RESULTS Univariate and multivariate logistic regression analyses identified insulin therapy (OR = 2.233; 95%Cl = 1.013-4.520; P = 0.026) and regular clinic visits (OR = 0.567; 95%Cl = 0.330-0.973; P = 0.040) as independent factors influencing glycemic control. No observed interactions between the two variables were noted. CONCLUSION History of insulin therapy and regular clinic visits were significantly and independently associated with glycated hemoglobin control in T2DM patients. Tailored interventions based on individual circumstances are recommended to optimize glycemic control.
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Affiliation(s)
- Wenting Luo
- Department of Scientific Research, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, No.24, Bailu Road, Siming District, Xiamen, 361003, Fujian, China
| | - Jiayu Zhang
- Department of Intensive Care Medicine, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, China
| | - Yanxing Luo
- School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Qiuwan Wu
- Department of Scientific Research, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, No.24, Bailu Road, Siming District, Xiamen, 361003, Fujian, China
| | - Longfei Chen
- Department of Scientific Research, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, No.24, Bailu Road, Siming District, Xiamen, 361003, Fujian, China
| | - Changqin Liu
- Department of Endocrinology and Diabetes, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, China
| | - Minqiang Lin
- Department of Scientific Research, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, No.24, Bailu Road, Siming District, Xiamen, 361003, Fujian, China.
- Institute of Clinical Medical Research, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, China.
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15
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Rein JL, Mackie K, Kleyman TR, Satlin LM. Cannabinoid receptor type 1 activation causes a water diuresis by inducing an acute central diabetes insipidus in mice. Am J Physiol Renal Physiol 2024; 326:F917-F930. [PMID: 38634131 DOI: 10.1152/ajprenal.00320.2022] [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: 01/03/2023] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
Cannabis and synthetic cannabinoid consumption are increasing worldwide. Cannabis contains numerous phytocannabinoids that act on the G protein-coupled cannabinoid receptor type 1 (CB1R) and cannabinoid receptor type 2 expressed throughout the body, including the kidney. Essentially every organ, including the kidney, produces endocannabinoids, which are endogenous ligands to these receptors. Cannabinoids acutely increase urine output in rodents and humans, thus potentially influencing total body water and electrolyte homeostasis. As the kidney collecting duct (CD) regulates total body water, acid/base, and electrolyte balance through specific functions of principal cells (PCs) and intercalated cells (ICs), we examined the cell-specific immunolocalization of CB1R in the mouse CD. Antibodies against either the C-terminus or N-terminus of CB1R consistently labeled aquaporin 2 (AQP2)-negative cells in the cortical and medullary CD and thus presumably ICs. Given the well-established role of ICs in urinary acidification, we used a clearance approach in mice that were acid loaded with 280 mM NH4Cl for 7 days and nonacid-loaded mice treated with the cannabinoid receptor agonist WIN55,212-2 (WIN) or a vehicle control. Although WIN had no effect on urinary acidification, these WIN-treated mice had less apical + subapical AQP2 expression in PCs compared with controls and developed acute diabetes insipidus associated with the excretion of large volumes of dilute urine. Mice maximally concentrated their urine when WIN and 1-desamino-8-d-arginine vasopressin [desmopressin (DDAVP)] were coadministered, consistent with central rather than nephrogenic diabetes insipidus. Although ICs express CB1R, the physiological role of CB1R in this cell type remains to be determined.NEW & NOTEWORTHY The CB1R agonist WIN55,212-2 induces central diabetes insipidus in mice. This research integrates existing knowledge regarding the diuretic effects of cannabinoids and the influence of CB1R on vasopressin secretion while adding new mechanistic insights about total body water homeostasis. Our findings provide a deeper understanding about the potential clinical impact of cannabinoids on human physiology and may help identify targets for novel therapeutics to treat water and electrolyte disorders such as hyponatremia and volume overload.
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Affiliation(s)
- Joshua L Rein
- Renal Section, Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ken Mackie
- Gill Center for Biomolecular Medicine, Indiana University, Bloomington, Indiana, United States
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, United States
| | - Thomas R Kleyman
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Lisa M Satlin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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16
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Tiffany P, Brackman S, Gilley SP, Manning WA. Case 3: Poor Weight Gain in a 4-month-old Girl. Pediatr Rev 2024; 45:337-340. [PMID: 38821899 DOI: 10.1542/pir.2022-005582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 06/02/2024]
Affiliation(s)
- Patrick Tiffany
- University of Colorado Pediatric Residency Program, Aurora, CO
| | | | | | - W Aaron Manning
- Department of Pediatrics
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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17
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Monnerat S, Drivakos N, Chapman FA, Dhaun N, Refardt J, Christ-Crain M. Apelin and Copeptin Levels in Patients With Chronic SIAD Treated With Empagliflozin. J Endocr Soc 2024; 8:bvae106. [PMID: 38872994 PMCID: PMC11170659 DOI: 10.1210/jendso/bvae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Indexed: 06/15/2024] Open
Abstract
Background Empagliflozin increases sodium levels in patients with a chronic syndrome of inappropriate antidiuresis (SIAD), and dapagliflozin increases apelin levels in patients with diabetes mellitus. Exogenous apelin increases sodium levels in rats with SIAD. We aimed to investigate whether an increase in plasma apelin concentration may contribute to the efficacy of empagliflozin in SIAD. Methods Post hoc secondary analysis of a double-blind, crossover, placebo-controlled trial performed from December 2017 to August 2021 at the University Hospital Basel, Switzerland, investigating the effect of 4-week treatment with empagliflozin 25 mg/day as compared to placebo in 14 outpatients with chronic SIAD (NCT03202667). The objective was to investigate the effect of empagliflozin on plasma apelin and copeptin concentrations and their ratio. Results Fourteen patients, 50% female, with a median [interquartile range] age of 72 years [65-77] were analyzed. Median apelin concentration was 956 pmol/L [853, 1038] at baseline. Median [interquartile range] apelin relative changes were +11% [0.7, 21] and +8% [-5, 25] (P = .672) at the end of the placebo and empagliflozin phases, respectively. Median copeptin concentration was 2.6 [2.2, 4.5] pmol/L at baseline and had a relative change of +5 [-2. 11]% and +25% [10, 28] (P = .047) over the placebo and empagliflozin phases, respectively. Conclusion Empagliflozin did not lead to significant changes in apelin or the apelin/copeptin ratio in patients with chronic SIAD but led to an increase in copeptin. This suggests that the efficacy of empagliflozin in SIAD is independent of apelin and is not blunted by the adaptative increase in copeptin.
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Affiliation(s)
- Sophie Monnerat
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
| | - Nikolaos Drivakos
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Nephrology, Hospital Center of Biel, 2501 Biel, Switzerland
| | - Fiona A Chapman
- BHF/University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Neeraj Dhaun
- BHF/University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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18
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Giunta R, Gervasi L, Torrisi I, Aliotta R, Marcantoni C. Lesson for the clinical nephrologist: diagnostic approach to polyuria-polydipsia syndrome in the adult. J Nephrol 2024:10.1007/s40620-024-01945-4. [PMID: 38709446 DOI: 10.1007/s40620-024-01945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/24/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Rosa Giunta
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy.
