Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma

Smith, Diarmuid; Finucane, Francis; Phillips, Jack; Baylis, P. H.; Finucane, J; Tormey, William; Thompson, CJ

doi:10.1111/j.1365-2265.2004.02086.x

Cited by 80 publications

(47 citation statements)

References 24 publications

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“…We further evaluated causes of hypopituitarism and considered only cases where posterior pituitary damage was likely. 30,31 The following cases were excluded: subclinical hypopituitarism (n ¼ 16); 4,6,8,11 -13,17,19,25,28,29 cause of hypopituitarism not specified (n ¼ 1); 21 first-trimester miscarriages (n ¼ 15). 1,4,12,19 Sixteen case reports 3,5-7,9,10,14 -16,18,20,22-24,26,27 describing the outcome of 18 pregnancies and one trial 1 reporting 13 pregnancies in nine women were included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

High-risk pregnancy management in women with hypopituitarism

et al. 2009

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Pregnancy after complete loss of pituitary function is uncommon. However, advances in fertility treatment have led to increased pregnancy rates in hypopituitary women. We hereby present a literature review of pregnancies affected by hypopituitarism, including a comparison with published controls; further, we add one case report of severe hypopituitarism where third-trimester oxytocin supplementation was performed. As only limited information is available on management and outcome, our purpose was to determine obstetric complications associated with deficiency of pituitary hormones. The analysis of 31 pregnancies in 27 women revealed that hypopituitary women are at increased risk: postpartum hemorrhage occurred in 8.7%, transverse lie in 16%; 42.4% of the newborns were small for gestational age. These findings are supposedly the result of uterine dysfunction caused by hormone deficiency. Oxytocin supplementation was performed with the aim to establish physiologic conditions and to prevent postpartum uterine inertia. In this case substitution may have contributed to correct fetal presentation but did not prevent postpartum hemorrhage. Further investigations into both oxytocin-dependent and -independent mechanisms regulating uterine contractions and contractility are necessary to develop strategies for prevention of uterine inertia in oxytocin-deficient pregnancies.

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Section: Methodsmentioning

confidence: 99%

High-risk pregnancy management in women with hypopituitarism

et al. 2009

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“…Smith et al (31) reported absence of thirst in 19% of adults with DI treated with surgery combined or not with CRT. A loss of temperature control (very low temperature) was recorded in adult CP patients after surgery for a CP (32).…”

Section: Thirst Disorder Thermoregulatory Disorders Somnolence and mentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5-2.0 cases/million per year and approximately 60% of CP is seen in adulthood. The therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. Typical initial manifestations at diagnosis in children are symptoms of elevated intracranial pressure, visual disturbances and hypopituitarism. CPs have the highest mortality of all pituitary tumours. The standardised overall mortality rate varies from 2.88 to 9.28 in cohort studies. Adults with CP have a 3-19-fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health and reduction in quality of life and cognitive function.

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“…If the diagnosis of adipsic DI was suggested clinically and by the results of thirst visual analogue scale applied to the WDT, the formal diagnosis of adipsic DI was confirmed by thirst and AVP responses to the i.v. infusion of hypertonic saline (855 nmol/l), as previously described by Smith et al (9) in our centre.…”

Section: Diagnosis and Definition Of Abnormalitiesmentioning

confidence: 99%

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Behan

Sherlock

Moyles

et al. 2015

European Journal of Endocrinology

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Context and objective: Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst. Design: The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis. Results: A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa C 131-134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa C %130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, PZ0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02). Conclusion: OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

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Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma

Abstract: This study demonstrates following surgery for craniopharyngioma there is a high incidence of cranial diabetes insipidus and a significant incidence of abnormal thirst responses to osmotic stimuli.

Cited by 80 publications

References 24 publications

High-risk pregnancy management in women with hypopituitarism

High-risk pregnancy management in women with hypopituitarism

Endocrine aspects and sequel in patients with craniopharyngioma

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

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