Diagnóstico diferencial de adenoma folicular y carcinoma papilar de tiroides mediante variables cariométricas. Matanzas 2013-2016 / Differential diagnosis of thyroidal follicular adenoma and papillary carcinoma by means of karyometric variables. Matanzas 2013-2016

RESUMEN Introducción: los carcinomas diferenciados de tiroides se originan en el epitelio folicular. De ellos el carcinoma papilar muestra una mayor incidencia. Una variante del mismo es la folicular, que en ocasiones muestra un patrón arquitectural que imita a un adenoma folicular. Objetivo: contribuir al diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular de tiroides, utilizando variables cariométricas de las células foliculares. Materiales y métodos: se aplicaron técnicas morfométricas a muestras de biopsias de tiroides con carcinoma papilar variante folicular y adenoma folicular, así como a muestras sin patología, en el período comprendido de enero de 2013 a diciembre de 2016, obtenidas en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Las técnicas aplicadas se basaron en las variables cuantitativas: área, perímetro y factor de forma nuclear de las células foliculares. Los resultados se expresaron en porcentajes; la media aritmética como medida de tendencia central; desviación típica, incluyéndose el cálculo de los valores máximo, mínimo y recorrido para cada variable comprendida en el estudio, reflejados en tablas y gráficos realizados a través del software Microsoft Office Excel. Resultados: se obtuvieron valores elevados de área y perímetro nuclear de las células foliculares del carcinoma papilar variante folicular con relación al adenoma folicular, mientras que el factor de forma no arrojó resultados significativos para la diferenciación de dichas enfermedades tiroideas. Conclusiones: la aplicación de técnicas morfométricas a variables cariométricas en el tiroides, para el diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular, ofrece resultados aplicables en estudios histopatológicos (AU).

ABSTRACT Introduction: differentiated thyroid carcinomas are originated in the follicular epithelium. Of them, the papillary carcinoma shows higher incidence. Follicular carcinoma, one of its variants, occasionally shows an architectural pattern imitating a follicular adenoma. Objective: to contribute to the differential diagnosis between the papillary carcinoma, follicular variant, and thyroid follicular adenoma, using karyometric variables of follicular cells. Materials and methods: morphometric techniques were applied to samples of biopsies of thyroids with papillary carcinoma, follicular variant, and follicular adenoma, and also to samples without any pathology, in the period from January 2013 to December 2016, gathered in the University Hospital Comandante Faustino Perez, of Matanzas. The applied techniques were based on quantitative variables: area, perimeter and nuclear form factor. Results were expressed in percentages; the arithmetic median as measure of central tendency; typical deviation, including the calculation of maximal, minimal values and the course for each variable included in the study, were drawn in tables and graphics using Microsoft Office Excel software. Results: highs values of area and nuclear perimeter of the follicular cells of the papillary carcinoma, follicular variant, were obtained, while the shape factor did not show significant results for those thyroidal diseases differentiation. Conclusions: the application of morphometric techniques to karyometric variables in the thyroids, for the differential diagnosis between the papillary carcinoma, follicular variant, in follicular carcinoma, offers results that can be applied in histopathological studies (AU).

Diabetes insipidus secondary to tuberculous meningoencephalitis with hypothalamic involvement extending to the hypophysis: a case report

Abstract The involvement of Mycobacterium tuberculosis in the central nervous system (CNS) is an uncommon and devastating manifestation of tuberculosis. We report a case of disseminated tuberculosis presenting as meningoencephalitis, hypothalamic involvement with extension to the hypophysis, and secondary insipidus diabetes diagnosed at autopsy.

Diabetes Insípida inducida por el embarazo o gestacional: a propósito de un caso / Pregnancy or Gestational Diabetes Insipidus: a purpose of a case

RESUMEN Antecedentes: La incidencia de la diabetes insípida gestacional es aproximadamente 1/30.000 gestaciones. Objetivo: A propósito de un caso de diabetes insípida gestacional ocurrida en nuestra unidad, se decide comunicar y revisar la literatura referente a opciones de manejo y tratamiento del mismo. Caso clínico: Mujer de 38 años, primigesta de 32 semanas con clínica de poliuria y polidipsia con una ingesta hídrica diaria de hasta 7 litros. Tras realizar las pertinentes exploraciones complementarias y descartar otras patologías más frecuentes, se establece el diagnóstico de diabetes insípida gestacional. Conclusiones: La diabetes insípida gestacional es una entidad muy poco frecuente que puede desencadenar en un estado de deshidratación intensa con hipernatremia y su consecuente afectación neurológica. Es importante el diagnóstico precoz para evitar las complicaciones tanto a nivel materno como fetal, así como realizar un manejo multidisciplinar de esta patología.