| | - Luciano Gervasi
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
| | - Irene Torrisi
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
| | - Roberta Aliotta
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
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19
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Atila C, Beck J, Refardt J, Erlic Z, Drummond JB, Sailer CO, Liechti ME, Rocha BSS, Beuschlein F, Winzeler B, Christ-Crain M. Psychopathological characteristics in patients with arginine vasopressin deficiency (central diabetes insipidus) and primary polydipsia compared to healthy controls. Eur J Endocrinol 2024; 190:354-362. [PMID: 38551325 DOI: 10.1093/ejendo/lvae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Distinguishing arginine vasopressin deficiency (AVP-D; central diabetes insipidus) from primary polydipsia (PP), commonly referred to as psychogenic polydipsia, is challenging. Psychopathologic findings, commonly used for PP diagnosis in clinical practice, are rarely evaluated in AVP-D patients, and no comparative data between the two conditions currently exist. DESIGN Data from two studies involving 82 participants [39 AVP-D, 28 PP, and 15 healthy controls (HC)]. METHODS Psychological evaluations were conducted using standardized questionnaires measuring anxiety [State-Trait Anxiety Inventory (STAI)], alexithymia [Toronto Alexithymia Scale (TAS-20)], depressive symptoms (Beck's Depression Inventory-II (BDI-II), and overall mental health [Short Form-36 Health Survey (SF-36)]. Higher STAI, TAS-20, and BDI-II scores suggest elevated anxiety, alexithymia, and depression, while higher SF-36 scores signify better overall mental health. RESULTS Compared to HC, patients with AVP-D and PP showed higher levels of anxiety (HC 28 points [24-31] vs AVP-D 36 points [31-45]; vs PP 38 points [33-46], P < .01), alexithymia (HC 30 points [29-37] vs AVP-D 43 points [35-54]; vs PP 46 points [37-55], P < .01), and depression (HC 1 point [0-2] vs AVP-D 7 points [4-14]; vs PP 7 points [3-13], P < .01). Levels of anxiety, alexithymia, and depression showed no difference between both patient groups (P = .58, P = .90, P = .50, respectively). Compared to HC, patients with AVP-D and PP reported similarly reduced self-reported overall mental health scores (HC 84 [68-88] vs AVP-D 60 [52-80], P = .05; vs PP 60 [47-74], P < .01). CONCLUSION This study reveals heightened anxiety, alexithymia, depression, and diminished overall mental health in patients with AVP-D and PP. The results emphasize the need for careful interpretation of psychopathological characteristics to differentiate between AVP-D and PP.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Julia Beck
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, 3015 Rotterdam, The Netherlands
| | - Zoran Erlic
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, 8091 Zürich, Switzerland
| | - Juliana B Drummond
- Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Matthias E Liechti
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, 4056 Basel, Switzerland
| | - Beatriz Santana Soares Rocha
- Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, 8091 Zürich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- The LOOP Zurich Medical Research Center, LOOBesity, 8044 Zurich, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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20
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Dmitrieva NI, Boehm M, Yancey PH, Enhörning S. Long-term health outcomes associated with hydration status. Nat Rev Nephrol 2024; 20:275-294. [PMID: 38409366 DOI: 10.1038/s41581-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Body water balance is determined by fundamental homeostatic mechanisms that maintain stable volume, osmolality and the composition of extracellular and intracellular fluids. Water balance is maintained by multiple mechanisms that continuously match water losses through urine, the skin, the gastrointestinal tract and respiration with water gains achieved through drinking, eating and metabolic water production. Hydration status is determined by the state of the water balance. Underhydration occurs when a decrease in body water availability, due to high losses or low gains, stimulates adaptive responses within the water balance network that are aimed at decreasing losses and increasing gains. This stimulation is also accompanied by cardiovascular adjustments. Epidemiological and experimental studies have linked markers of low fluid intake and underhydration - such as increased plasma concentration of vasopressin and sodium, as well as elevated urine osmolality - with an increased risk of new-onset chronic diseases, accelerated aging and premature mortality, suggesting that persistent activation of adaptive responses may be detrimental to long-term health outcomes. The causative nature of these associations is currently being tested in interventional trials. Understanding of the physiological responses to underhydration may help to identify possible mechanisms that underlie potential adverse, long-term effects of underhydration and inform future research to develop preventative and treatment approaches to the optimization of hydration status.
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Affiliation(s)
- Natalia I Dmitrieva
- Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA.
| | - Manfred Boehm
- Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Paul H Yancey
- Biology Department, Whitman College, Walla Walla, Washington, USA
| | - Sofia Enhörning
- Perinatal and Cardiovascular Epidemiology, Lund University Diabetes Centre, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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21
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Doi K, Kawakami K, Ikuta T, Inoue A. A cAMP-biosensor-based assay for measuring plasma arginine-vasopressin levels. Sci Rep 2024; 14:9453. [PMID: 38658606 PMCID: PMC11043374 DOI: 10.1038/s41598-024-60035-4] [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: 02/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
Arginine-vasopressin (AVP), a cyclic peptide hormone composed of nine amino acids, regulates water reabsorption by increasing intracellular cyclic adenosine monophosphate (cAMP) concentrations via the vasopressin V2 receptor (V2R). Plasma AVP is a valuable biomarker for the diagnosis of central diabetes insipidus (CDI) and is commonly measured using radioimmunoassay (RIA). However, RIA has several drawbacks, including a long hands-on time, complex procedures, and handling of radioisotopes with special equipment and facilities. In this study, we developed a bioassay to measure plasma AVP levels using HEK293 cells expressing an engineered V2R and a cAMP biosensor. To achieve high sensitivity, we screened V2R orthologs from 11 various mammalian species and found that the platypus V2R (pV2R) responded to AVP with approximately six-fold higher sensitivity than that observed by the human V2R. Furthermore, to reduce cross-reactivity with desmopressin (DDAVP), a V2R agonist used for CDI treatment, we introduced a previously described point mutation into pV2R, yielding an approximately 20-fold reduction of responsiveness to DDAVP while maintaining responsiveness to AVP. Finally, a comparison of plasma samples from 12 healthy individuals demonstrated a strong correlation (Pearson's correlation value: 0.90) between our bioassay and RIA. Overall, our assay offers a more rapid and convenient method for quantifying plasma AVP concentrations than existing techniques.
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Affiliation(s)
- Kosuke Doi
- Research and Development Section, Diagnostics Division, YAMASA Corporation, Choshi, Chiba, 288-0056, Japan
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, 980-8578, Japan
| | - Kouki Kawakami
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, 980-8578, Japan
| | - Tatsuya Ikuta
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, 980-8578, Japan
| | - Asuka Inoue
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, 980-8578, Japan.
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22
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Yanagisawa S, Oikawa Y, Endo M, Inoue K, Nakajima R, Yasuda S, Sato M, Iwata N, Fujisawa H, Suzuki A, Sugimura Y, Isshiki M, Shimada A. A Pregnant Woman with Excess Vasopressinase-Induced Diabetes Insipidus Complicated by Central Diabetes Insipidus like Lymphocytic Infundibulo-Neurohypophysitis. Case Rep Endocrinol 2024; 2024:8687054. [PMID: 38646198 PMCID: PMC11032210 DOI: 10.1155/2024/8687054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 03/11/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Background Gestational diabetes insipidus (DI) is a very rare complication of pregnancy. We present a case of gestational DI combining two different types of DI. Case Presentation. A 39-year-old pregnant woman suddenly presented with thirst, polydipsia, and polyuria after 31 gestation weeks (GWs). Based on laboratory findings of hypotonic urine (78 mOsm/kgH2O) with higher plasma osmolality (298 mOsm/kgH2O) and higher serum sodium levels (149 mEq/L), gestational DI was suspected, and the clinical course was monitored without therapy until the results of a measurement of plasma arginine vasopressin (AVP) levels were available. However, she subsequently developed acute prerenal failure and underwent an emergency cesarean section at 34 GWs. Her resected placenta weighed 920 g, nearly twice the normal weight. Immediately following delivery, intranasal 1-desamino-8-D-arginine vasopressin was administered, and her symptoms promptly disappeared. Afterward, her predelivery plasma AVP level was found to have been inappropriately low (0.7 pg/mL) given her serum sodium level. The patient's serum vasopressinase level just before delivery was 2,855 ng/mL, more than 1,000 times the upper limit of the normal range, suggesting excess vasopressinase-induced DI. The presence of anti-rabphilin-3A antibodies in the patient's blood, a hypertonic saline infusion test result, and loss of the high-intensity signal of the posterior pituitary on fat-suppressed T1-weighted magnetic resonance images without thickening of the stalk and enlargement of the neurohypophysis suggested concurrent central DI-like lymphocytic infundibulo-neurohypophysitis (LINH). Conclusion In addition to the degradation of AVP by excess placental vasopressinase due to the enlarged placenta, an insufficient compensatory increase in AVP secretion from the posterior pituitary gland due to LINH-like pathogenesis might have led to DI symptoms.
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Affiliation(s)
- Shinnosuke Yanagisawa
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Mai Endo
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Kazuyuki Inoue
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Ritsuko Nakajima
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Shigemitsu Yasuda
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Masayasu Sato
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Naoko Iwata
- Department of Endocrinology and Diabetes, Daido Hospital, 9 Hakusui-cho, Minami-ku, Nagoya, Aichi 457-8511, Japan
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Haruki Fujisawa
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Masashi Isshiki
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
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23
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Rasi V, Riekhof F, Mahmoud M, Ejiofor S, Lentine KL. A Case of Hypernatremia in a Newly Diagnosed Patient With Acute Myeloid Leukemia: Lessons for Nephrologists. Cureus 2024; 16:e59186. [PMID: 38807832 PMCID: PMC11130080 DOI: 10.7759/cureus.59186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Arginine vasopressin deficiency (AVP-D), formerly known as central diabetes insipidus, is a disease characterized by polyuria, polydipsia, and hypernatremia. The concomitant diagnosis of acute myeloid leukemia (AML) is an underappreciated event that requires prompt recognition and treatment by practicing nephrologists and hematologists. This report highlights this importance by describing the case of a 39-year-old patient newly diagnosed with AML who developed severe hypernatremia. The role of diagnostic testing through desmopressin (DDAVP) challenge and copeptin testing to confirm the diagnosis of AVP-D in this context and the use of DDVAP for treatment are discussed. Practicing nephrologists and primary care providers taking care of patients with similar symptoms will benefit from understanding the pathophysiology of AVP-D, its relationship with AML, and the prognosis in this patient cohort.
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Affiliation(s)
- Valerio Rasi
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
- Internal Medicine, Baylor College of Medicine, Houston, USA
| | - Forest Riekhof
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Maya Mahmoud
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Shannon Ejiofor
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Krista L Lentine
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
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24
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Pedersen AN, Andreassen M, Rasmussen AK, Krogh J. Desmopressin Dose Requirements in Adults with Congenital and Acquired Central Diabetes Insipidus. Horm Metab Res 2024; 56:206-213. [PMID: 37879354 DOI: 10.1055/a-2198-7207] [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] [Indexed: 10/27/2023]
Abstract
Central diabetes insipidus is a rare disorder characterized by a deficiency of vasopressin. The first line drug to treat this disorder is a synthetic analogue of vasopressin, desmopressin.The primary aim of this retrospective register study was to compare desmopressin dose requirements in patients with acquired and congenital DI, and secondly to assess the influence of BMI on dose requirement and risk of hyponatremia with different drug administrations. We included all patients with suspected DI attending the endocrine department at Rigshospitalet, Copenhagen, Denmark in 2022. We identified 222 patients who were included whereof 130/222 (58.6%) were females and median age was 53 years (IQR 35 to 63). The etiology included 7/222 (3.2%) congenital and 215/222 (96.8%) acquired. After converting nasal and sublingual doses to equivalent oral doses, the median daily dose requirement was 600 μg in patients with congenital etiology compared to 200 μg in patients with acquired etiology (p=0.005). We found no association between BMI and desmopressin dose requirements (p=0.6). During the past 12 months, 66/215 (30.7%) had sodium levels<136 mmol/l including 20/215 (9.3%) with sodium levels<131 mmol/l. No increased risk of hyponatremia was found, when nasal and oral were compared (p=0.9). Daily desmopressin dose requirements were higher in patients with congenital DI compared to patients with acquired DI. However, this result was associated with uncertainty due to the small congenital group. BMI did not influence daily dose requirements and nor did type of administration influence the risk of hyponatremia.
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Affiliation(s)
- Aslak Nykjær Pedersen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Andreassen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Aase Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Krogh
- Department of Endocrinology, Zealand University Hospital Koge, Koge, Denmark
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25
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Junkins MS, Feng NY, Murphy LA, Curtis G, Merriman DK, Bagriantsev SN, Gracheva EO. Neural control of fluid homeostasis is engaged below 10°C in hibernation. Curr Biol 2024; 34:923-930.e5. [PMID: 38325375 PMCID: PMC11232715 DOI: 10.1016/j.cub.2024.01.035] [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: 05/14/2023] [Revised: 11/29/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Thirteen-lined ground squirrels (Ictidomys tridecemlineatus) hibernate for several months each winter without access to water,1 but the mechanisms that maintain fluid homeostasis during hibernation are poorly understood. In torpor, when body temperature (TB) reaches 4°C, squirrels decrease metabolism, slow heart rate, and reduce plasma levels of the antidiuretic hormones arginine vasopressin (AVP) and oxytocin (OXT).1 Squirrels spontaneously undergo interbout arousal (IBA) every 2 weeks, temporarily recovering an active-like metabolism and a TB of 37°C for up to 48 h.1,2 Despite the low levels of AVP and OXT during torpor, profound increases in blood pressure and heart rate during the torpor-IBA transition are not associated with massive fluid loss, suggesting the existence of a mechanism that protects against diuresis at a low TB. Here, we demonstrate that the antidiuretic hormone release pathway is activated by hypothalamic supraoptic nucleus (SON) neurons early in the torpor-arousal transition. SON neuron activity, dense-core vesicle release from the posterior pituitary, and plasma hormone levels all begin to increase before TB reaches 10°C. In vivo fiber photometry of SON neurons from hibernating squirrels, together with RNA sequencing and c-FOS immunohistochemistry, confirms that SON is electrically, transcriptionally, and translationally active to monitor blood osmolality throughout the dynamic torpor-arousal transition. Our work emphasizes the importance of the antidiuretic pathway during the torpor-arousal transition and reveals that the neurophysiological mechanism that coordinates the hormonal response to retain fluid is active at an extremely low TB, which is prohibitive for these processes in non-hibernators.
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Affiliation(s)
- Madeleine S Junkins
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience and Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Ni Y Feng
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience and Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Neuroscience & Behavior Program, Wesleyan University, 52 Lawn Ave, Middletown, CT 06459, USA.
| | - Lyle A Murphy
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Genevieve Curtis
- Department of Biology, Wesleyan University, 52 Lawn Ave, Middletown, CT 06459, USA
| | - Dana K Merriman
- Department of Biology, University of Wisconsin-Oshkosh, 800 Algoma Blvd, Oshkosh, WI 54901, USA
| | - Sviatoslav N Bagriantsev
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Elena O Gracheva
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Neuroscience and Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Kavli Institute for Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
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26
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Hoshino Y, Inoue K, Ikeda S, Goshima Y, Tatsushima K, Fukuhara N, Okada M, Nishioka H, Yamada S, Takeuchi Y, Takeshita A. Clinical Factors Affecting Daily Dosage of Desmopressin Orally Disintegrating Tablets in Arginine Vasopressin Deficiency. J Clin Endocrinol Metab 2024; 109:e983-e996. [PMID: 38019190 DOI: 10.1210/clinem/dgad694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
CONTEXT Desmopressin orally disintegrating tablets (ODTs) are widely used to treat arginine vasopressin deficiency (AVP-D). However, limited information is available on the dosage regimen; the dosage for each patient is selected based on their response to the initiation dose. OBJECTIVE To investigate the relationships between clinical characteristics and the daily dose of ODTs and to identify factors that affect ODT dosages. METHODS This retrospective study included 209 adult patients with AVP-D. Patients were administered ODTs sublingually and instructed to restrict eating and drinking for 30 minutes after taking ODTs using a patient leaflet. ODT dose titration was conducted during hospitalization with close monitoring of urine output, body weight, and serum sodium levels. Multivariable linear regression models were applied to identify clinical factors associated with the daily dose of ODTs at discharge. We also evaluated the dosage at 1 year in 134 patients who were followed up in our hospital. RESULTS The median daily dose of ODTs at discharge was 90 µg (IQR 60-120 µg). Multivariable linear regression models identified sex, age, and estimated creatinine clearance (eCCr) as significant factors associated with the daily dose of ODTs, with eCCr having the strongest effect. After excluding patients recovering from AVP-D, 71% of those followed up at our hospital took the same daily dose at 1 year after discharge. CONCLUSION To achieve the safe and stable treatment of AVP-D, the daily dose of ODT needs to be selected based on a patient's sex, age, and eCCr under appropriate sublingual administration by patient education.
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Affiliation(s)
- Yoshitomo Hoshino
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan
- Hakubi Center, Kyoto University, Kyoto, 606-8501, Japan
| | - Sara Ikeda
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Yukiko Goshima
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Keita Tatsushima
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, 105-8470, Japan
| | - Mitsuo Okada
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Shozo Yamada
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
- Hypothalamic and Pituitary Center, Moriyama Memorial Hospital, Tokyo, 134-0081, Japan
| | - Yasuhiro Takeuchi
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Akira Takeshita
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, 105-8470, Japan
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27
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Yao B, Lv J, Du L, Zhang H, Xu Z. Phoenixin-14 protects cardiac damages in a streptozotocin-induced diabetes mice model through SIRT3. Arch Physiol Biochem 2024; 130:110-118. [PMID: 34618648 DOI: 10.1080/13813455.2021.1981946] [Citation(s) in RCA: 6] [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] [Received: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type I diabetes is a metabolic syndrome that severely impacts the normal lives of patients through its multiple complications, such as diabetic cardiomyopathy (DCM). Phoenixin-14 is a peptide found to be widely expressed in eukaryons with multiple protective properties, including anti-oxidative stress and anti-inflammatory effects. The present study aims to explore the potential therapeutic impacts of Phoenixin-14 on DCM. METHODS Type I diabetes was induced by treatment with a single dose of STZ (40 mg/kg body weight) intraperitoneally for 5 consecutive days. Mice were divided into four groups: the Control, Phoenixin-14, T1DM, and Phoenixin-14 +T1DM groups. The levels of myocardial injury markers were measured. Cardiac hypertrophy was assessed using wheat germ agglutinin (WGA) staining. RESULTS Phoenixin-14 was significantly downregulated in the cardiac tissue of diabetic mice. The myocardial injury and deteriorated cardiac function in diabetic mice induced by STZ were significantly ameliorated by Phoenixin-14, accompanied by the alleviation of cardiac hypertrophy. In addition, the severe oxidative stress and inflammation in diabetic mice were dramatically mitigated by Phoenixin-14. Lastly, the downregulated SIRT3 and upregulated p-FOXO3 in diabetic mice were pronouncedly reversed by Phoenixin-14. It is worth mentioning that compared to the Control, no significant changes to any of the investigated parameters in the present study were found in the Phoenixin-14-treated normal mice, suggesting that treatment with it has no side effects. CONCLUSION Our data revealed that Phoenixin-14 protected against cardiac damages in STZ-induced diabetes mice models.
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Affiliation(s)
- Bo Yao
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Third Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junlin Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Le Du
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Third Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Zhang
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Third Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhao Xu
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Third Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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28
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Huynh T, Signal D, Christ-Crain M. Paediatric perspectives in the diagnosis of polyuria-polydipsia syndrome. Clin Endocrinol (Oxf) 2024. [PMID: 38164825 DOI: 10.1111/cen.15011] [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: 10/29/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
The elucidation of the underlying cause of polyuria-polydipsia syndrome (PPS) is a challenging-especially in the differentiation of partial defects of arginine vasopressin (AVP) secretion or action from primary polydipsia. The water deprivation test has been utilized for many decades, and its application in the paediatric population has been applied using parameters predominantly established in adult cohorts. In more recent times, the development of automated commercial assays for copeptin, a surrogate marker for AVP, has represented a significant advancement in the diagnostic approach to PPS. Measurement of copeptin concentrations has major advantages and has essentially superseded measurement of AVP in diagnostic protocols for PPS. Additionally, stimulated-copeptin protocols utilizing hypertonic saline infusion, arginine, and glucagon have been investigated, and are promising. However, further studies are required in the population-incorporating the differences in physiological regulation of water homeostasis, and safety requirements-before there is widespread adoption into clinical practice.
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Affiliation(s)
- Tony Huynh
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- Department of Chemical Pathology, Mater Health Services, South Brisbane, Queensland, Australia
| | - Dana Signal
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Queensland Clinical Unit, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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29
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Boot C. The laboratory investigation of diabetes insipidus: A review. Ann Clin Biochem 2024; 61:19-31. [PMID: 36650746 DOI: 10.1177/00045632231154391] [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] [Indexed: 01/19/2023]
Abstract
Diabetes insipidus (DI) is a group of disorders that lead to inappropriate production of large volumes of dilute urine. The three main forms are central DI (CDI), nephrogenic DI (NDI) and primary polydipsia (PP). Differentiating CDI/NDI from PP is important as patients with true DI are at risk of severe dehydration without treatment. Biochemical testing is key in the diagnosis of DI. The indirect water deprivation test (WDT) is commonly used in the investigation of DI but has drawbacks including being cumbersome and sometimes producing equivocal results. Direct measurement of AVP has theoretical advantages but has generally only been used in specialist centres. Disadvantages include the requirement to measure AVP under hypertonic stimulation and pre-analytical/analytical challenges. Copeptin (CT-proAVP) is a proxy marker for AVP that is more stable, easier to measure and has been studied more widely in recent years. Historically, the evidence supporting the diagnostic performance of these tests has been relatively poor, being based on a few small, usually single-centre studies. However more recent, well-designed prospective studies are improving the evidence base for investigation of DI. These studies have focused on the utility of copeptin measurements during stimulation tests. There is evidence that measurement of copeptin under stimulation offers improved diagnostic performance compared to the WDT. There is currently a lack of systematic, evidence-based guidelines on the diagnosis of DI, but as the quality of the evidence defining the diagnostic performance of tests for DI continues to improve, a clearer consensus on the optimal approach should become achievable.
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Affiliation(s)
- Christopher Boot
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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30
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Fujisawa H, Takeuchi T, Ishii A, Muto J, Kamasaki H, Suzuki A, Sugimura Y. Absence of anti-rabphilin-3A antibodies in children and young adults with idiopathic central diabetes insipidus: a potential clue to elucidating a tumor etiology. Hormones (Athens) 2023; 22:747-758. [PMID: 37697216 PMCID: PMC10651553 DOI: 10.1007/s42000-023-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Central diabetes insipidus (CDI) is a rare condition caused by various underlying diseases, including neoplasms, autoimmune diseases, and infiltrative diseases. Differentiating between CDI etiologies is difficult. What has initially been classified as "idiopathic" central diabetes insipidus might in fact underlie various pathogenic mechanisms that are less understood to date and/or are not obvious at initial presentation. Therefore, even if idiopathic CDI is diagnosed at the time of onset, it is common for tumors such as germinoma to develop during surveillance. Crucially, a delayed diagnosis of germinoma may be associated with a worse prognosis. Recently, the presence of anti-rabphilin-3A antibodies has been found to be a highly sensitive and specific marker of lymphocytic infundibuloneurohypophysitis, an autoimmune-mediated CDI. CASE PRESENTATION We herein present two cases, namely, a 13-year-old boy (patient 1) and a 19-year-old young man (patient 2) who were diagnosed with idiopathic CDI. In both patients, panhypopituitarism developed. Magnetic resonance imaging revealed pituitary stalk thickening and pituitary swelling approximately 1 1/2 years after the onset of CDI. Western blotting did not reveal the presence of anti-rabphilin-3A antibodies in serum in either patient, suggesting that autoimmune mechanisms might not be involved. Both patients were subsequently diagnosed with germinoma on pathological examination. They received chemotherapy, followed by radiation therapy. Notably, testosterone and insulin-like growth factor-1 levels normalized, and libido and beard growth recovered after chemoradiotherapy in patient 2. CONCLUSION Our data suggest that the absence of anti-rabphilin-3A antibodies in young patients clinically diagnosed with idiopathic CDI may increase the probability of the development of non-lymphocytic lesions, including germinoma. We thus recommend a more attentive approach at the onset of these diseases.
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Affiliation(s)
- Haruki Fujisawa
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Takako Takeuchi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Akira Ishii
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Jun Muto
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Hotaka Kamasaki
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
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Gordon AJ, Dastagirzada Y, Schlacter J, Mehta S, Agrawal N, Golfinos JG, Lebowitz R, Pacione D, Lieberman S. Health Care Disparities in Transsphenoidal Surgery for Pituitary Tumors: An Experience from Neighboring Urban Public and Private Hospitals. J Neurol Surg B Skull Base 2023; 84:560-566. [PMID: 37854536 PMCID: PMC10581820 DOI: 10.1055/s-0042-1757613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 10/17/2022] Open
Abstract
Objectives Few studies have assessed the role of socioeconomic health care disparities in skull base pathologies. We compared the clinical history and outcomes of pituitary tumors at private and public hospitals to delineate whether health care disparities exist in pituitary tumor surgery. Methods We reviewed the records of patients who underwent transsphenoidal pituitary tumor resection at NYU Langone Health and Bellevue Hospital. Seventy-two consecutive patients were identified from each hospital. The primary outcome was time-to-surgery from initial recommendation. Secondary outcomes included postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, and gross total resection. Results Of 144 patients, 23 (32%) public hospital patients and 24 (33%) private hospital patients had functional adenomas ( p = 0.29). Mean ages for public and private hospital patients were 46.5 and 51.1 years, respectively ( p = 0.06). Private hospital patients more often identified as white ( p < 0.001), spoke English ( p < 0.001), and had private insurance ( p < 0.001). The average time-to-surgery for public and private hospital patients were 46.2 and 34.8 days, respectively ( p = 0.39). No statistically significant differences were found in symptom duration, tumor size, reoperation, CSF leak, or postoperative length of stay; however, public hospital patients more frequently required emergency surgery ( p = 0.03), developed transient diabetes insipidus ( p = 0.02), and underwent subtotal resection ( p = 0.04). Conclusion Significant socioeconomic differences exist among patients undergoing pituitary surgery at our institution's hospitals. Public hospital patients more often required emergency surgery, developed diabetes insipidus, and underwent subtotal tumor resection. Identifying these differences is an imperative initial step in improving the care of our patients.
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Affiliation(s)
- Alex J. Gordon
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, United States
| | - Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Jamie Schlacter
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, United States
| | - Sonal Mehta
- Division of Endocrinology, Department of Medicine, NYU Langone Health, New York, New York, United States
| | - Nidhi Agrawal
- Division of Endocrinology, Department of Medicine, NYU Langone Health, New York, New York, United States
| | - John G. Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Richard Lebowitz
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, United States
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32
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Affiliation(s)
- John Newell-Price
- From the School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
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33
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Refardt J, Atila C, Chifu I, Ferrante E, Erlic Z, Drummond JB, Indirli R, Drexhage RC, Sailer CO, Widmer A, Felder S, Powlson AS, Hutter N, Vogt DR, Gurnell M, Soares BS, Hofland J, Beuschlein F, Fassnacht M, Winzeler B, Christ-Crain M. Arginine or Hypertonic Saline-Stimulated Copeptin to Diagnose AVP Deficiency. N Engl J Med 2023; 389:1877-1887. [PMID: 37966286 DOI: 10.1056/nejmoa2306263] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Distinguishing between arginine vasopressin (AVP) deficiency and primary polydipsia is challenging. Hypertonic saline-stimulated copeptin has been used to diagnose AVP deficiency with high accuracy but requires close sodium monitoring. Arginine-stimulated copeptin has shown similar diagnostic accuracy but with a simpler test protocol. However, data are lacking from a head-to-head comparison between arginine-stimulated copeptin and hypertonic saline-stimulated copeptin in the diagnosis of AVP deficiency. METHODS In this international, noninferiority trial, we assigned adult patients with polydipsia and hypotonic polyuria or a known diagnosis of AVP deficiency to undergo diagnostic evaluation with hypertonic-saline stimulation on one day and with arginine stimulation on another day. Two endocrinologists independently made the final diagnosis of AVP deficiency or primary polydipsia with use of clinical information, treatment response, and the hypertonic-saline test results. The primary outcome was the overall diagnostic accuracy according to prespecified copeptin cutoff values of 3.8 pmol per liter after 60 minutes for arginine and 4.9 pmol per liter once the sodium level was more than 149 mmol per liter for hypertonic saline. RESULTS Of the 158 patients who underwent the two tests, 69 (44%) received the diagnosis of AVP deficiency and 89 (56%) received the diagnosis of primary polydipsia. The diagnostic accuracy was 74.4% (95% confidence interval [CI], 67.0 to 80.6) for arginine-stimulated copeptin and 95.6% (95% CI, 91.1 to 97.8) for hypertonic saline-stimulated copeptin (estimated difference, -21.2 percentage points; 95% CI, -28.7 to -14.3). Adverse events were generally mild with the two tests. A total of 72% of the patients preferred testing with arginine as compared with hypertonic saline. Arginine-stimulated copeptin at a value of 3.0 pmol per liter or less led to a diagnosis of AVP deficiency with a specificity of 90.9% (95% CI, 81.7 to 95.7), whereas levels of more than 5.2 pmol per liter led to a diagnosis of primary polydipsia with a specificity of 91.4% (95% CI, 83.7 to 95.6). CONCLUSIONS Among adult patients with polyuria polydipsia syndrome, AVP deficiency was more accurately diagnosed with hypertonic saline-stimulated copeptin than with arginine-stimulated copeptin. (Funded by the Swiss National Science Foundation; CARGOx ClinicalTrials.gov number, NCT03572166.).
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Affiliation(s)
- Julie Refardt
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Cihan Atila
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Irina Chifu
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Emanuele Ferrante
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Zoran Erlic
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Juliana B Drummond
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Rita Indirli
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Roosmarijn C Drexhage
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Clara O Sailer
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Andrea Widmer
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Susan Felder
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Andrew S Powlson
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Nina Hutter
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Deborah R Vogt
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Mark Gurnell
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Beatriz S Soares
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Johannes Hofland
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Felix Beuschlein
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Martin Fassnacht
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Bettina Winzeler
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Mirjam Christ-Crain
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
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Reins J, Balling F, Baader C, Böck E, Schöniger W, van Erp R, Eff S, Hafner S. [Nephrogenic diabetes insipidus after inhalation sedation with sevoflurane in a patient with COVID-19-associated acute respiratory distress syndrome]. DIE ANAESTHESIOLOGIE 2023; 72:799-802. [PMID: 37847389 DOI: 10.1007/s00101-023-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Johannes Reins
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Florian Balling
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Christoph Baader
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Elfriede Böck
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Wolfgang Schöniger
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Rene van Erp
- Via Medis Nierenzentrum Neu-Ulm MVZ GmbH, Neu-Ulm, Deutschland
| | - Sebastian Eff
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland
| | - Sebastian Hafner
- Abteilung für Anästhesie und Intensivmedizin, Kreiskliniken Günzburg-Krumbach, Klinik Krumbach, Mindelheimer Str. 69, 86381, Krumbach, Deutschland.
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Brunori L, Dolan C, Elias Santo‐Domingo N. Occurrence and clinical relevance of postoperative hypernatremia in dogs undergoing cholecystectomy. J Vet Intern Med 2023; 37:2171-2177. [PMID: 37682033 PMCID: PMC10658579 DOI: 10.1111/jvim.16847] [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: 02/13/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients undergoing cholecystectomy have not been reported previously to develop clinically relevant postoperative hypernatremia. OBJECTIVES Describe the frequency of postoperative hypernatremia in dogs undergoing cholecystectomy and its clinical relevance (duration of hospitalization and survival). ANIMALS Thirty-seven dogs undergoing cholecystectomy at 2 private referral hospitals. METHODS Retrospective study of dogs undergoing cholecystectomy with available preoperative and postoperative serum sodium concentrations. RESULTS Postoperative hypernatremia (>150 mEq/L) was common (56%; 95% confidence interval [CI], 40%-70%) and was associated with significantly higher mortality compared to nonhypernatremic patients (52%; 95% CI, 30%-70% vs 12.5%; 95% CI, 2%-40%; P = .02). Nonsurvivors had higher mean postoperative peak serum sodium concentrations (155 mEq/L; range, 146-172) than survivors (150 mEq/L; range, 142-156; P = .01). Dogs developing hypernatremia within 6 hours after surgery had 7.7 higher odds of nonsurvival (odds ratio [OR], 7.7; 95% CI, 5.9-9.4). A delta value (serum sodium concentration on admission [T0] - serum sodium concentration 6 hours postoperatively [T2]) of ≥10 mEq/L carried 3.3 higher odds of mortality (OR, 3.3; 95% CI, 1.6-5.1). All dogs with a postoperative peak sodium concentration >160 mEq/L did not survive. Admission acute patient physiologic laboratory evaluation fast (APPLEfast ) scores were not different between survivors and nonsurvivors or between postoperative hypernatremic and normonatremic patients. Hospitalization time was no different between hypernatremic and normonatremic patients (6 days vs 4.5 days; P = .15). Dogs with gallbladder mucocele were more likely to develop postoperative hypernatremia and have poorer outcomes. CONCLUSIONS Hypernatremia was a common and clinically relevant postoperative complication in dogs after cholecystectomy. Detection of hypernatremia within 6 hours after surgery may be associated with poorer outcomes.
