1/15. diabetes insipidus in a patient with a highly malignant B-cell lymphoma and stomatitis.A 37-year-old male patient with a diffuse pleomorphic B-cell-lymphoma, which has been diagnosed two month earlier with the primary site at the pterygopalatine fossa on both sides with infiltration of the clivus and cavernous sinus was referred to our hospital for continuation of the third course of CHOP chemotherapy. At admission he reported about a recent history of painful swallowing and intermittent substernal chest pain. Alleviation of the pain on swallowing and the chest pain was apparently only possible by drinking 10 to 15 l of cold coca cola throughout the day and night, a regimen that resulted in polyuria. physical examination revealed extensive thrush stomatitis and soor esophagitis. Despite successful treatment with fluconazole, polydipsia continued unabated. The classic osmotic test of dehydration and exogenous vasopressin revealed hypothalamic diabetes insipidus (DI). Basal hormones and stimulated endocrine function tests of the adenohypophysis were found to be normal. MRI-scan revealed lymphoma infiltration of the neurohypophysis. After the third course of CHOP chemotherapy the patient surprisingly recovered completely from his excessive thirst. The present report shows that clinical disorders such as thrush stomatitis can mask diabetes insipidus caused by an early relapsing lymphoma.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
2/15. A patient with partial central diabetes insipidus: clarifying pathophysiology and designing treatment.Studies were undertaken in a 32-year-old man who developed polyuria (4 L/d) a few days after a basal skull fracture; the condition persisted 1 year after the accident. The other major features were thirst, a plasma sodium of 143 mmol/L, 24-hour urine osmolality of 221 mOsm/kg H(2)O, and levels of vasopressin in plasma that were less than 0.5 pg/mL on 20 separate occasions. The 24-hour urine volume implied that the diagnosis was partial rather than complete central diabetes insipidus; however, several random urine samples had a much higher osmolality. An infusion of hypertonic saline led to the release of vasopressin and the excretion of concentrated urine. We propose that the basis for the lesion may be the transection of some, but not all, of the fibers connecting the osmostat and vasopressin release center. This partial transection could permit vasopressin to be secreted in response to a larger rise in plasma sodium concentration. This pathophysiologic analysis provided the basis for therapy to minimize the degree of polyuria.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
3/15. Differential diagnosis of polyuria and polydipsia in a patient with spinal cord injury.We report the case of a 35-yr-old tetraplegic man who experienced increased water intake, constant thirst, and a copious amount of urine excretion after his spinal cord injury and in whom an intermittent catheterization program was unmanageable. Laboratory evaluation revealed low serum and urine osmolality, which were suggestive of psychogenic polydipsia, and hypokalemia, which might lead to polyuria with a compensatory polydipsia. His water intake was reduced with antidepressant therapy and potassium supplementation and normalized on the third month of the treatment. physicians should be aware of the differential diagnosis of polyuria and polydipsia, which interfere with neurogenic bladder management in patients with spinal cord injury.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
4/15. Dipsogenic diabetes insipidus: report of a novel treatment strategy and literature review.Dipsogenic diabetes insipidus is a syndrome of disordered thirst, in patients without psychiatric disease, which may be confused with partial central diabetes insipidus. Distinguishing these entities involves monitored water testing. Therapy with antidiuretic hormone in patients with dipsogenic diabetes insipidus is thought to be contraindicated for fear of inducing water intoxication. We report a case of a 26-year-old woman without psychiatric illness referred for longstanding polyuria and polydipsia. Otherwise healthy, she complained of near-constant thirst and frequent urination, causing severe disruption of her personal and professional life. She had been consistently eunatremic and polyuric, with low urine osmolality. Results of extensive water testing revealed intact urinary concentrating and diluting capacity, physiologic though blunted antidiuretic hormone (ADH) release, and an abnormally low thirst threshold, consistent with the diagnosis of dipsogenic diabetes insipidus. To control her polyuria we initiated treatment with intermittent, low-dose, intranasal desmopressin and strict water restriction during drug dosing. In follow-up she reported excellent control of polyuria and significant functional improvement. The reviewed literature demonstrates a limited number of reports about dipsogenic diabetes insipidus, and no prior report of a similar treatment strategy. Dipsogenic diabetes insipidus is an uncommonly (and not universally) recognized disorder, requiring monitored testing in order to distinguish it from incomplete forms of central diabetes insipidus. Though therapy with desmopressin cannot be recommended based on the results of a single case, the outcome presented here is intriguing and suggests that larger studies in such patients is warranted to assess the broader application of such an intervention.- - - - - - - - - - ranking = 3keywords = thirst (Clic here for more details about this article) |
