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- · Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms.
- Craniopharyngiomas are relatively benign (WHO grade I) neoplasms that typically arise in the sellar/suprasellar region. They account for ~1-5% of primary brain.
- GLOBAL KLEPTOCRACY Self-serving leaders throughout the world increasingly assume power with the goal of becoming rich at the expense of the majority of their.
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Frequently Asked Questions LCH in Adults. The questions below are regarding LCH in Adults specifically. Please click on a question to view the answer. Symptoms of the following disorders can be similar to those of Rosai-Dorfman disease. Comparisons may be useful for a differential diagnosis: Langerhans cell.
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LCH is a disorder presenting in either single or multiple locations and thus causing a variety of signs and symptoms from mild to life-threatening.
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Diabetes Insipidus: Practice Essentials, Background, Etiology. DI is usually an acquired disorder, with central DI having different causes than does nephrogenic DI. In rare cases, central or nephrogenic DI may be an inherited disorder. Central diabetes insipidus. Central DI has many possible causes. According to the literature, the principal causes of central DI and their oft- cited approximate frequencies are as follows: Idiopathic - 3.
Malignant or benign tumors of the brain or pituitary - 2. Cranial surgery - 2. Idiopathic DIIdiopathic central DI presumably develops when cells in the hypothalamus are damaged or destroyed. Identification of antibodies against AVP- secreting cells and advances in imaging techniques have made idiopathic cases less common than they previously were. Increasingly, the role of inflammation and autoimmunity in DI is being recognized.
Cases of lymphocytic hypophysitis were possibly classified as idiopathic prior to improved imaging studies. This disorder is characterized by lymphocytic infiltration of the stalk and posterior pituitary. Magnetic resonance imaging (MRI) may show abnormalities in these structures. Antibodies directed against vasopressin cells have been found in patients with idiopathic central DI; however, these antibodies have also been found in patients with Langerhans cell histiocytosis (LCH) or germinomas, which indicates that this finding can not be considered a reliable marker of autoimmune etiology in central DI. Indeed, reliance on AVP antibodies may delay the diagnosis of LCH or germinoma. Given the possible diagnostic confusion, close clinical and MRI follow- up is necessary. Serial contrast- enhanced brain MRIs (every 3- 6 months for the first 2 years) in patients with central DI who have pituitary stalk thickening may shorten the time to diagnosis of germinoma by as much as 1 year.
The role of human chorionic gonadotropin (h. CG) in the early diagnosis of germinoma is not fully established. A negative result for h. CG in the cerebrospinal fluid (CSF) does not exclude germinoma. Tumor- associated DIPrimary intracranial tumors causing DI include craniopharyngiomas, germinomas, and pineal tumors, among others. The appearance of other hypothalamic manifestations may be delayed for as long as 1.
Craniopharyngioma is a benign tumor that arises from squamous cell nests in the primitive Rathke pouch. It is the most frequent pediatric intracranial neoplasm, accounting for nearly 5. Central DI insipidus and multiple pituitary hormone deficiencies are common manifestations in childhood craniopharyngiomas. Surgery is the preferred treatment. Postoperative DIThe frequency with which DI develops after neurosurgery varies with the surgery’s scope.
Approximately 1. 0- 2. DI after transsphenoidal removal of an adenoma, compared with 6. Not all cases of postoperative DI are permanent. In a German study of metabolic disturbances after transsphenoidal pituitary adenoma surgery, only 8. DI cases persisted for more than 3 months.
Postoperative polyuria does not necessarily indicate DI. The most common causes of postoperative polyuria are excretion of excess fluid administered during surgery and an osmotic diuresis resulting from treatment for cerebral edema. DI in head trauma. Central DI can be an acute or chronic complication of head injury or subarachnoid hemorrhage. Risk factors for acute DI include penetrating trauma and severe head trauma. Other forms of pituitary dysfunction (eg, adrenocorticotropic hormone deficiency) may accompany posttraumatic DI. The dysfunction may be transient or, less commonly, may develop gradually.
Hereditary central DIApproximately 1. DI cases are familial (although some experts suggest that familial DI may be underdiagnosed). Most of these cases show autosomal dominant inheritance and result from a defect in the AVP- NP2 gene on chromosome 2. The defect results in the production of mutant prohormone that is toxic to the neuron and eventually destroys it. There are also autosomal recessive forms of DI, which result from defects in the AVP- NP2 (AVP neurophysin) gene, as well as in the WFS1 gene. The latter gene encodes for wolframin, a tetrameric protein that may serve as a novel endoplasmic reticular calcium channel in pancreatic beta cells and neurons. Mutations in WFS1 lead to Wolfram syndrome, which is also known by the acronym DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness).
Another recessive form of central DI results from the production of biologically inactive AVP. In addition, an X- linked form of neurohypophyseal DI exists. A specific genetic defect has not been identified. Genetic testing to determine the specific etiology can obviate the search for another cause. Finding a genetic anomaly will also answer recurrence risk questions for the family, and may prove to be helpful with treatment options. Additional causes.
Other causes of central DI include the following: Cancer - Eg, metastatic lung cancer, lymphoma, leukemia. A study by Lee et al found that 1.