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Affiliation(s)
- Lara Brunori
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
| | - Cormac Dolan
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
| | - Neus Elias Santo‐Domingo
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
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Cheng X, Hou Y. Importance of metabolic and immune profile as a prognostic indicator in patients with diabetic clear cell renal cell carcinoma. Front Oncol 2023; 13:1280618. [PMID: 37927470 PMCID: PMC10623455 DOI: 10.3389/fonc.2023.1280618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Background ccRCC, also known as clear cell renal cell carcinoma, is a cancer that is highly metabolically active and has a strong connection with the immune system. The objective of this research was to investigate the correlation between pathways associated with metabolism, diabetes, immune infiltration, and their impact on the prognosis of ccRCC. Method We conducted an extensive examination utilizing ssGSEA, ESTIMATE algorithm, WGCNA, and GSVA for gene set enrichment analysis, gene co-expression network analysis, and gene set variation analysis. An established prognostic model, utilizing immune-related WGCNA findings, was evaluated for its association with clinical characteristics and the tumor microenvironment (TME). Result The ssGSEA effectively categorized ccRCC into groups based on low and high metabolism. Strong associations were observed between scores related to metabolism and immune scores, ESTIMATE scores, stromal scores, and gene expression related to HLA. The analysis conducted by WGCNA revealed a module called the 'yellow module' that exhibited a significant correlation with the infiltration of immune cells and the survival rates of patients. A risk model was developed, demonstrating reliable predictive performance for patient survival outcomes. The risk model also correlated significantly with immune scores and HLA-related gene expressions, suggesting potential immune evasion mechanisms. The analysis of mutations in TCGA data revealed the mutational patterns of ccRCC, and there was a significant correlation between the risk score and clinical characteristics. The GSVA analysis revealed a notable enrichment of pathways associated with cancer in patients at high risk. Finally, in order to evaluate the role of CX3CL1 in renal cell carcinoma cells, we then performed the cell proliferation assays. The results demonstrated that the over expression of CXCL1 could promote the cell proliferation ability in renal cell carcinoma cells. Conclusion Our findings provide a novel perspective on the interactions between diabetes, metabolic pathways, and the immune landscape in ccRCC. The predictive value of the prognostic model established in this research has the potential to guide the development of new therapeutic and prognostic approaches for patients with ccRCC.
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Affiliation(s)
- Xiangyu Cheng
- Department of Urology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yanlian Hou
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
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Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocr Rev 2023; 44:819-861. [PMID: 36974717 PMCID: PMC10502587 DOI: 10.1210/endrev/bnad010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023]
Abstract
Hyponatremia is the most common electrolyte disorder, affecting more than 15% of patients in the hospital. Syndrome of inappropriate antidiuresis (SIAD) is the most frequent cause of hypotonic hyponatremia, mediated by nonosmotic release of arginine vasopressin (AVP, previously known as antidiuretic hormone), which acts on the renal V2 receptors to promote water retention. There are a variety of underlying causes of SIAD, including malignancy, pulmonary pathology, and central nervous system pathology. In clinical practice, the etiology of hyponatremia is frequently multifactorial and the management approach may need to evolve during treatment of a single episode. It is therefore important to regularly reassess clinical status and biochemistry, while remaining alert to potential underlying etiological factors that may become more apparent during the course of treatment. In the absence of severe symptoms requiring urgent intervention, fluid restriction (FR) is widely endorsed as the first-line treatment for SIAD in current guidelines, but there is considerable controversy regarding second-line therapy in instances where FR is unsuccessful, which occurs in around half of cases. We review the epidemiology, pathophysiology, and differential diagnosis of SIAD, and summarize recent evidence for therapeutic options beyond FR, with a focus on tolvaptan, urea, and sodium-glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Annabelle M Warren
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel 4031, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel 4031, Switzerland
| | - Nicholas Russell
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
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Gippert S, Brune M, Dirksen RL, Choukair D, Bettendorf M. Arginine-Stimulated Copeptin-Based Diagnosis of Central Diabetes Insipidus in Children and Adolescents. Horm Res Paediatr 2023; 97:270-278. [PMID: 37607514 DOI: 10.1159/000532015] [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: 01/02/2023] [Accepted: 07/06/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Diagnosis of central diabetes insipidus (CDI) remains challenging. Water deprivation testing and hypertonic saline infusion, as established diagnostic tests, are mentally and physically demanding for patients. Arginine-stimulated copeptin has been shown as a putative parameter for the differential diagnosis of CDI in adults. METHODS In this single-centre retrospective study, we identified paediatric patients with suspected pituitary disorders who underwent standard arginine testing. Patients with CDI, matched controls, and primary polydipsia (PP) were identified. Diagnoses were confirmed retrospectively using comprehensive clinical and diagnostic characteristics. Serum copeptin concentrations were measured using a commercially available automated immunofluorescence assay (B.R.A.H.M.S Copeptin-proAVP KRYPTOR®) in samples stored for a median of 4.6 years (1.3-10.84) and collected before and 60 min after arginine infusion. Cut-off analyses were performed using ROC curves. RESULTS Serum samples from 32 patients with CDI, 32 matched controls, and 5 patients with PP (n = 69; 51 males, 18 females) were available for analysis. Median copeptin concentrations increased from 4.47 pmol/L (interquartile range [IQR]: 3.47-8.36) to 6.96 pmol/L (IQR: 4.51-12.89; p < 0.001) in controls, from 1.46 pmol/L (IQR: 1.21-2.12) to 1.44 (IQR: 1.10-1.87; p = 0.645, ns) in CDI, and from 4.40 pmol/L (3.95-6.33) to 9.58 pmol/L (8.19-11.42; p < 0.001) in PP. The published cut-off value of 3.8 pmol/L revealed a sensitivity of 100% and a specificity of 86.5% in confirming CDI. CONCLUSION Our results suggest that arginine-stimulated serum copeptin concentrations are a sensitive and specific diagnostic tool for CDI in paediatric patients, which may replace and simplify the conventional diagnostic pathway of water deprivation testing and hypertonic saline infusion.
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Affiliation(s)
- Sebastian Gippert
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany
- Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Maik Brune
- Division of Endocrinology, Diabetes, Metabolic Diseases and Clinical Chemistry, Central Laboratory, University Hospital Heidelberg, Heidelberg, Germany
| | - Ruth L Dirksen
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany
- Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany
- Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany
- Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Sandhya P. Urine concentration defects including nephrogenic diabetes insipidus in patients with Sjögren's Syndrome and renal tubular acidosis. Minerva Urol Nephrol 2023; 75:542-543. [PMID: 37293815 DOI: 10.23736/s2724-6051.23.05231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Pulukool Sandhya
- Department of Rheumatology, St Stephen's Hospital, Delhi, India -
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Cappola AR, Auchus RJ, El-Hajj Fuleihan G, Handelsman DJ, Kalyani RR, McClung M, Stuenkel CA, Thorner MO, Verbalis JG. Hormones and Aging: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1835-1874. [PMID: 37326526 DOI: 10.1210/clinem/dgad225] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Multiple changes occur across various endocrine systems as an individual ages. The understanding of the factors that cause age-related changes and how they should be managed clinically is evolving. This statement reviews the current state of research in the growth hormone, adrenal, ovarian, testicular, and thyroid axes, as well as in osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism, with a specific focus on older individuals. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The goal of this statement is to inform future research that refines prevention and treatment strategies in age-associated endocrine conditions, with the goal of improving the health of older individuals.
