Endocrine Abstracts

Lithium-induced Nephrogenic Diabetes Insipidus is the commonest type of Nephrogenic Diabetes Insipidus. Management remains challenging even when Lithium is discontinued as non-reversibility of Diabetes Insipidus can be irreversible. Possible treatment options include Hydrochlorothiazide, Amiloride or Acetazolamide. We report a case of possible Nephrogenic Diabetes Insipidus 1 year after discontinuation of Lithium. Our patient is an 85-year old lady who was referred for an Endo...

An 18 year old gentleman was first reviewed in our endocrine adolescent transition clinic. He had been under the care of the paediatricians since birth, where he initially presented with developmental delay. This triggered investigations which led to the diagnosis of septo-optic dysplasia. At aged 12 he developed cranial diabetes insipidus (DI) and secondary hypothyroidism. This was managed with intranasal DDAVP (20 ug BD) and thyroxine 125 μg. Due to an abnormal thirst t...

A 34-year old female with type 1 diabetes presented to the antenatal clinic complaining of polydipsia, polyuria and nocturia. She was 12 weeks pregnant with adequate glycaemic control on a basal-bolus insulin regime. She reported new onset headaches but no deterioration in vision. On examination, her visual fields were full to confrontation with red pin. She was eunatraemic (Na 138 mmol/l), had an early morning cortisol of 332 nmol/l and normal thyroid function tests (FT4 16 p...

Isolated Central Diabetes Insipidus is a rare condition characterised by deficiency of arginine vasopressin (AVP) which presents with polyuria and polydipsia. The reported prevalence of diabetes insipidus is 1 in 25,000. The pathogenesis of central diabetes insipidus is often uncertain however the known causes can be divided into acquired, through trauma or vascular injury as well as infiltrative including malignancy, and congenital abnormalities which accounts for less than 1...

We present a case of a 79 year old gentleman who attended the emergency department with a one day history of acute confusion and hallucinations. His background included trans-sphenoidal surgery for a gonadotrophic pituitary macro-adenoma in 2012 with subsequent panhypopituitarism and post-operative diabetes insipidus. He also had a history of restless-leg-syndrome for which he took Amitriptyline chronically, COPD and tablet-controlled diabetes mellitus. Of significant note, th...

A 38 female patient with a diagnosis of primary CNS lymphoma was admitted for MATRIX (methotrexate, rituximab, thiopeta, cytarabine) chemotherapy. Prior to chemotherapy and while on steroids she became increasingly polydipsic and polyuric with blood biochemistry demonstrating a sodium of 164 mmol/l. An endocrine review of the patient was requested and a diagnosis of cranial diabetes insipidus was suspected due to the extent of infiltration of the hypothalamus and pituitary sta...

Water balance disorders following neurosurgery are well recognised and may give rise to both hypo- and hypernatraemia. We present the case of a 42-year-old male who developed a triphasic response after extended transsphenoidal surgery for a pituitary stalk lesion. The patient presented with a 4 month history of unremitting frontal headaches and dizziness. MRI confirmed a 15×15 mm stalk lesion. Clinical examination including formal visual perimetry was unremarkable. Blood ...

Cranial diabetes insipidus in critically ill patient increases the complexity of fluid management. Well patients with cranial diabetes insipidus can drink enough fluid to replace their urine losses driven by their thirst mechanisms. In critically ill patients the thirst response cannot be relied upon. When fluid input is not adequate it results in hypernatremia. Here dextrose, water or hypo-tonic intravenous fluid is used. Complications related to this are high glucose levels,...

A 31 year-old lady presented to clinic with an acute, three-week history of rapidly worsening polyuria and polydipsia. She described an eighteen month history of dysmenorrhoea with no galactorrhoea and reported no change in her vision. Her past medical history included alopecia areata one year previously from which she made a full recovery. Clinical examination was normal including full visual fields to red-pin confrontation. Biochemistry identified serum sodium of 141 mmol/l,...

A previously well 49 year old woman was referred to our endocrine service with a compelling 4 month history of polyuria and polydipsia. Her 24 h fluid intake was estimated to be 12 l with 4 l of this taken overnight; these estimates had doubled in the 2 months since referral. Due to the development of an increasingly severe frontal headache, her GP organised a CT head scan which was largely unremarkable aside from a ‘slight fullness’ to the pituitary gland. Pituitary...

Cranial diabetes insipidus (CDI) is commonly idiopathic but can also be due to tumours of the pituitary & hypothalamus or surgery to remove these tumours. It can also occur due to infiltrative processes including metastatic malignancy. Pituitary metastases are not a common clinical entity although it can be a common finding in autopsy in advanced cancer when the pituitary & the sella have been evaluated. In this abstract, I will discuss two cases of CDI as a presentati...

A 47 years old gentelman was admitted as a case of DKA. She was kept on insulin infusion protocol despite hydartion her Na remained to be high so she was kept on Na 18% her glucose was controlled but her sodium remained on the higher side so they used clinical disgnosis to start her on miniril tablet twice dialy. MRI pituitary showed thickening of pituitary stalk no adenoma she was discharged on insulin Three doses mix insulin. Her blood tets shows anemia of normochromic normo...

Introduction: Central diabetes insipidus (DI) is a frequent complication of transfenoidal surgery for Cushing’s disease (CD). It can be transient or, more infrequently, permanent. The most common mechanism results from surgical neurohypophyseal damage rather than local mass effect from the pituitary adenoma.Case report: A 40 years old woman was referred to our Endocrinology outpatient clinic at the beginning of 2015 for new onset hypertension, signi...