Symptoms Of Polydipsia Research Articles

A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children

Objectives: We aimed to study the characterizing clinical and biochemical profiles of Diabetic Ketoacidosis (DKA) in children with newly diagnosed Type 1 Diabetes Mellitus (Type 1DM) compared to children with established diagnosis of Type 1DM presenting with DKA admitted to the pediatric intensive care unit of a large university hospital in the eastern region of Saudi Arabia. Methods: We retrospectively reviewed the medical records of 211 patients who were admitted to the pediatric intensive care unit with diabetic ketoacidosis between 2010 and 2019. The diagnosis of diabetic ketoacidosis was based on symptoms of polydipsia, polyurea, weight loss, vomiting, dehydration, abdominal pain, breathing problems, lethargy or coma, biochemical hyperglycemia (blood glucose level of >200 mg/dL), venous pH of <7.3, serum bicarbonate level of ≤15 mEq/L, and ketonemia (blood β -hydroxybutyrate concentration of ≥3 mM) or moderate or severe ketonuria (diagnosed as newly acquired type 1 diabetes). Results: The rate of newly diagnosed Type 1 DM with DKA was 41.7%, out of them who got severe and moderate diabetic ketoacidosis were 61.6% and 38.4%, respectively. We observed significantly increased heart and respiratory rates in patients newly diagnosed with diabetic ketoacidosis and in those with severe diabetic ketoacidosis (p<0.001) compared to known cases with Type 1DM presenting with DKA. We also identified significantly increased biochemical indices including HbA1c, random blood sugar, serum osmolality, blood urea nitrogen, creatinine, chloride, lactate, and anion gap in relation to severe diabetic ketoacidosis and newly diagnosed type 1 diabetes (p ≤ 0.05). Conclusions: We found that the clinical and biochemical profiles of patients with newly diagnosed Type 1 DM children were significantly affected compared to children who were known Type 1DM presenting with DKA.

Primary suprasellar germinoma: A series of 15 cases

Primary suprasellar germinoma (PSG) is a rare malignant tumor of the central nervous system. This study aimed to explore the clinical characteristics, treatment protocol, and prognosis of patients with PSG. This case series retrospectively analyzed the clinical data of patients with PSG in Tianjin Huanhu Hospital diagnosed between January 2016 and December 2021. Fifteen patients with an average age of 19.6 years were included, in which nine of them were males. The mean duration between initial symptoms and admission was 17.0 months. The mean follow-up was 40.8 months. Ten patients had polydipsia and polyuria, visual impairments were observed in 8 patients, and 2 cases (13.3%) had symptoms both from suprasellar and pineal regions. All 15 cases were histopathologically confirmed as germinoma through craniotomy or biopsy. Most patients (80%) underwent radiotherapy combined with chemotherapy. During follow-up, all the patients showed a reduction in tumor size, especially in the bifocal cases. Symptoms of polydipsia, polyuria, and visual impairment were markedly relieved to different degrees. All patients had recovered well at discharge. Patients with polydipsia and polyuria took desmopressin daily. A histological confirmation by open biopsy through craniotomy or endoscopic biopsy might be recommended for PSG to start the appropriate treatments. Patients with PSG will usually have a good prognosis, but attention should be paid to the treatment of endocrine deficiencies.

Autosomal Dominant Familial Neurohypophyseal Diabetes Insipidus in Three Generations

Familial neurohypophysial diabetes insipidus (FNDI), an autosomal dominant disorder, comes in many forms that are differentiated by the inheritance pattern and the underlying genetic lesion. The disease is caused by mutations in the vasopressin-neurophysin 2- copeptin protein (AVP-NPII), in wolframin (WFS1) or in proprotein convertase subtilisin/kexin type 1 (PCSK1) genes. Materials and methods: In this study, we report a case of familial neurohypophyseal DI in three generations; followed in unit of the endocrinology, diabetology, metabolic diseases and nutrition department of the Mohammed VI University Hospital of Marrakesh. Results: This was a 45-year-old patient who had been suffering from polyuro-polydipsia syndrome since the age of 12, with daily urine volumes ranging from 8.0 to 15.0 litres, but had not seen a doctor. The patient was born without complications and had normal puberty. In the family history, three other members of the patient’s family have also had polypolypolydispic syndrome since adolescence, covering three generations, including the patient’s mother, her younger sister and daughter. A water restriction test was performed but the patient did not tolerate it. We completed with the minirin test with a good clinical response: urine concentrated with a volume of 500ml, and urinary osmolarity at H4 of 276.13 (Fig 2). As presented in (Fig 3), cranial MRI revealed a hypersignal region in the posterior pituitary lobe. Serum cortisol, thyroid function, and estrogen were all in the normal range The growth hormone (GH), insulin like growth factor (IGF)-1 levels and the genetic testing were not performed due to limited financial resources. After treatment with oral desmopressin 60 ug two times daily was started, the symptoms of polydipsia and polyuria were satisfactorily controlled.