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Affiliation(s)
- Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
- Endocrinology and Metabolism Section, Medical Service, LTC Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI 48015, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology, Department of Internal Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Andrology Department, Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael McClung
- Oregon Osteoporosis Center, Portland, OR 97213, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Cynthia A Stuenkel
- Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, CA 92093, USA
| | - Michael O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20057, USA
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Ilie MD, Raverot G. Oxytocin deficiency in patients with arginine vasopressin deficiency (central diabetes insipidus). Lancet Diabetes Endocrinol 2023; 11:442-443. [PMID: 37192643 DOI: 10.1016/s2213-8587(23)00126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Mirela Diana Ilie
- Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, Lyon, France; Endocrinology Department, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Gérald Raverot
- Endocrinology Department, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania; Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, 69677 Bron, France.
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Koumpis E, Kyriazopoulou L, Tigas S, Kapsali E, Hatzimichael E. Central Diabetes Insipidus in a Patient With Lymphoma: A Case Report. Cureus 2023; 15:e41500. [PMID: 37551214 PMCID: PMC10404345 DOI: 10.7759/cureus.41500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Primary central nervous system (CNS) lymphoma or systemic non-Hodgkin lymphoma that infiltrates the CNS can cause central diabetes insipidus (CDI). Polyuria and polydipsia should raise the suspicion of CDI development in patients with lymphoma that infiltrates the CNS. CDI is effectively treated with desmopressin. However, careful monitoring of the patient's serum sodium, fluid intake, urine output, and weight is necessary because patients receiving desmopressin may develop hyponatremia, so they should be alert to recognize this side effect promptly. Moreover, CDI due to lymphoma can occasionally be reversible. Therefore, the dosage of desmopressin should be adapted during or after the treatment of lymphoma.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Lydia Kyriazopoulou
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Stelios Tigas
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Eleni Kapsali
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
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Atila C, Holze F, Murugesu R, Rommers N, Hutter N, Varghese N, Sailer CO, Eckert A, Heinrichs M, Liechti ME, Christ-Crain M. Oxytocin in response to MDMA provocation test in patients with arginine vasopressin deficiency (central diabetes insipidus): a single-centre, case-control study with nested, randomised, double-blind, placebo-controlled crossover trial. Lancet Diabetes Endocrinol 2023; 11:454-464. [PMID: 37192642 DOI: 10.1016/s2213-8587(23)00120-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Disruptions of the hypothalamic-pituitary axis can cause an arginine vasopressin deficiency, also known as central diabetes insipidus. Patients with this condition are at high risk of additional oxytocin deficiency owing to the close anatomical proximity of oxytocin-producing neurons; however, no conclusive evidence for such a deficiency has been reported. We aimed to use 3,4-methylenedioxymethamphetamine (MDMA, also known as ecstasy), a strong activator of the central oxytocinergic system, as a biochemical and psychoactive provocation test to investigate oxytocin deficiency in patients with arginine vasopressin deficiency (central diabetes insipidus). METHODS This single-centre, case-control study with nested, randomised, double-blind, placebo-controlled crossover trial included patients with arginine vasopressin deficiency (central diabetes insipidus) and healthy controls (matched 1:1 by age, sex, and BMI) and was conducted at the University Hospital Basel, Basel, Switzerland. We used block randomisation to assign participants to receive either a single oral dose of MDMA (100 mg) or placebo in the first experimental session; patients received the opposite treatment at the next session, with a wash-out period of at least 2 weeks between the two sessions. Participants and investigators assessing the outcomes were masked to assignment. Oxytocin concentrations were measured at 0, 90, 120, 150, 180, and 300 min after MDMA or placebo. The primary outcome was the area under the plasma oxytocin concentration curve (AUC) after drug intake. The AUC was compared between groups and conditions using a linear mixed-effects model. Subjective drug effects were assessed throughout the study using ten-point visual analogue scales. Acute adverse effects were assessed before and 360 min after drug intake using a 66-item list of complaints. This trial is registered with ClinicalTrials.gov, NCT04648137. FINDINGS Between Feb 1, 2021, and May 1, 2022, we recruited 15 patients with arginine vasopressin deficiency (central diabetes insipidus) and 15 healthy controls. All participants completed the study and were included in the analyses. In healthy controls, median plasma oxytocin concentration was 77 pg/mL (IQR 59-94) at baseline and increased by 659 pg/mL (355-914) in response to MDMA, resulting in an AUC of 102 095 pg/mL (41 782-129 565); in patients, baseline oxytocin concentration was 60 pg/mL (51-74) and only slightly increased by 66 pg/mL (16-94) in response to MDMA, resulting in an AUC of 6446 pg/mL (1291-11 577). The effect of MDMA on oxytocin was significantly different between groups: the AUC for oxytocin was 82% (95% CI 70-186) higher in healthy controls than in patients (difference 85 678 pg/mL [95% CI 63 356-108 000], p<0·0001). The increase in oxytocin in healthy controls was associated with typical strong subjective prosocial, empathic, and anxiolytic effects, whereas only minimal subjective effects were observed in patients, in agreement with the lack of increase in oxytocin concentrations. The most frequently reported adverse effects were fatigue (eight [53%] healthy controls and eight [53%] patients), lack of appetite (ten [67%] healthy controls and eight [53%] patients), lack of concentration (eight [53%] healthy controls and seven [47%] patients), and dry mouth (eight [53%] healthy controls and eight [53%] patients). In addition, two (13%) healthy controls and four (27%) patients developed transient mild hypokalaemia. INTERPRETATION These findings are highly suggestive of clinically meaningful oxytocin deficiency in patients with arginine vasopressin deficiency (central diabetes insipidus), laying the groundwork for a new hypothalamic-pituitary disease entity. FUNDING Swiss National Science Foundation, Swiss Academy of Medical Sciences, and the G&J Bangerter-Rhyner Foundation.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Friederike Holze
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Rakithan Murugesu
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Nikki Rommers
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Nina Hutter
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Clara O Sailer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland.
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Van Matre ET, Rice PJ, Wempe MF, Lyda C, McAlwee T, Larkin M, Kiser TH. Extended Stability of Vasopressin Injection in Polyvinyl Chloride Bags and Polypropylene Syringes and Its Impact on Critically Ill Patient Care and Medication Waste. Hosp Pharm 2023; 58:205-211. [PMID: 36890958 PMCID: PMC9986564 DOI: 10.1177/00185787221130229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background. Vasopressin is frequently utilized for a variety of shock states in critically ill patients. Short stability (≤24 hours) after intravenous admixture with current manufacturer labeling requires just in time preparation and may lead to delays in therapy and increased medication waste. We aimed to evaluate vasopressin stability in 0.9% sodium chloride stored in polyvinyl chloride bags and polypropylene syringes for up to 90 days. Additionally, we evaluated the impact of extended stability on the time to administration and cost savings from reduced medical waste at an academic medical center. Methods. Dilutions of vasopressin to concentrations of 0.4 and 1.0 unit/mL were performed under aseptic conditions. The bags and syringes were stored at room temperature (23°C-25°C) or under refrigeration (3°C-5°C). Three samples of each preparation and storage environment were analyzed on days 0, 2, 14, 30, 45, 60, and 90. Physical stability was performed by visual examination. The pH was assessed at each point and upon final degradation evaluation. Sterility of the samples was not assessed. Chemical stability of vasopressin was evaluated using liquid chromatography with tandem mass spectrometry. Samples were considered stable if there was <10% degradation of the initial concentration. Results. Vasopressin diluted to 0.4 and 1.0 unit/mL with 0.9% sodium chloride injection was physically stable throughout the study. No precipitation was observed. At days 2, 14, 30, 45, 60, and 90 all bags and syringes diluted to 0.4 units/mL had <10% degradation. Vasopressin diluted to 1 unit/mL and stored under refrigeration had <10% degradation at all measured days, but when stored under room temperature was found to have >10% degradation at day 30. Implementation of a batching process resulted in reduced waste ($185 300) and improved time to administration (26 vs 4 minutes). Conclusion. Vasopressin diluted to a concentration of 0.4 units/mL with 0.9% sodium chloride injection is stable for 90 days at room temperature and under refrigeration. When diluted to 1.0 unit/mL with 0.9% sodium chloride injection it is stable for 90 days under refrigeration. Use of extended stability and sterility testing to batch prepare infusions may lead to improved time to administration and cost savings from reduced medication waste.
