Idiopathic partial central diabetes insipidus

ABSTRACT Diabetes insipidus is a rare disorder characterized by the inability to concentrate urine, which results in hypotonic urine and increased urinary volume. It may occur because of antidiuretic hormone deficiency or resistance to its action in the renal tubules. When there is a deficiency in the synthesis of antidiuretic hormones, diabetes insipidus is called central; when there is resistance to its action in the renal tubules, it is said to be nephrogenic. We report a case of idiopathic partial central diabetes insipidus and highlight the management and treatment of the disease.

Otorhinolaryngological adverse effects of urological drugs

ABSTRACT Purpose: To describe the otorhinolaryngological adverse effects of the main drugs used in urological practice. Materials and Methods: A review of the scientific literature was performed using a combination of specific descriptors (side effect, adverse effect, scopolamine, sildenafil, tadalafil, vardenafil, oxybutynin, tolterodine, spironolactone, furosemide, hydrochlorothiazide, doxazosin, alfuzosin, terazosin, prazosin, tamsulosin, desmopressin) contained in publications until April 2020. Manuscripts written in English, Portuguese, and Spanish were manually selected from the title and abstract. The main drugs used in Urology were divided into five groups to describe their possible adverse effects: alpha-blockers, anticholinergics, diuretics, hormones, and phosphodiesterase inhibitors. Results: The main drugs used in Urology may cause several otorhinolaryngological adverse effects. Dizziness was most common, but dry mouth, rhinitis, nasal congestion, epistaxis, hearing loss, tinnitus, and rhinorrhea were also reported and varies among drug classes. Conclusions: Most of the drugs used in urological practice have otorhinolaryngological adverse effects. Dizziness was most common, but dry mouth, rhinitis, nasal congestion, epistaxis, hearing loss, tinnitus, and rhinorrhea were also reported. Therefore, doctors must be aware of these adverse effects to improve adherence to the treatment and to minimize damage to the health of patients.

Clinical efficacy and safety of doxazosin combined with desmopressin in treatment of nocturia in patients with benign prostatic hyperplasia / 中华全科医师杂志

Thirty six patients aged 50-70 years with benign prostatic hyperplasia (BPH) received doxazosin and desmopressin treatment for 4 weeks.After treatment the International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores of patients were significantly improved (17.4 ± 2.5 vs.11.8 ± 1.1 and 3.9 ±0.6 vs.1.8 ± 1.3,respectively;both P ＜ 0.01).The nocturia frequency was decreased from 4.6±1.5 to 2.1±1.6 (P＜0.01);nocturnal urine output from (564±73) to (348±45) ml (P＜0.05);the hours of undisturbed sleep increased from (88.6 ± 17.5) min to (146.2 ± 12.8) min (P ＜0.05).There were no significant differences in serum levels of sodium,potassium and chlorine,and osmoticpressure before and after treatment.The results indicate that doxazosin combined with desmopressin is safe and effective for treatment of nocturia in patients with BPH.

Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents. .

Sick Sinus Syndrome Following Severe Hyponatremia Associated with Desmopressin Therapy / 대한내과학회지

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the arginine vasopressin that is widely used in the treatment of diabetes insipidus, nocturnal enuresis, and polyuria. Although it is generally well-tolerated, DDAVP can cause hyponatremia, especially in elderly patients. There are many reports of DDAVP-induced hyponatremia, but there has been only one case report in which sinus node dysfunction was caused by severe hyponatremia. Here we report a case of sick sinus syndrome that occurred during an episode of severe hyponatremia induced by chronic use of desmopressin in a 91-year-old man who had nocturnal enuresis.

The Regulatory Functions of Aquaporin 2 by Deamino Arginine Vasopressin in Cochleas of Gui nea Pigs / 听力学及言语疾病杂志

Objective To investigate the expression of aquaporin 2 (AQP2) in an endolymphatic hydrops ani-mal model .Methods Forty adult guinea pigs were randomly divided into experiment group and control group (20 animals in each group ) . Guinea pigs in the experiment group were treated with deamino arginine vasopressin (DDAVP) intraperitoneally at the dosage of 4 μg · kg -1 · d-1 for 7 days ,while those in the control group were treated with physiological saline .The endolymphatic hydrops and expression of AQP2 in cochleas of all animals were evaluated by Hematoxylin and Eosin stain ,immunohistochemistry and Western blot .Results The endolymphatic hydrops in the experiment group were more severe than that in the control group(P<0 .05) .Expression of AQP2 were found in the stria vascularis and spiral ganglions in both groups with similar patterns .Both immunohistochem-istry and Western blot showed that the expressions of AQP2 in the experiment group were significantly stronger(P<0 .05 ) .Conclusion DDAVP can up-regulate the expression of AQP2 in the cochleae of guinea pigs ,thus may be closely related to the pathogenesis of endolymphatic hydrops .