Psychogenic diabetes insipidus: A case report of behaviour psychotherapy

Introduction. Psychogenic diabetes insipidus is potentially a life-threating condition manifesting as a psychogenic thirst disorder with excessive fluid intake (more than 3 L per day) and a preserved function of neurohypophysis and kidneys. Case report. We presented a boy aged 4 years and 8 months with symptoms of polydipsia, polyuria, nocturia and malnutrition. Pediatric examination and laboratory analysis were performed, but clear discrimination between psychogenic and nonpsychogenic diabetes insipidus could not be made. A psychiatric consultation was performed to examine the possibility of compulsive fluid taking. The differentiation was performed in two stages. In the first stage, the child was separated from the mother in short intervals. In the second stage, the behavioral psychotherapy interventions were performed: distraction of attention, and positive and negative reinforcement for delaying compulsive fluid taking. The mother was trained to use methods of operant conditioning, privilege and deprivation, as well as methods of exposure and response prevention and relaxation of the child. It was suggested to continue with multidisciplinary treatment (pediatric, liaison psychiatric and behaviour psychotherapeutic). Evaluation of behaviour therapy was performed after 4 and 12 weeks. During 4 weeks of follow-up, the boy reduced the daily fluid intake by 3.5 L, and added 1 kg of body weight. Also, intervals between fluid intake were significantly extended. This therapeutic effect could not be explained by the pediatric treatment introduced prior to the application of behaviour therapy and psychoeducation of the mother. Conclusion. Consultations and multidisciplinary approach by different health specialists in resolving of a number of predominantly somatic disorders in children with psychogenic diabetes insipidus should be highlighted as a way of treatment.

SUN-430 An Unusual Presentation of Hypopituitarism in the Setting of Metastatic Breast Carcinoma: A Case Report

Introduction: Metastasis to the pituitary gland (PM) are infrequent (1). Breast and lung cancer are the most common primary cancer of PM. We report an interesting case of metastatic breast cancer with pituitary gland involvement debuting with diabetes insipidus as the initial symptom. Clinical Case: A 59-year-old woman presented with symptoms of polydipsia, polyuria, unquantifiable weight loss, and generalized body weakness. Initial assessment showed evidence of panhypopituitarism as per: FT4 0.39 (0.60-1.32 ng/dL), TSH 1.39 (0.45-5.33 uIU/mL), Cortisol 1.8 (6.7-22.6 ug/dL), ACTH 13 (6-50 pg/mL), Prolactin 223.5 (2.74-19.64 ng/mL), Estradiol 222 (<= 31 pg/mL) while on estradiol pellets, LH 0.2 (10.87-58.64 mIU/mL), FSH 1.6 (16.74-113.59 mIU/mL), Na 146 mmol/L, Cl 112 mmol/L, and urine specific gravity 1.004. MRI of the brain reported a pituitary macroadenoma measuring 1.0x1.6x1.8 cm, extending posteriorly along the infundibulum. She was initially treated with hydrocortisone, levothyroxine, cabergoline, and desmopressin. Physical examination was remarkable for a right breast lump. Breast ultrasound showed a mass measuring 1.2x1.2 cm. A biopsy was performed reporting invasive lobular carcinoma, Nottingham histologic grade 2 [ER (85%) PR (61%) and HER2 negative with a KI67 of 2%]. Posteriorly, the patient underwent pituitary biopsy and trans sphenoidal resection with pathology report of metastatic breast carcinoma [ER 20% PR 2% HER2 negative by FISH]. Pituitary stains were negative for prolactin.Subsequent breast cancer staging with CT Abdomen/pelvis and 18F-FDG PET/CT revealed widely metastatic disease including right and left breast, bilateral axillary LAD, moderate bilateral hydronephrosis, and extensive bone disease in the axial and appendicular skeleton. Patient has been treated with 15 cycles of whole-brain radiation therapy, and the current treatment approach is no longer curative, focused on palliative chemotherapy and hormonal replacement therapy. Prolactin levels have normalized. Conclusion: Our case remarks the importance of working up pituitary macroadenomas with diabetes insipidus. Even though metastatic pituitary tumors are rare, awareness of clinical presentation is essential to keep in our differential that isolated pituitary tumors can be an initial presentation of the metastatic process, allowing early diagnosis and interventions. Keywords: Hypopituitarism, Pituitary Gland, Pituitary Metastasis

Primary Polydipsia in Children: Two Case Reports

Primary polydipsia (PP) is marked by an increase in thirst, and most often presents in patients with psychiatric illnesses. Although uncommon in children, we experienced cases of PP in a 15-month-old boy and a 5-year-old girl. Both were admitted to the hospital with symptoms of polydipsia and polyuria that appeared 1–3 months before admission. Brain magnetic resonance imaging in both patients was normal. A water restriction test was performed after hospitalization and showed normal results. The symptoms improved after the parents were instructed to implement water-intake restriction for 2 weeks. Our report provides useful information for the treatment of PP in children. Key words: Primary polydipsia; Diabetes insipidus; Children; Water restriction

Intracranial pure yolk sac tumor in the anterior third ventricle of an adult: A case report.

A 45-year-old female patient presented with symptoms of polydipsia and polyuria, menopause, headache, gait disturbance and deteriorated mental state. Brain magnetic resonance imaging (MRI) showed an irregular mass in the anterior third ventricle. The tumor was excised using a transfrontal approach from the anterior section of the third ventricle. The histological diagnosis was of an intracranial pure yolk sac tumor. The patient underwent radiotherapy and suffered no tumor recurrence one year after the surgery. Overall, when heterogeneous enhancement and an irregular mass with surrounding invasion and ventricular dilation are observed in the anterior third ventricle of an adult, a yolk sac tumor should be considered, and MRI may aid the differential diagnosis. A combination of surgical resection and radiotherapy is recommended for the yolk sac tumor.

Primary Polydipsia

Primary polydipsia (PP) is etiologically associated with physical factors and psychiatric disorders ("psychogenic polydipsia"). We present the case of a 28-year-old man with severe symptoms of polydipsia and polyuria. After a comprehensive physical assessment, the only finding was a lesion suggestive of pituitary microadenoma in the magnetic resonance imaging (MRI) scan of the brain. A thorough clinical and diagnostic assessment and the administration of a wide range of psychometric tools revealed no major psychiatric disorder apart from chronic anxiety and mild depressive symptoms. Our patient's PP symptoms might be associated with a dysfunction of the thirst center, which is located closely to the neuroanatomical lesion found in the MRI scan. Given that the underlying pathophysiology of PP remains, to a large extent, unclear, we emphasize on the difficulties to distinguish between PP's subtypes.

Effect of Euonymus alatus on the blood glucose and hemorheology in the rat model of Type 2 diabetes mellitus with blood stagnation

To explore the effect of Euonymus alatus on the blood glucose and hemorheology in rat model of Type 2 diabetes mellitus with blood stagnation (DMBS). High fat diet with streptozocin was used to establish the rat model of Type 2 diabetes mellitus, followed by the prednisolone and adrenaline muscle injection to obtain DMBS. DMBS rats were divided into a DMBS group (treated with saline gavage), an Euonymus alatus group (treated with Euonymus alatus gavage), and a glybenzoylamide group (treated with glybenzoylamide gavage).A blank group was treated with saline gavage. The experiment lasted 4 weeks, followed by the evaluation of rats' behavior, and detection of fasting blood glucose and hemorheology. Compared with DMBS rats, the symptoms of polydipsia and diuresis in Euonymus alatus rats were improved, with increased body weight (P<0.05), better fur and mental state, increased resistance for being caught, and reduced tongue stagnation. Compared with DMBS group, though body weight increased, resistance for being caught decreased in the glybenzoylamide group with bad fur and mental state,and tongue stagnation. As to the fasting blood glucose, there was significant difference between the Euonymus alatus group and the DMBS group (P<0.05). As to the hemorheology, including whole blood viscosity (shear rates 1,5,50, and 100 s(-1)), plasma viscosity, and hematocrit, the Euonymus alatus rats had a better efficacy than DMBS rats and glybenzoylamide rats (P<0.05 or P<0.01). Euonymus alatus can reduce the fasting blood glucose of DMBS and improve blood stagnation.