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Affiliation(s)
| | - Peter J. Rice
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Michael F. Wempe
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
- University of Colorado Cancer Center,
Aurora, CO, USA
| | - Clark Lyda
- University of Colorado Hospital,
Aurora, CO, USA
| | | | | | - Tyree H. Kiser
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Pan C, Qi J, Wu J, Wu B, Xie S, Wu X, Tang B, Hong T. Predictors of the Spontaneous Resolution of Central Diabetes Insipidus Following Endoscopic Endonasal Surgery for Craniopharyngioma. World Neurosurg 2023; 172:e667-e678. [PMID: 36739895 DOI: 10.1016/j.wneu.2023.01.118] [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] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Central diabetes insipidus (CDI) is the most common complication of endoscopic endonasal surgery (EES) for craniopharyngioma. However, some cases of CDI could spontaneously resolve during the follow-up period. Hence, this study aimed to determine the predictive factors for the spontaneous resolution of CDI. METHODS Data of patients with CDI who underwent EES for craniopharyngioma between February 2009 and June 2021 were retrospectively reviewed. All patients were divided into 2 groups based on the resolution of CDI during follow-up: the recovery and no recovery groups. The baseline characteristic, surgical, and follow-up results of patients were compared. RESULTS We identified 84 patients with CDI (35 in the recovery group and 49 in the no recovery group). A direct comparison showed that retaining the pituitary stalk (57.1% vs. 14.3%, P = 0.000) and no-hypothalamic injury (HI) (68.6% vs. 20.4%, P = 0.000) were more common in the recovery group, whereas hydrocephalus at diagnosis (8.6% vs. 46.9%, P = 0.000) was significantly more common in the no recovery group. Subsequently, we found through univariate and multivariate analysis that the spontaneous resolution of CDI was associated with hydrocephalus at diagnosis (yes vs. no: odds ratio [OR], 0.198; P = 0.045), pituitary stalk injury (retaining vs. sectioning: OR, 7.055; P = 0.004), and the Hong et al HI pattern (mild-HI vs. no-HI: OR, 0.183; P = 0.038; unilateral-HI vs. no-HI: OR, 0.147; P = 0.017; bilateral-HI vs. no-HI: OR, 0.154; P = 0.044). CONCLUSIONS Hydrocephalus at diagnosis, pituitary stalk injury, and the Hong et al HI pattern might be predictors of the spontaneous resolution of CDI following EES for craniopharyngioma.
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Affiliation(s)
- Chengbing Pan
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialong Qi
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bowen Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shenhao Xie
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Tang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Hong
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China.
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Klussmann E. Aquaporin-2 is not alone. Kidney Int 2023; 103:458-460. [PMID: 36822749 DOI: 10.1016/j.kint.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 02/23/2023]
Abstract
Arginine-vasopressin induces water reabsorption in collecting duct principal cells through the water channels aquaporin (AQP) 2, 3, and 4. Only the presence of these AQPs allows for short-term adjustments of plasma osmolality by arginine-vasopressin. How principal cells maintain the expression of the AQPs is unclear. Zhang et al., for the first time, identify a mechanism that explains the expression of the AQPs under resting conditions. They show that the transcription coregulator, yes-associated protein, is responsible for the coordinated expression of the 3 AQPs.
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Affiliation(s)
- Enno Klussmann
- Research Area Cardiovascular & Metabolic Diseases, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; DZHK (German Center for Cardio vascular Research), Partner Site Berlin, Germany.
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Patel N, Patel D, Farouk SS, Rein JL. Salt and Water: A Review of Hypernatremia. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:102-109. [PMID: 36868726 DOI: 10.1053/j.akdh.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 03/05/2023]
Abstract
Serum sodium disorders are generally a marker of water balance in the body. Thus, hypernatremia is most often caused by an overall deficit of total body water. Other unique circumstances may lead to excess salt, without an impact on the body's total water volume. Hypernatremia is commonly acquired in both the hospital and community. As hypernatremia is associated with increased morbidity and mortality, treatment should be initiated promptly. In this review, we will discuss the pathophysiology and management of the main types of hypernatremia, which can be categorized as either a loss of water or gain of sodium that can be mediated by renal or extrarenal mechanisms.
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Affiliation(s)
- Niralee Patel
- Division of Nephrology and Hypertension, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - Dhwanil Patel
- Division of Nephrology, Overlook Medical Center, Summit, NJ
| | - Samira S Farouk
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua L Rein
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Kermond R, Mallett A, McCarthy H. A clinical approach to tubulopathies in children and young adults. Pediatr Nephrol 2023; 38:651-662. [PMID: 35585366 PMCID: PMC9842573 DOI: 10.1007/s00467-022-05606-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/21/2023]
Abstract
Kidney tubules are responsible for the preservation of fluid, electrolyte and acid-base homeostasis via passive and active mechanisms. These physiological processes can be disrupted by inherited or acquired aetiologies. The net result is a tubulopathy. It is important to make a prompt and accurate diagnosis of tubulopathies in children and young adults. This allows timely and appropriate management, including disease-specific therapies, and avoids complications such as growth failure. Tubulopathies can present with a variety of non-specific clinical features which can be diagnostically challenging. In this review, we build from this common anatomical and physiological understanding to present a tangible appreciation of tubulopathies as they are likely to be clinically encountered among affected children and young adults.
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Affiliation(s)
- Rachael Kermond
- Department of Renal Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Andrew Mallett
- Department of Renal Medicine, Townsville University Hospital, Douglas, QLD, Australia.
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.
- Institute for Molecular Bioscience & Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Hugh McCarthy
- Department of Renal Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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Choy KW, Georgiadis E. Investigating the polyuria-polydipsia syndrome: the "PP" Shiny app. Clin Chem Lab Med 2023; 61:e126-e127. [PMID: 36701813 DOI: 10.1515/cclm-2022-1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Kay Weng Choy
- Department of Pathology, Northern Health, Epping, VIC, Australia
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50
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Sodium Homeostasis, a Balance Necessary for Life. Nutrients 2023; 15:nu15020395. [PMID: 36678265 PMCID: PMC9862583 DOI: 10.3390/nu15020395] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Body sodium (Na) levels must be maintained within a narrow range for the correct functioning of the organism (Na homeostasis). Na disorders include not only elevated levels of this solute (hypernatremia), as in diabetes insipidus, but also reduced levels (hyponatremia), as in cerebral salt wasting syndrome. The balance in body Na levels therefore requires a delicate equilibrium to be maintained between the ingestion and excretion of Na. Salt (NaCl) intake is processed by receptors in the tongue and digestive system, which transmit the information to the nucleus of the solitary tract via a neural pathway (chorda tympani/vagus nerves) and to circumventricular organs, including the subfornical organ and area postrema, via a humoral pathway (blood/cerebrospinal fluid). Circuits are formed that stimulate or inhibit homeostatic Na intake involving participation of the parabrachial nucleus, pre-locus coeruleus, medial tuberomammillary nuclei, median eminence, paraventricular and supraoptic nuclei, and other structures with reward properties such as the bed nucleus of the stria terminalis, central amygdala, and ventral tegmental area. Finally, the kidney uses neural signals (e.g., renal sympathetic nerves) and vascular (e.g., renal perfusion pressure) and humoral (e.g., renin-angiotensin-aldosterone system, cardiac natriuretic peptides, antidiuretic hormone, and oxytocin) factors to promote Na excretion or retention and thereby maintain extracellular fluid volume. All these intake and excretion processes are modulated by chemical messengers, many of which (e.g., aldosterone, angiotensin II, and oxytocin) have effects that are coordinated at peripheral and central level to ensure Na homeostasis.
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