
Diabetes insipidus is a rare complication of ischemic infarction of the brain. It is caused by problems with a chemical called arginine vasopressin (AVP), which is produced by the hypothalamus and stored in the pituitary gland. In the event of a stroke, AVP fails to properly regulate the body's water level, leading to the production and passing of excessive amounts of urine. This condition, known as AVP deficiency, can be the result of brain damage caused by a sudden loss of oxygen during a stroke. While rare, there have been reported cases of transient central diabetes insipidus following an ischemic stroke, with one case study detailing the successful treatment of a young male with desmopressin therapy.
Characteristics | Values |
---|---|
Diabetes insipidus type | Central diabetes insipidus (CDI) |
Cause of CDI | Ischemic infarction of the brain |
Possible cause of CDI | Posterior pituitary ischemia |
Possible cause of CDI | Inferior hypophyseal artery disruption |
Possible cause of CDI | Osmotic causes |
Age of patient | 35 years old |
Sex of patient | Male |
Symptoms | Left hemiparesis, tonic-clonic seizure, obtundation of sensorium |
Treatment | Desmopressin nasal spray |
Treatment duration | 5 days |
Resolution | Full recovery, no other pituitary hormone deficiency |
What You'll Learn
- Brain damage caused by a stroke can lead to diabetes insipidus
- Posterior pituitary ischemia may cause central diabetes insipidus (CDI)
- CDI can be caused by a stroke interrupting blood supply to the pituitary gland
- A stroke can cause CDI by damaging the hypothalamus
- A stroke can cause hypernatremia, which can lead to diabetes insipidus
Brain damage caused by a stroke can lead to diabetes insipidus
In DI, AVP fails to properly regulate the body's water level, leading to excessive urine production. There are two main types of DI: AVP deficiency and AVP resistance. AVP deficiency occurs when the body does not produce enough AVP, resulting in excessive water loss through urine. AVP resistance happens when AVP is produced in the right amounts, but the kidneys do not respond to it normally.
Brain damage from a stroke can cause DI by disrupting the production or function of AVP. This can include damage to the hypothalamus or pituitary gland, which are crucial for AVP production and release. Posterior pituitary ischemia, or inadequate blood flow to the pituitary gland, has been identified as a possible cause of DI. This can occur due to hypoperfusion, or low blood pressure, in the setting of an ischemic stroke.
Additionally, stroke-related damage to the osmoreceptors in the hypothalamus and posterior pituitary can contribute to the development of DI. These osmoreceptors play a vital role in regulating water balance in the body. When they are affected by a stroke, it can lead to the onset of DI.
The link between stroke and DI is further supported by cases where patients with DI following a stroke showed improvement or complete resolution of DI during their neurological recovery. This suggests that the vascular mechanism of the stroke may be a contributing factor to the development of DI.
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Posterior pituitary ischemia may cause central diabetes insipidus (CDI)
Posterior pituitary ischemia, or a lack of blood flow to the posterior pituitary, is a rare but possible cause of Central Diabetes Insipidus (CDI). CDI is a rare complication of ischemic infarction of the brain. In the case of a 35-year-old male with no history of diabetes, hypertension, or preceding transient ischemic attack, a sudden onset of left hemiparesis developed into tonic-clonic seizures and progressive obtundation of sensorium. A CT scan revealed bilateral frontal, temporoparietal, and occipital ischemic infarcts, which were confirmed by an MRI.
The patient's worsening level of consciousness led to a decompressive craniectomy with expansile duroplasty. Subsequently, the patient's urine output increased significantly, with a corresponding fluid intake of 3000-4000 ml over three days. This increase in urine output, or polyuria, is a classic symptom of diabetes insipidus. A water deprivation test was performed, and the results confirmed a diagnosis of CDI. The patient was started on desmopressin nasal spray, and his urine output decreased to a normal level within a few days.
Posterior pituitary ischemia is believed to be caused by inferior hypophyseal arteries and can lead to idiopathic CDI. This is supported by the observation that CDI resolved during the patient's neurological recovery, suggesting a vascular mechanism for this defect. Late-onset polyuria after a stroke can be attributed to residual stored AVP in the posterior pituitary nerve endings.
Diabetes insipidus is caused by problems with a chemical called arginine vasopressin (AVP) or antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland. It regulates water levels in the body by controlling the amount of urine produced by the kidneys. In diabetes insipidus, AVP fails to regulate water levels properly, leading to excessive urine production.
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CDI can be caused by a stroke interrupting blood supply to the pituitary gland
Central Diabetes Insipidus (CDI) is a rare complication of ischemic infarction of the brain. It can be caused by a stroke interrupting blood supply to the pituitary gland, specifically, the posterior pituitary. The pituitary gland is located below the brain, behind the bridge of the nose. It releases a chemical called arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), which regulates the level of water in the body by controlling the amount of urine produced by the kidneys.