5/15. polydipsia, polyuria, and hypertension associated with renin-secreting wilms tumor.A 16-month-old black male infant had unusual thirst, polyuria, hyponatremia, and hypertension. His polyuria was unresponsive to vasopressin therapy, and his high blood pressure was not effectively controlled by antihypertensive drugs. Radiographic examinations revealed an occult wilms tumor in the right kidney. After removal of the tumor, the signs and symptoms were relieved. The tumor had a renin activity about 280 times that of the adjacent renal cortex, and many intracytoplasmic secretory granules were found on electron microscopy. The pathogenesis of these clinical manifestations appears to be mediated through the physiologic pathways of renin-angiotensin ii and renin-aldosterone.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
6/15. Non-psychogenic primary polydipsia in autoimmune chronic active hepatitis with severe hyperglobulinaemia.The association of hyperglobulinaemia with renal tubular acidosis and nephrogenic diabetes insipidus is well established. A patient with marked hyperglobulinaemia due to autoimmune chronic active hepatitis is described who presented with severe polydipsia and polyuria but had entirely normal renal tubular function indicating a primary thirst disorder.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
7/15. Recurrent pregnancy-induced polyuria and thirst due to hypothalamic diabetes insipidus: an investigation into possible mechanisms responsible for polyuria.A young patient developed hypothalamic diabetes insipidus due to histiocytosis in infancy and was satisfactorily treated with Pitressin. As a teenager she no longer had thirst or polyuria after treatment was stopped. These symptoms only returned during her two pregnancies. When non-pregnant her urine output was 1.7-2.0 1/24 h, basal plasma osmolality 288-290 mOsm/kg, and during pregnancy 24 h urine volume was 4.5-5.21, plasma osmolality 278-280 mOsm/kg. Studies on osmoregulation of thirst and AVP release, and on renal sensitivity to the V2 agonist desmopressin and endogenous vasopressin were performed in pregnant and non-pregnant states. She had no circulating antibodies to AVP, and the effect of pregnancy-associated vasopressinase was eliminated. Results showed lowered basal plasma osmolality and osmolar thirst threshold in pregnancy but no failure of the renal concentrating mechanism. plasma AVP concentrations after osmotic stimulation were lower in pregnancy. We propose that she developed thirst and polyuria during pregnancy because of lowering of her osmolar thirst threshold to plasma osmolalities which caused her to drink sufficient quantities of fluid to further reduce AVP secretion. We cannot exclude, however, the possibility that there was increased clearance of circulating AVP.- - - - - - - - - - ranking = 9keywords = thirst (Clic here for more details about this article) |
8/15. diabetes insipidus following obstetric shock.The first known case of obstetric shock followed by diabetes insipidus without anterior pituitary deficiency is presented. A patient developed extreme thirst and polyuria after massive bleeding and prolonged shock due to placenta previa percreta with bladder invasion. Evaluation confirmed diabetes insipidus sensitive to vasopressin administration. Anterior pituitary deficiency could not be identified, either acutely or 6 months later.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
9/15. polyuria and inappropriate secretion of arginine vasopressin in hypothalamic sarcoidosis.Inappropriate arginine vasopressin release and polyuria with excessive thirst were found in a patient with hypothalamic sarcoidosis subsequently confirmed at autopsy. He became intensely thirsty during a 5% saline infusion at a plasma osmolality of 274 mosmol/liter. The normal thirst threshold under these conditions is 294 /- 3 mosmol/liter ( /- SD). An increase in radioimmunoassayable arginine vasopressin was detected at an inappropriately low plasma osmolality, and free water clearance was negative despite a plasma osmolality of 265 /- 5 mosmol/liter with ad libitum fluid intake. The syndrome of inappropriate antidiuresis has not been described previously in combination with hypothalamic sarcoidosis. demeclocycline therapy was associated with an exacerbation of the patient's polyuria. propranolol administration, however, was associated with a reduction of urine output and an increase in plasma osmolality to 279 mosmol/liter on one and 299 mosmol/liter on another occasion.- - - - - - - - - - ranking = 3keywords = thirst (Clic here for more details about this article) |
10/15. Primary polydipsia. syndrome of inappropriate thirst.A patient with lifelong severe polyuria and polydipsia had normal serum antidiuretic hormone (ADH) levels and responded to water deprivation with a prompt increase in urine osmolality and maintenance of normal plasma osmolality (less than 290 mOsm/kg), despite extreme thirst. When treated with desmopressin acetate and allowed free access to water, she was able to reduce plasma osmolality below 270 mOsm/kg, and her compelling thirst disappeared. The disorder is interpreted to be the result of excessive fluid intake in response to a thirst stimulus that was not inhibited by normal plasma osmolality. This study indicates that osmoreceptor control of ADH secretion is normal. Continued administration of vasopressin has relieved the symptoms and has not resulted in water intoxication.- - - - - - - - - - ranking = 7keywords = thirst (Clic here for more details about this article) |
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