ABSTRACT Background: The incidence of diabetes insipidus during pregnancy is approximately 1 in 30,000 pregnancies. Objective: We herein report a case of a patient with gestational diabetes insipidus occurring in our unit. We decided to communicate the case and review the literature regarding management and treatment options. Case report: A 38-year-old woman at 32 week of pregnancy with polyuria, polydipsia, and daily water intake of up to 7 liters. After performing the complementary tests and ruling out other more frequent conditions, the diagnosis of gestational diabetes insipidus was established. Conclusion: Gestational diabetes insipidus is a very rare entity that can cause a state of intense dehydration with hypernatremia and its consequent neurological impairment. Early detection is important in order to avoid complications of both mother and fetus, as well as to carry out a multidisciplinary management of this condition.

Diabetes mellitus vs diabetes insípida y un factor común: la poliuria. Presentación de un caso / Diabetes mellitus versus diabetes insipidus and a common factor: polyuria. Case presentation

La diabetes mellitus es una enfermedad crónica no trasmisible muy frecuente en la ciudad de Matanzas, se presenta en cualquier grupo etáreo, siendo tipo I o tipo II. En la diabetes tipo I, el cuerpo no produce insulina. En la diabetes tipo II, la más común, el cuerpo no produce o no usa la insulina adecuadamente. Sin suficiente insulina, la glucosa permanece en la sangre, provocando múltiples complicaciones tanto agudas como crónicas. La diabetes insípida es un trastorno poco común del metabolismo del agua. Esto quiere decir que el balance entre la cantidad de agua o líquido que usted toma no corresponde con el volumen de excreción urinaria. Es causada por una falta de respuesta o una respuesta deficiente a la hormona antidiurética vasopresina. Esta hormona controla el balance hídrico mediante la concentración de orina. Los pacientes con diabetes insípida orinan mucho, por lo cual necesitan beber bastantes líquidos para reemplazar los que pierden. Se presenta un paciente de 45 años con antecedentes de salud que debutó con una diabetes insípida y un año más tarde con una diabetes mellitus tipo II concomitando ambas, corroborándose por los complementarios correspondientes y mejorando con tratamiento (AU).

Diabetes mellitus is a non-transmissible chronic disease, very frequent in the city of Matanzas, which is present in any age group, and is classified as type I and type II. In the type I diabetes, the body does not produce insulin. In the type II diabetes, the most common one, the body does not produce or does not use it effectively. Without enough insulin, glucose remains in the blood, causing several complications, both acute and chronic. The diabetes insipidus is a few common disorder of the water metabolism. That means that the balance between the quantity of water or any other fluid someone drinks does not coincide with the volume of the urinary excretion. It is due to a lack of answer or a deficient answer to the anti-diuretic hormone vasopressin. This hormone controls the water balance through the urine concentration. The patients with diabetes insipidus urinate a lot, so they need to drink many liquids to replace those they lose. It is presented the case of a patient aged 45 years, with health antecedents, that debuted with diabetes insipidus and a year later with a concomitant type II diabetes mellitus. The complementary tests confirmed that and the patient got better with the treatment (AU).

Diabetes insipidus como manifestação inicial de leucemia mieloide aguda em paciente com monossomia do cromossomo 7 / Diabetes insipidus as initial manifestation of acute myeloid leukemia in a patient with monosomy of chromosome 7

O diabetes insipidus (DI) central é uma síndrome caracterizada pela incapacidade de concentração urinária devido à deficiência do hormônio antidiurético. O envolvimento do sistema nervoso central é frequente nas leucemias, mas a ocorrência de DI é rara e confere pior prognóstico. A patogênese do DI na leucemia não é totalmente conhecida, mas a infiltração do eixo hipotálamo-hipofisário por células leucêmicas parece ser um fator responsável. O presente relato descreve o caso de um paciente que apresentou DI como primeira manifestação de leucemia mieloide aguda e que evoluiu com dificuldades de ajustes do sódio sérico, da poliúria e da reposição volêmica, necessitando de permanência prolongada em unidade de cuidados intensivos(AU)

Central diabetes insipidus (DI) is a syndrome characterized by the inability to concentrate urine due to a lack of antidiuretic hormone. Involvement of the central nervous system is common in acute leukemia, but the occurrence of DI is rare and determines a worse prognosis. The pathogenesis of DI in leukemia has not been fully understood yet, but infiltration of the hypothalamic-pituitary axis by leukemic cells seems to be involved. This report describes a case of a patient who presented with DI as the first manifestation of acute myeloid leukemia. Difficulties in the management of serum sodium, fluid replacement and polyuria led to prolonged length of stay in an intensive care unit(AU)

Polidipsia primaria y diabetes insípida parcial central: dos entidades no excluyentes / Primary polidipsia and partial central diabetes insipidous: two non-exclusive entities

Partial forms of diabetes insipidus (DI) can be combined sometimes with alterations in the functionality of antidiuretic hormone (ADH) as a result of other co-morbidities. These entities are sometimes combined, it being necessary to assess this possibility further diagnostic protocols in particular cases. If clinical patient is within the spectrum of a DI of neurohypophyseal origin is described.

