OBJECTIVETo summarize our experience in the management of adipsic central diabetes insipidus(ADI) accompanied with intracranial calcification.

METHODThe clinical data of one ADI patient accompanied with intracranial calcification who was treated in our hospital since December 2011 were retrospectively summarized.

RESULTSThe 24-hour urine volume was 800 ml. She didn't feel thirsty even with increased plasma sodium concentration(153 mmol/L) and blood osmotic pressure(333 mmol/L) . Combined water deprivation and vasopressin test revealed the diagnosis of central diabetes insipidus. The high intensity signal(on T1-weighted magnetic resonance imaging) in the posterior lobe of pituitary gland was found. Computed tomography showed calcifications in the bilateral basal ganglia.Serum cytomegalovirus IgG was positive. She was treated with desmopressin and asked for regular water intake regardless of the adipsia. The plasma sodium concentration was still below 150 mmol/L during the 4-month follow-up.

CONCLUSIONSRoutine adipsia evaluation and combined water deprivation and vasopressin test are critical for the diagnosis and treatment of ADI. Past insidious intracranial cytomegalovirus infection may explain the cause of ADI and calcification.

Brain Diseases ; complications ; Calcinosis ; complications ; Child ; Cytomegalovirus ; Diabetes Insipidus, Neurogenic ; complications ; diagnosis ; etiology ; Drinking ; Female ; Humans ; Sodium ; blood

Metastatic brain tumors from gastric cancer are extremely rare. A 61-year-old Korean woman, initially presenting with polydipsia and polyuria, was found to have metastatic lesions in the brain by MRI. We performed several diagnostic procedures to determine the origin of the brain metastases. She was revealed to have a soft tissue mass of the right adrenal gland and fungating ulcers in the stomach. Histologic studies of both the adrenal gland mass and gastric tissues revealed malignant tumors composed of anaplastic cells. Based on the electron microscopy study, the malignant tumor of the right adrenal gland was a metastatic lesion from the anaplastic carcinoma of stomach. Therefore, the malignant tumors of the brain were assumed to have originated from the gastric cancer. This case report is presented to make clinicians aware of the possibility that diabetes insipidus (polydipsia) may present as an initial manifestation of brain metastases.
Adrenal Gland Neoplasms/diagnosis/*secondary ; Brain Neoplasms/diagnosis/*secondary ; Carcinoma/*diagnosis ; Diabetes Insipidus/*etiology ; Female ; Humans ; Middle Aged ; Stomach Neoplasms/*diagnosis

Rathke's Cleft Cyst (RCC), which is located at the intrasellar region, is considered to be the distended remnants of Rathke's pouch, an invagination of the stomodeum. Lined with columnar or cuboidal epithelium of ectodermal origin, RCC usually contains mucoid material and it is found in 13-22% of normal pituitary glands. The cyst rarely leads to the development of symptoms but, when it does, the most common presenting symptoms are headache, visual impairment, hypopituitarism and hypothalamic dysfunction. However, in some cases it presents symptoms of diabetes insipidus, decreased libido and impotence. Recently we experienced a case of RCC inflammation presenting with diabetes insipidus and treated with transsphenoidal surgery. To our knowledge, this is the first report of RCC presenting with symptoms of diabetes insipidus in Korea.
Aged ; Case Report ; Central Nervous System Cysts/complications/*diagnosis/surgery ; Diabetes Insipidus/diagnosis/*etiology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Human ; Pituitary Neoplasms/complications/*diagnosis/surgery

Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine output and was diagnosed with central DI as a complication of cerebral edema, and eventually died. Our findings suggest that central DI should be considered as a possible complication following unexpected hypernatremia with increased urine output during therapeutic hypothermia and that desmopressin acetate should be used to treat central DI.
Adult ; Cardiopulmonary Resuscitation/*adverse effects ; Diabetes Insipidus, Neurogenic/diagnosis/etiology ; Fatal Outcome ; Female ; Heart Arrest/complications/therapy ; Humans ; Hypernatremia/*etiology ; Hypothermia, Induced/*adverse effects ; Pulmonary Embolism/complications

No abstract available.
Adult ; DNA Mutational Analysis ; Diabetes Insipidus, Nephrogenic/*complications/diagnosis/genetics/therapy ; Disease Progression ; Genetic Predisposition to Disease ; Humans ; Kidney Failure, Chronic/diagnosis/*etiology ; Male ; Mutation ; Phenotype ; Receptors, Vasopressin/genetics ; Renal Dialysis ; Tomography, X-Ray Computed

Central diabetes insipidus (DI) can be the outcome of a number of diseases that affect the hypothalamic-neurohypophyseal axis. The causes of the condition can be classified as traumatic, inflammatory, or neoplastic. Traumatic causes include postoperative sella or transection of the pituitary stalk, while infectious or inflammatory causes include meningitis, lymphocytic hypophysitis, and granulomatous inflammations such as sarcoidosis and Wegener's granulomatosis. Various neoplastic conditions such as germinoma, Langerhans cell histiocytosis, metastasis, leukemic infiltration, lymphoma, teratoma, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, hypothalamic glioma, and meningioma are also causes of central DI. In affected patients, careful analysis of these MR imaging features and correlation with the clinical manifestations can allow a more specific diagnosis, which is essential for treatment.
Adolescent ; Adult ; Aged ; Diabetes Insipidus, Neurogenic/diagnosis/etiology/*pathology ; Female ; Human ; Inflammation/complications ; *Magnetic Resonance Imaging ; Male ; Middle Age ; Neoplasms/complications ; Pituitary Gland, Posterior/injuries/pathology ; Sella Turcica/pathology/surgery

Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Adult ; Antidiuretic Agents/therapeutic use ; Coronary Artery Bypass/*adverse effects ; Coronary Vessels ; Deamino Arginine Vasopressin/therapeutic use ; Diabetes Insipidus, Neurogenic/*diagnosis/drug therapy/etiology ; Humans ; Hypothalamus/radionuclide imaging ; Magnetic Resonance Imaging ; Male ; Pituitary Gland/radionuclide imaging ; Polyuria/diagnosis/etiology ; Postoperative Complications/*diagnosis/drug therapy/etiology