Endocrine Abstracts

Hyponatraemia occurs in 14% of hospitalised patients. Our data shows that plasma sodium concentrations < 130 mmol/l occur in 8% of patients with traumatic brain injury (TBI) and in 6% of patients undergoing hypophysectomy. The causes of hyponatraemia in neurosurgical patients include SIADH, cerebral salt wasting (CSW), diuretic therapy, intravenous fluids, and glucocorticoid deficiency.The greatest diagnostic challenge is to distinguish between SIADH ...

Craniopharyngioma (CP) is associated with considerably higher mortality and morbidity than pituitary adenomas. The tumours are rare, but present a considerable management challenge. In addition to the endocrine and mass effects which are common to all tumours arising from the region of the pituitary fossa, the site, size, and sometimes the treatment of CP, dictate that the endocrinologist must also manage hypothalamic complications. Endocrinologists are aware of the high frequ...

Hyponatraemia is the commonest electrolyte abnormality in clinical practice; epidemiological data would suggest that SIAD is the commonest cause of hyponatraemia, and it is particularly important in patients undergoing neurosurgery, in whom SIAD is common. Recent data has shown that even mild hyponatraemia (plasma sodium 125–135 mmol/l) is associated with gait instability, falls, fractures, osteoporosis and increased mortality. This has led to the recognition that correct...

Permanent pan-anterior hypopituitarism is a rare complication of bacterial sinusitis, with only six cases reported worldwide. However, all were reported before the advent of MR imaging and most did not have what is now regarded as gold standard evaluation of pituitary function. Also, all previous cases noted an interval of months between resolution of sinusitis and development of hypopituitarism. We report two cases of previously healthy Caucasian adults who developed pan-ante...

The syndrome of inappropriate antidiuresis (SIAD) is characterised by plasma hyponatraemia and plasma hypoosmolality with a high urinary sodium in a clinically euvolaemic patient. We describe only the second reported case of SIAD due to carboplatin administration, with consequent acute severe hyponatraemia.A 61-year-old lady with no background history of note received neoadjuvant carboplatin and paclitaxel for stage III ovarian carcinoma. Five days after...

Anterior pituitary dysfunction is a well-recognized complication of traumatic brain injury (TBI) but recovery is an exceptional event, with only three previously published case reports.We report a case of a 25 year old man who suffered severe TBI in a road traffic accident in 1997. His neurological recovery was slow and incomplete with significant cognitive deficit and recurrent seizures. He developed polyphagia and his weight increased by 20 Kilograms i...

There is little information on the effects on pituitary function of cranial irradiation for non-pituitary tumours. We have studied anterior and posterior pituitary function in 17 patients (6 males), with a median age 19 years (range 5-48) at the time of radiotherapy. 16 patients had primary brain tumours and one had acute lymphocytic leukaemia. The patients were selected by the radiotherapists for investigation . Pituitary functions were assessed at a median of 60 months (rang...

Adipsic diabetes insipidus (ADI) is a rare condition which has been reported following clipping of anterior communicating artery aneurysms, craniopharyngioma and brain trauma, but not with pituitary adenoma. We report a case of ADI following surgery for a pituitary macroprolactinoma. A 14-year-old boy presented with bitemporal hemianopia due to a large macroprolactinoma. Two debulking surgeries were performed without the development of diabetes insipidus. Following a third rad...

Hypopituitarism has been reported in 28-65% of long-term survivors of traumatic brain injury (TBI). We attempted to define the natural history of post-traumatic hypopituitarism in order to devise guidelines for the optimal timing of patient assessment and hormone replacement.Fifty consecutive patients with severe or moderate TBI were enrolled in a prospective study of pituitary function during the acute phase, at 6 months and, at 12 months following TBI....

The syndrome of inappropriate antidiuretic hormone (SIADH) is characterised by euvolamic hyponatraemia. Patients with SIADH continue to drink normal amounts of fluid, despite plasma osmolalities well below the physiological osmotic threshold for the onset of thirst. The regulation of thirst has not been previously studied in SIADH. We studied the characteristics of osmotically-stimulated thirst and vasopressin (AVP) secretion, and the non-osmotic suppression of thirst and AVP ...