Diabetes insípido na infância: importância do diagnóstico diferencial / Diabetes Insipidus in children: the importance of a differential diagnosis

O diabetes insipidus (DI) é uma síndrome clínica caracterizada por poliúria e polidipsia, que pode decorrer de uma deficiência de hormô- nio antidiurético (DI central) ou de uma insensibilidade renal ao hormônio (DI nefrogênica). Os autores relatam o caso de paciente do sexo masculino, de 3 anos e 10 meses de idade, que apresentou quadro clínico e exames complementares sugestivos de diabetes insipidus, e discutem a epidemiologia, apresentação clínica e diagnóstico desta doença (AU)

Diabetes insipidus (DI) is a clinical syndrome characterized by polyuria and polydipsia, which may result from a deficiency of antidiuretic hormone (central DI) or a renal insensitivity to the hormone (nephrogenic DI). The authors report the case of a male patient, 3 years and 10 months of age, who presented clinical and complementary tests suggestive of diabetes insipidus, and discuss the epidemiology, clinical presentation and diagnosis of this disease (AU)

Diabetes insípida en pediatría: serie clínica y revisión de la literatura / Diabetes insipidus in pediatrics

Introduction: Diabetes insipidus (DI) is a syndrome characterized by polyuria and polydipsia secondary to a decreased secretion or action of the antidiuretic hormone (ADH). An early diagnosis is essential. Diagnosis is made by measuring plasma and urinary osmolarity and their changes under water deprivation and after DDAVP administration. Objective: Lo describe the clinical, radiological characteristics as well as the initial treatment of eight children with DI, 3 of them nephrogenic DI (DIN) and 5 with central DI. Methods: A Retrospective, descriptive study in DI patients under control at the Catholic University of Chile and Sotero del Rio Hospital between 1998-2008 is presented. Clinical files were evaluated collecting clinical, epidemiologic, biochemical and image data. Serum (Sosm) and urinary osmolarity (Uosm) were registered. DI was diagnosed with a Sosm > 300 and Usm < 600 mOsm/L. Central DI was defined as the inability to reach a Uosm > 600 or a 50 percent-increase after DDAVP treatment. Otherwise DI was classified as DIN. Results: Eight patients (5 males) were studied. Chief complaints were polydipsia/polyuria (5/8), hyperthermia (2/8), and failure to grow (1/8). MRI showed endocraneal lesion in all patients with Central DI. All of these utilized oral or inhalatory DDAVP treatment. Patients with Nephrogenic DI were trated with Hydrochlrothiazide. Conclusion: Polydipsia, polyuria, hyperthermia with hypernatremia are suggestive of DI in the first year of life. Water deprivation test is diagnostic in differentiating Central and Nephrogenic DI. MRI is an essential diagnostic tool in CDI. Manegement should be multidisciplinary, including a pediatician, nephrologist, endocrinologist and nutricionist.

Introducción: La diabetes insípida (DI) se caracteriza por poliuria y polidipsia, secundario a una disminución de la secreción o acción de la hormona antidiurética. Su diagnóstico precoz es fundamental. Objetivo: Describir las características clínicas, radiológicas y tratamiento inicial de una serie de ocho pacientes con DI. Diseño: Estudio descriptivo-restrospectivo. Universo: Pacientes con DI evaluados en la Universidad Católica de Chile y Hospital Dr. Sótero del Río entre 1998-2008. Pacientes y Métodos: Desde la ficha clínica se analizaron variables clínicas, epidemiológicas, bioquímicas e imágenes. Se determinó Osmolaridad sérica (OsmS) y urinaria (OsmU). Se consideró DI sí la OsmS > 300 mOsm con OsmU < 600 mOsm, Di-central (DIC) sí posterior a DDAVP la OsmU aumento > 50 por ciento ó > 600 mOsm, de los contrario se clasificó como nefrogénica (DIN). Resultados: Se reclutaron ocho pacientes con DI (5 varones), fueron DIN 3/8. El motivo de consulta fue: polidipsia-poliuria (5/8), hipertermia (2/8) y talla baja (1/8). La RNM mostró lesión intracraneana en todos los pacientes con DIC: nodulo hipofisiario, aracnoidocele selar, Histiocitosis X, germinoma y un paciente sin se±al de neurohipófisis. Los sujetos con DIC usaron DDAVP inhalatoria (4) y oral (1). Los sujetos con DIN usaron hidroclorotiazida. Conclusión: Polidipsia, poliuria, hipertermia con hipernatremia y falla de medro en lactantes son sugerentes de DI. La prueba de deprivación hídrica es fundamental en la diferenciación de DIC y DIN. La RNM cerebral es una herramienta diagnóstica imprescindible en la DIC. El tratamiento de estos pacientes debe ser multidiciplinario interactuando pediatra, nefrólogo, endocrinólogo y nutricionista.

Central diabetes insipidus: clinical profile and factors indicating organic etiology in children.

OBJECTIVE: To evaluate the profile of children with central diabetes insipidus (DI) and identify factors indicating organic etiology. DESIGN: Retrospective chart review. SETTING: Tertiary referral hospital. SUBJECTS: Fifty-nine children with central DI (40 boys, 19 girls). METHODS: Features of organic and idiopathic central DI were compared using students t test and chi square test. Odds ratio was calculated for factors indicating organic etiology. RESULTS: Diagnosis included post-operative central DI (13, 22%), central nervous system (CNS) malformations (5, 8.6% holoprosencephaly 4 and hydrocephalus 1), histiocytosis (11, 18.6%), CNS pathology (11, 18.6%; craniopharyngioma 3, empty sella 2, germinoma 2, neuro-tuberculosis 2, arachnoid cyst 1 and glioma 1) and idiopathic central DI (19, 32.2%). Children with organic central DI were diagnosed later (7.8+/- 3.1 years against 5.3+/-2.4 years, P=0.03) and had lower height standard deviation score (-2.7+/-1.0 versus -1.0+/- 1.0, P<0.001) compared to idiopathic group. A greater proportion of children with organic central DI had short stature (81.8% against 10.5%, P <0.001, odds ratio 38.25), neurological features (45.5% against 0%, p 0.009) and anterior pituitary hormone deficiency (81.8% against 5.3%, P<0.001, odds ratio 81) compared to idiopathic group. A combination of short stature and onset after five years of age led to discrimination of organic central DI from idiopathic group in all cases. CONCLUSION: Organic central DI should be suspected in children presenting after the age of five years with growth retardation and features of anterior pituitary deficiency.

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

BACKGROUND: Cerebral salt wasting syndrome (CSWS), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery. PURPOSE: To identify these syndromes following neurosurgery. METHOD: The study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping. Sodium levels in serum and urine and urine volume were measured daily up to the 5th day following surgery. Plasma arginine vasopressin (AVP) was measured on the first, third and fifth days post-surgery. RESULTS: CSWS was found in 27/30 patients (90 percent), in 14 (46.7 percent) of whom it was associated with a reduction in the levels of plasma AVP (mix syndrome). SIADH was found in 3/30 patients (10 percent). There was no difference between the two groups of patients. CONCLUSION: CSWS was the most common syndrome found, and in half the cases it was associated with DI. SIADH was the least frequent syndrome found.

INTRODUÇÃO: A síndrome perdedora de sal (SPS), síndrome da secreção inapropriada do hormônio antidiurético (SIADH) e diabetes insipidus (DI) são freqüentemente encontradas no pós-operatório de neurocirurgia. OBJETIVO: Identificar essas síndromes relacionadas à neurocirurgia. MÉTODO: Foram estudados 30 pacientes submetidos à ressecção de tumor (n=19) e clipagem de aneurisma (n=11) cerebral durante os primeiros cinco dias do pós-operatório. Os pacientes foram submetidos a dosagens diárias de sódio sérico e urinário até o 5° dia pós-operatório, com controle de volume urinário neste período e dosagem de arginina-vasopressina (AVP) plasmática no 1°, 3° e 5° dias pós-operatórios. RESULTADOS: A SPS foi encontrada em 27/30 pacientes (90 por cento), em 14/27 (46,7 por cento) associada à diminuição dos níveis de AVP plasmática (síndrome mista). A SIADH foi encontrada em 3/30 pacientes (10 por cento). Não houve diferença entre os dois grupos de pacientes. CONCLUSÃO: A SPS foi a síndrome mais freqüente, em metade de casos associada ao DI. A SIADH foi a menos freqüente.

Successful treatment of diabetes insipidus with oral desmopressin

Acute-onset polyuria, with urine volumes exceeding 3 litres per day, is a relatively uncommon clinical condition. If managed on appropriate guidelines, an excellent recovery is expected

A Case of Rathke's Cleft Cyst Inflammation Presenting with Diabetes Insipidus

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.

Optimal use of laboratory tests in pediatric endocrine practice.

Optimal use of the laboratory in the practice of pediatric endocrinology begins with careful consideration of the patient's history and physical findings. After a review of the differential diagnosis, an orderly plan of laboratory investigation can be devised. This paper outlines some of the more common laboratory tests used to evaluate some common pediatric endocrine disorders. The intent is to provide a concise, logical approach to choose the most efficient approach.