In the case of a 35-year-old male patient, an ischemic stroke resulted in bilateral frontal, temporoparietal, and occipital infarcts, leading to the development of CDI. The stroke caused a disruption in the release of AVP, leading to excessive urine production. This condition was managed with desmopressin therapy, and the patient's urine output returned to normal within a few days.
Another case study describes a 50-year-old female who suffered a vertebral artery dissection, leading to a subarachnoid hemorrhage and the development of CDI. The patient was treated conservatively with intravenous normal saline, analgesics, and bed rest, resulting in a gradual decrease in urine output.
Posterior pituitary ischemia, or inadequate blood supply to the posterior pituitary, has been proposed as a possible cause of CDI. This can occur due to interruptions in the blood supply by the inferior hypophyseal arteries, which supply blood to the posterior pituitary. This hypothesis is supported by studies that have found abnormal blood supply to the posterior pituitary in patients with idiopathic CDI.
The resolution of CDI during neurological recovery from a stroke suggests a vascular mechanism for this defect. The late onset of polyuria after a stroke can be attributed to residual stored AVP in the posterior pituitary nerve endings.
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A stroke can cause CDI by damaging the hypothalamus
A stroke can cause Central Diabetes Insipidus (CDI) by damaging the hypothalamus. The hypothalamus is an area of the brain that controls mood and appetite. It also produces a chemical called arginine vasopressin (AVP), also known as the antidiuretic hormone (ADH). AVP is crucial for regulating water levels in the body by controlling the amount of urine produced by the kidneys. When the body's water levels decrease, the pituitary gland releases stored AVP to conserve water and stop urine production.
In CDI, AVP fails to properly regulate water levels, leading to excessive urine production. This can occur due to AVP deficiency, where the body does not produce enough AVP, or AVP resistance, where the kidneys do not respond normally to AVP despite its presence. AVP deficiency can result from damage to the hypothalamus, which can be caused by a stroke.
A stroke can damage the hypothalamus and disrupt AVP production, leading to CDI. This is a rare complication of a stroke, but it has been observed in some cases. The resolution of CDI during neurological recovery from a stroke suggests a vascular cause for the condition.
The involvement of osmoreceptors in the hypothalamus and posterior pituitary by hypoperfusion during a stroke can lead to CDI. While the pituitary gland may appear intact on imaging, the disruption of AVP production or release can result in CDI. This highlights the importance of considering CDI as a possible complication of a stroke and the need for appropriate diagnostic tests and management.
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A stroke can cause hypernatremia, which can lead to diabetes insipidus
Diabetes insipidus (DI) is a condition characterised by excessive urination and thirst due to inadequate production or response to arginine vasopressin (AVP), also known as the antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland, which is located below the brain, behind the bridge of the nose. It plays a crucial role in regulating water levels in the body by controlling the amount of urine produced by the kidneys.
In the setting of a stroke, DI can occur due to ischemia of the posterior pituitary or damage to the hypothalamus, which can disrupt AVP production or release. This disruption leads to a failure in properly regulating water levels, resulting in excessive urine production. This condition is known as Central Diabetes Insipidus (CDI).
Post-stroke hypernatremia, or elevated blood sodium levels, is often a consequence of CDI. This can occur when stroke patients develop neurological lesions that prevent them from accessing water, leading to dehydration and increased sodium concentrations in the blood. Additionally, stroke patients may experience hypodipsia, a reduction in thirst, which further contributes to hypernatremia.
The management of post-stroke hypernatremia involves scheduling supervised water intake to normalise plasma sodium levels and prevent significant neurological symptoms. This simple measure can lead to an increase in diuresis and a reduction in plasma sodium levels, improving symptoms such as lethargy and muscle weakness.
In summary, while rare, it is important to recognise that a stroke can lead to hypernatremia, which may then trigger CDI. Prompt diagnosis and management are crucial to prevent further complications and ensure the patient's full recovery.
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Frequently asked questions
Diabetes insipidus is a condition where the body fails to regulate its water levels due to problems with a chemical called arginine vasopressin (AVP), also known as antidiuretic hormone (ADH).
There are two main types: AVP deficiency, where the body does not produce enough AVP, and AVP resistance, where the kidneys do not respond normally to AVP.
AVP deficiency can be caused by a brain tumour, severe head injury, or complications during brain or pituitary surgery. In about a third of cases, no cause is found, but it is believed to be related to the immune system attacking healthy cells producing AVP.
AVP resistance can be congenital or acquired. Congenital AVP-R is caused by genetic mutations, while acquired AVP-R can be caused by long-term lithium use or conditions affecting kidney function, such as hypercalcaemia and hypokalemia.
A stroke can cause diabetes insipidus by damaging the hypothalamus or pituitary gland, leading to AVP deficiency. It can also cause brain damage due to a sudden loss of oxygen, resulting in AVP deficiency or resistance.