The prevalence of juvenile-onset gout has been increasing. Hereditary factors and
secondary diseases should be considered in these patients. Adipsic diabetes
insipidus (ADI) is characterized by arginine vasopressin (AVP) deficiency, which
results in hypotonic polyuria, and dysfunction of thirst osmoreceptors, which
results in failure to generate a thirst sensation in response to hypernatremia.
We herein report a case of a boy with gouty arthritis, refractory hyperuricemia,
prominent hypernatremia, a high creatinine concentration, and a history of
surgery for a hypothalamic hamartoma. The patient was diagnosed with central
diabetes insipidus after endocrine evaluation. Because he never had symptoms of
thirst, the final diagnosis was corrected to ADI. This is the first report of
gout due to chronic ADI in an adolescent. Volume contraction due to ADI might be
one cause of hyperuricemia and renal impairment in such patients. Moreover, AVP
deficiency might directly lead to low urate clearance due to the lack of
vasopressin receptor 1 stimulation. Lack of polydipsia and polyuria may delay
the diagnosis of ADI and lead to severe complications of a chronic hyperosmolar
status. Sufficient and effective establishment of normovolemia is critical for
these patients.
Background: Despite advances in non-invasive imaging, the characterization of atherosclerotic plaque remains superior with frequency-domain optical coherence tomography (FD-OCT) in the clinical coronary and experimental cerebrovascular literature. An assessment of the feasibility and safety of FD-OCT for intracranial atherosclerotic stenosis (ICAS) is desirable.Methods: We analyzed a cohort of all consecutive FD-OCT evaluations for ICAS performed at our institution from April 2017 to August 2018 (16 months) in patients who suffered from transient ischemic attack (TIA) or non-disabling stroke despite optimal medical management within 90 days of admission attributable to angiographically verified 70–99% stenosis of an intracranial artery.Results: Thirty-three patients harboring 36 lesions with an average age of (57.6 ± 7.1) years (male sex 27 cases) comprising nine cases of lesions located within the anterior circulation and 24 cases within the posterior circulation were identified. Of the 33 patients with 36 lesions, the FD-OCT imaging catheter detected 35/36 (97%) lesions except in one case in which the FD-OCT catheter failed to navigate excessively tortuous vessels, and FD-OCT images in 27 patients (81.8%) were finally obtained successful, where the target lesion was fully visible, and image quality under at least one pullback was graded 2 or 3. There were no symptomatic complications. Blood flow was the most common artifact encountered (51.9%).Conclusion: FD-OCT is safe and feasible for the assessment of ICAS in the anterior and posterior circulation. The use of diagnostic interferometry will have to be weighed against its cost, and these preliminary findings should be verified by prospective large-scale studies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.