Homozygous NPHP1 deletions in Egyptian children with nephronophthisis including an infantile onset patient

Homozygous NPHP1 deletions in Egyptian children with nephronophthisis including an infantile onset patient

Autosomal Dominant Neurohypophyseal Diabetes Insipidus in Two Families

Background: Autosomal dominant familial neurohypophyseal diabetes insipidus (adFNDI) is a rare disease with symptoms of polydipsia, polyuria and dehydration caused by arginine vasopressin deficiency. Disease onset is within infancy or adolescence. A variety of disease-causing mutations of the arginine vasopressin neurophysin II gene (AVP) on chromosome 20p13 have been described. Methods: Two Polish families with adFNDI were screened for mutations. Processing of wild-type (WT) and mutant AVP was monitored using immunocytochemical methods in stably transfected Neuro2A cells. AVP secretion into the cell culture supernatant was investigated with an enzyme immunoassay. Results: In the first family a heterozygous p.G96D mutation was identified. Some patients additionally carried a novel heterozygous mutation p.A159T. The second family presented with a heterozygous mutation p.C98G. Confocal laser microscopy unveiled accumulation of p.G96D and p.C98G prohormones in the cellular bodies, whereas WT and p.A159T prohormones and/or processed products were located in the tips of cellular processes. Reduced levels of AVP in supernatant culture medium of p.G96D and p.C98G transfected cells in comparison to p.A159T and WT cells were found. Conclusions: We conclude that the p.G96D and p.C98G mutations cause adFNDI in the two reported families. The sequence variant p.A159T does not seem to have disease-causing effects.

Polyuria and Polydipsia in a Patient with Non–Small-Cell Lung Cancer

Tumor metastasis to the pituitary gland has been infrequently reported, and this is probably because only a small proportion of these patients are symptomatic. Most of the symptoms of this malady are related to diabetes insipidus. A 78-year-old man was diagnosed 2 years previously with stage IIIA adenocarcinoma of the lung and treated with sequential chemoradiation therapy and later with whole-brain radiation therapy because of newly developed brain metastasis; he was then admitted to our hospital with symptoms of polydipsia and polyuria. He was confirmed to have central diabetes insipidus that was caused by the pituitary metastasis from lung cancer. His symptoms resolved after treatment with desmopressin. Because of the rarity of this manifestation in lung cancer patients, we report on this case along with a brief review of the relevant literature.

Diabetes insipidus from sarcoidosis confined to the posterior pituitary

A young white man with new-onset central diabetes insipidus was discovered to have a posterior pituitary mass on magnetic resonance imaging. No other radiological abnormalities were noted in the anterior pituitary, infundibulum or hypothalamus. No other endocrinopathies were present: laboratory investigations showed normal basal concentrations of anterior pituitary hormones, including prolactin. The patient was suspected to have sarcoidosis affecting the posterior pituitary, because of the discovery of pulmonary sarcoidosis during his diagnostic evaluation. His symptoms of polydipsia and polyuria responded promptly to intranasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP). The patient demonstrated complete regression of the posterior pituitary mass after a course of corticosteroid therapy. However, his diabetes insipidus persisted and he continues to need DDAVP treatment, currently at 12 months of follow-up. The resolution of the neurohypophysial mass was compatible with the diagnosis of pituitary sarcoidosis and this precluded the need for a transsphenoidal biopsy or surgery.

Anterior Pituitary Dysfunction in Children with Idiopathic Central Diabetes Insipidus

Idiopathic central diabetes insipidus (CDI) is sometimes complicated with growth disturbances.We describe 5 children (4 boys and 1 girl) with idiopathic CDI and growth hormone deficiency (GHD). They were diagnosed as sufferings from CDI by the symptoms of polydipsia and polyuria, and the result of combination tests of water deprivation and Pitressin loading. The provocation tests showed low secretory responses of GH in all cases. One patient presented with panhypopituitarism, and two with hyperprolactinemia. Magnetic resonance imaging (MRI) showed no posterior pituitary high signals in all cases. Other findings were a small anterior lobe in two cases, transection of the pituitary stalk in one case, and a thickened infundibulum in two cases. Four patients who were treated by recombinant GH showed significant and continuous improvement of their height standard deviation (SD) scores.These patients indicate that idiopathic CDI is a heterogeneous disease which is frequently complicated with anterior pituitary dysfunction, especially GHD, and that GH replacement is effective.

Transplanted Vasopressin Neurones and Central Nervous System Effects of Vasopressin

Publisher Summary This chapter provides an overview of the studies on transplants of foetal vasopressin neurons and explains why such grafts, because of their ability to integrate with and functionally interact with the host nervous system, may prove useful in elucidating the roles and mechanisms of action of vasopressin in the brain. Neural peptides are significantly involved in central nervous system (CNS), and there are at least three potential anatomical routes by which vasopressin could influence the CNS; plasma-borne vasopressin in the brain vasculature, vasopressin in the cerebrospinal fluid and the extensive vasopressin-containing projections to extra-hypothalamic regions of the brain. Vasopressin may have multiple roles in the CNS with its specific effects depending not only on the route of administration but also on the population of the affected cells. Vasopressin neurons derived from normal foetal donors can be identified unambiguously in the brain of the vasopressin-deficient diabetes insipidus (DI) host by immunocytochemical staining and vasopressin-containing axons from the transplant traced to sites of termination in the host nervous system. The chapter explains that the neuroanatomical pattern of graft development correlates closely with the functional ability of the transplant as measured by amelioration of the hosts' symptoms of polydipsia and polyuria. Neural transplantation into various brain regions of DI rats, with correlated anatomical and functional analysis, may offer a valuable probe to analyze the CNS effects of vasopressin on these other behavioral patterns.

STENOSIS OF A BRANCH OF THE RENAL ARTERY CAUSING HYPERTENSION IN A CHILD

Marked hypertension is known to have persisted for a 2½-year period in a 5-year-old child. The symptoms of polydipsia and polyuria with enuresis as well as hyperactivity had been noted. The only physical findings were hypertension and its associated retinopathy. Attempts at translumbar aortography resulted in a large hemorrhage into the left pleural space. Two years later, however, a successful retrograde renal arteriogram revealed a stenosis of the superior branch of the right renal artery. Removal of this obstruction and re-anastomosis of the vessel resulted in the return of the blood pressure to normal as well as the complete relief of the symptoms. In the pediatric age group this is believed to be the first report of such a lesion treated successfully with vascular surgery. On the basis of observation with this child, as well as data from the literature, it is concluded that hypertension in children is almost never essential and every effort should be made to determine the cause. Children with enuresis, or polyuria and polydipsia, should have careful blood pressure determinations.

Urographic changes in diabetes insipidus; report of a case.

roles of the posterior pituitary gland and the supraopticohypophysial tract in diabetes insipidus 1 have been discussed in all their ramifications in the medical literature. There has, however, been a paucity of reports on the urinary tract changes that occur in this disorder. Osler 2 first described the secondary pathological changes. as follows: The kidneys have been found enlarged and congested. bladder has been found hypertrophied. Dilitation of the ureters and pelves of the kidneys has been present. Recently, Weller and co-workers 3 demonstrated these changes urographically. Their case was complicated by secondary hypertension, which was relieved by ureteral meatotomy. following case is one of idiopathic, hereditary diabetes insipidus uncomplicated by hypertension, in which there were classic urographic changes. REPORT OF A CASE A 25-year-old Japanese man was admitted to Tripler Army Hospital, Honolulu, on Aug. 3, 1951. His symptoms of polydipsia and polyuria with a urine