Influence of Type of Nocturia and Lower Urinary Tract Symptoms on Therapeutic Outcome in Women Treated With Desmopressin

PURPOSE: To investigate the type of nocturia and concomitant voiding dysfunction (VD) and the effect of desmopressin treatment on nocturia in women. MATERIALS AND METHODS: We reviewed 84 women who experienced more than 2 nocturia episodes as recorded on a pretreatment frequency volume chart and who were treated with desmopressin. All patients underwent history taking, physical examination, urinalysis, International Prostate Symptom Score assessment, completion of a urinary sensation scale, and completion of a 3 day frequency volume chart. Nocturia was divided into nocturnal polyuria (NP), reduced nocturnal bladder capacity (RNBC), and mixed type. After treatment with desmopressin, a reduction in nocturia of over 50% compared with baseline was regarded as effective. RESULTS: Among 84 women, the most common concomitant VD was overactive bladder (OAB, 60.7%). NP was observed in 70.2% (59/84) of the women, RNBC in 7.1% (6/84), and mixed type in 22.6% (19/84). After medication with desmopressin, 73 women (86.9%) showed a significantly reduced number of nocturia episodes (1.4+/-1.5) compared with baseline (3.7+/-1.3, p<0.05). Eleven women (13.1%) did not show improvement. Of the 73 women who showed improvement, 41 women showed a reduction of more than 50% over baseline, and these women had a lower baseline urgency grade. CONCLUSIONS: In the majority of women, nocturia coexisted with other VD such as OAB. Treatment with desmopressin effectively reduced the nocturia. However, other lower urinary tract symptoms (LUTS) such as urgency may reduce the effect of desmopressin. Therefore, consideration of concomitant LUTS seems to be necessary to increase the treatment effect of desmopressin on nocturia in women.

Uso de Desmopresina en paciente con trombopatía para cirugía mayor odontológica: presentación de un caso / Use of desmopressin in a patient with thrombopathy for odontological major surgery: a case presentation

Fundamento: la desmopresina, es un medicamento sintético similar a la vasopresina (hormona producida por el hombre) de la que se ha comprobado que promueve el aumento en la concentración plasmática del Factor VIII de la coagulación y de hecho del Factor Von Willebrand, a partir de las células endoteliales. Se ha utilizado con éxito en la Hemofilia y en la enfermedad de Von Willebrand. Caso clínico: se presenta el caso de una paciente de 13 años de edad, con trastorno de función plaquetaria severa y sangramientos mucosos frecuentes, que requirió cirugía mayor odontológica. La intervención cumplió todas las expectativas y la paciente no requirió otra terapéutica por sangrado. Conclusiones: se comprobó que en esta paciente el empleo de la desmospresina tuvo carácter hemostático e impidió de hecho el habitual uso de concentrados plaquetarios para estos casos y por consiguiente evitó el potencial riesgo biológico que siempre tienen los hemoderivados.

Background: desmopressin is a synthetic medication similar to vasopressin (hormone produce by man) which has been proven that promotes the increase in the plasmatic concentration of the coagulation VIII factor and in fact of the Von Willebrand factor, starting from the endothelial cells. It has been used with success in hemophilia and in Von Willebrand disease. Clinical case: a 13 year-old patient is presented, with a disorder of severe platelet function and frequent mucous bleedings who required odontological major surgery. The intervention achieved all the expectations and the patient did not require another therapy because of bleeding. Conclusions: it was proven in this patient the use of desmopressin had hemostatic character and it impeded the habitual use of platelet concentrates for these cases and consequently it avoided the potential biological risk always have the hemoderivatives.

Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity

To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.

A Multicenter Prospective Study of the Effect of Imipramine and Desmopressin on Arousability in Children with Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: We performed a multicenter, prospective study to evaluate the efficacy of imipramine and desmopressin to improve arousability and prevent nocturnal enuresis(NE). MATERIALS AND METHODS: The total of 48 children with NE were given questionnaires that included a scoring system for the assessing arousal from sleep. They were assigned into two groups: group 1(imipramine 25 mg, 3 girls and 16 boys, mean age 7.9 years), group 2(desmopressin 0.2 mg, 9 girls and 9 boys, mean age 7.5 years). The assessment of arousability was repeated 2 weeks and 4 weeks after medication. Eleven children were excluded because of incomplete data. RESULTS: Mean wetting events in group 1 decreased from 8.8 to 5.1 times(2 weeks) and 3.0 times(4 weeks)(p=0.009) versus 10.2 to 5.5 times(2 weeks) and 6.4 times(4 weeks)(p=0.007) for group 2. The mean threshold of arousability in group 1 was 4.9(baseline), 4.4(2 weeks), and 3.7(4 weeks), and, for group 2, 5.1(baseline), 4.8(2 weeks), and 4.8(4 weeks). The two groups were not different(p=0.14, p=0.73). CONCLUSIONS: Imipramine and desmopressin, which are commonly used in treating NE in Korea, influenced wetting events but not arousability.

El cateterismo bilateral y simult neo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing / Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing's syndrome

Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material and methods: Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS). Results: No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86 percent and the specificity 100 percent. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86 percent to 100 percent after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66 percent). Conclusions: The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSS.