Idiopathic central diabetes insipidus (CDI) is a disorder characterized by hypotonic polyuria and polydipsia, without any identified etiology. Here we report a case of a 57-year-old woman, with idiopathic CDI, admitted to our department with severe sepsis and acute kidney failure. After clinical and radiological investigations, she was diagnosed with idiopathic CDI. In this case report the findings suggest that severe sepsis could be the trigger for this disease. In addition, we hypothesise that apelin, a diuretic neuropeptide, plays a role in such a process. Apelin levels are known to increase during severe sepsis, which in turn counteracts vasopressin actions through inhibition of vasopressin neuron activity and vasopressin release.
Amyotrophic Lateral Sclerosis (ALS) is a degeneration of somatic motor neurons extending from upper motor cortical pyramidal neurons to lower motor neurons of the brainstem and cord. During the course of the disease patients require invasive procedures for nutrition and ventilation. Percutaneous Endoscopic Gastrostomy (PEG), performed in patients with impaired swallowing, is a safe procedure for the administration of Enteral Nutrition (EN). In the advanced stages of the disease patients develop a ventilatory failure due to muscolar weakness in these case they need a permanent tracheal tube with mechanical ventilation. Here we reported a case of a patient with Amyotrophic Lateral Sclerosis (ASL) who developed an increased gastric endocavitary pressure after a Percutaneous Endoscopic Gastrostomy (PEG).
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