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Management of Disorders of Water Metabolism in Patients with Pituitary Tumors

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Abstract

Disorders of body fluids, notably central diabetes insipidus (CDI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), are relatively uncommon as a presenting symptom of sellar and suprasellar masses, but quite common following surgical resection of such lesions. It therefore behooves clinicians treating such patients to have a good understanding of the pathophysiology, the differential diagnosis and the management of these disorders. This review discusses some general issues concerning the pathogenesis, differential diagnosis, clinical manifestations and therapy of hyperosmolar and hypoosmolar syndromes, including CDI and SIADH, and then more specifically addresses the evaluation and treatment of pre- and postoperative disorders of water metabolism in patients with pituitary adenomas.

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References

  1. Verbalis JG. The syndrome of inappropriate antidiuretic hormone secretion and other hypoosmolar disorders. In: Schrier RW, ed. Diseases of the Kidney and Urinary Tract. Philadelphia: Lippincott Williams & Wilkins, 2001:2511–2548.

    Google Scholar 

  2. Katz MA. Hyperglycemia-induced hyponatremia-calculation of expected serum sodium depression. N Eng J Med 1973;289:843–844.

    Google Scholar 

  3. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: Evaluating the correction factor for hyperglycemia. Am J Med 1999;106(4):399–403.

    Google Scholar 

  4. Phillips PA, Rolls BJ, Ledingham JG, et al. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med 1984;311(12):753–759.

    Google Scholar 

  5. Robertson GL. Posterior pituitary. In: Felig P, Baxter J, Frohman L, eds. Endocrinology and Metabolism. New York: McGraw-Hill, 1995:385–432.

    Google Scholar 

  6. Fujiwara TM, Morgan K, Bichet DG. Molecular biology of diabetes insipidus. Annu Rev Med 1995;46:331–343.

    Google Scholar 

  7. Robinson AG. Disorders of antidiuretic hormone secretion. Clin Endocrinol Metab 1985;14:55–88.

    Google Scholar 

  8. Knepper MA, Verbalis JG, Nielsen S. Role of aquaporins in water balance disorders. Curr Opin Nephrol Hypertens 1997;6(4):367–371.

    Google Scholar 

  9. Zerbe RL, Robertson GL. A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. N Eng J Med 1981;305:1539–1546.

    Google Scholar 

  10. Robertson GL. Diabetes insipidus. Endocrinol Metab Clin North Am 1995;24(3):549–572.

    Google Scholar 

  11. Robertson GL. Dipsogenic diabetes insipidus: A newly recognized syndrome caused by a selective defect in the osmoregulation of thirst. Trans Assoc Am Phys 1987;100:241–249.

    Google Scholar 

  12. Thrasher TN, Keil LC, Ramsay DJ. Lesions of the organum vasculosum of the lamina terminalis (OVLT) attenuate osmotically-induced drinking and vasopressin secretion in the dog. Endocrinology 1982;110(5):1837–1839.

    Google Scholar 

  13. Johnson AK, Buggy J. Periventricular preoptic-hypothalamus is vital for thirst and normal water economy. Am J Physiol 1978;234(3):R122–R129.

    Google Scholar 

  14. Baylis PH, Thompson CJ. Diabetes insipidus and hyperosmolar syndromes. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: Lippincott Williams & Wilkins, 2001:285–293.

    Google Scholar 

  15. Gullans SR, Verbalis JG. Control of brain volume during hyperosmolar and hypoosmolar conditions. Annu Rev Med 1993;44:289–301.

    Google Scholar 

  16. Verbalis JG. Hyponatremia and hypoosmolar disrders. In: Greenberg A, ed. Primer on Kideny Diseases. San Diego: Academic Press, 2001:57–63.

    Google Scholar 

  17. Spital A. Diuretic-induced hyponatremia. Am J Nephrol 1999;19(4):447–452.

    Google Scholar 

  18. Chung HM, Kluge R, Schrier RW, Anderson RJ. Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 1987;83:905–908.

    Google Scholar 

  19. Schrier RW. Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (1). N Eng J Med 1988;319:1065–1072.

    Google Scholar 

  20. Schrier RW. Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (2). N Eng J Med 1988;319:1127–1134.

    Google Scholar 

  21. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342(21):1581–1589.

    Google Scholar 

  22. Arieff AI, Llach F, Massry SG. Neurological manifestations and morbidity of hyponatremia: Correlation with brain water and electrolytes. Medicine 1976;55:121–129.

    Google Scholar 

  23. Verbalis JG, Gullans SR. Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 1991;567:274–282.

    Google Scholar 

  24. Vexler ZS, Ayus JC, Roberts TP, Fraser CL, Kucharczyk J, Arieff AI. Hypoxic and ischemic hypoxia exacerbate brain injury associated with metabolic encephalopathy in laboratory animals. J Clin Invest 1994;93:256–264.

    Google Scholar 

  25. Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Int Med 1992;117:891–897.

    Google Scholar 

  26. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. Brit Med J 1992;304:1218–1222.

    Google Scholar 

  27. Verbalis JG, Robinson AG, Moses AM. Postoperative and posttraumatic diabetes insipidus. In: Czernichow P, Robinson AG, eds. Diabetes Insipidus in Man. Basel: Karger, 1984:247–265.

    Google Scholar 

  28. Carroll PB, McHenry L, Verbalis JG. Isolated adrenocorticotrophic hormone deficiency presenting as chronic hyponatremia. N Y State J Med 1990;90:210–213.

    Google Scholar 

  29. Verbalis JG. SIADH and other hypoosmolar disorders. In: Schrier RW, ed. Diseases of the Kidney and Urinary Tract. Philadelphia: Lippincott Williams & Wilkins, 2001:2511–2548.

    Google Scholar 

  30. Dohanics J, Hoffman GE, Verbalis JG. Chronic hyponatremia reduces survival of magnocellular vasopressin and oxytocin neurons following axonal injury. J Neurosci 1996;16:2372–2380.

    Google Scholar 

  31. Cusick JF, Hagen TC, Findling JW. Inappropriate secretion of antidiuretic hormone after transsphenoidal surgery for pituitary tumors. N Eng J Med 1984;311:36–38.

    Google Scholar 

  32. Olson BR, Rubino D, Gumowski J, Oldfield EH. Isolated hyponatremia after transsphenoidal pituitary surgery. J Clin Endocrinol Metab 1995;80(1):85–91.

    Google Scholar 

  33. Ultmann MC, Hoffman GE, Nelson PB, Robinson AG. Transient hyponatremia after damage to the neurohypophyseal tracts. Neuroendocrinology 1992;56(6):803–811.

    Google Scholar 

  34. Robinson AG, Verbalis JG. Diabetes insipidus. Curr Ther Endocrinol Metab 1997;6:1–7.

    Google Scholar 

  35. Adams JH, Daniel PM, Prichard MML. Transection of the pituitary stalk in man: Anatomical changes in the pituitayr glands of 21 patients. Journal of Neurology, Neurosurgery and Psychology 1966;29:545–555.

    Google Scholar 

  36. Daniel PM, Prichard MM. Regeneration of hypothalamic nerve fibres after hypophysectomy in the goat. Acta Endocrinol (Copenh) 1970;64(4):696–704.

    Google Scholar 

  37. Daniel PM, Prichard MM. The human hypothalamus and pituitary stalk after hypophysectomy or pituitary stalk section. Brain 1972;95(4):813–824.

    Google Scholar 

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Authors and Affiliations

  1. Georgetown University School of Medicine, Washington, DC, USA

    Joseph G. Verbalis

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  1. Joseph G. Verbalis
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Verbalis, J.G. Management of Disorders of Water Metabolism in Patients with Pituitary Tumors. Pituitary 5, 119–132 (2002). https://doi.org/10.1023/A:1022368615879

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