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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recent epidemiologic studies (11) have shown a frequency of 3-5% of hyponatremia in chronic psychiatric patients, characterized by headaches, blurry vision, weakness, cramps, vomiting and sometimes seizures or coma leading to death. The etiopathology of this electrolytic syndrome is still debated and intriguing. Six to 17% of hospitalized patients in psychiatry present primary polydipsia, among which 25-50% develop hyponatremia. Another cause is the syndrome of inappropriate secretion of anti-diuretic hormone, SIADH, which may be due to a number of psychotropic drugs as carbamazepine, thioridazine, amitriptyline, desipramine, haloperidol, chlorpromazine and fluoxetine (1, 2, 7, 9, 15, 18, 24). These medications can be associated with primary polydipsia but not necessarily, and the hyponatremia is reversible after discontinuiting the treatment. We describe a case of hyponatremia possibly related to clomipramine which has been rarely reported in the literature and discuss the relations between hyponatremia, psychosis, and SIADH.
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PMID:[Hyponatremia of therapeutic origin. Apropos of a case]. 782 16

A 34-year-old woman with a long-term history of amenorrhoea, headache and visual disturbances was operated for a hypothalamic tumor which could be completely removed. Postoperatively the patient developed a transient SIADH-syndrome and deep vein thrombosis; otherwise the clinical course was uneventful. There has been no sign of tumor recurrence at a follow-up period of fifteen months. Histological examination of the tumor revealed an ectopic pituitary adenoma with production of ACTH and TSH shown by immunohistochemistry.
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PMID:ACTH and TSH producing ectopic suprasellar pituitary adenoma of the hypothalamic region: case report. 839 55

A 45-year-old woman had pyrexia, headaches, collapse and hyponatraemia. Intracerebral abscess, bacterial meningitis and subarachnoid haemorrhage were excluded. She was given intravenous antibiotics and gradually recovered. One month later she was readmitted with diplopia, headache and vomiting. Serum sodium was low (107 mmol/l) and a diagnosis of inappropriate ADH secretion was made. MRI scan showed a suprasellar tumour arising from the posterior pituitary gland. A skin rash gradually faded. Serum cortisol, prolactin, gonadotrophins and thyroid hormone levels were low. A pituitary tumour was removed trans-sphenoidally, she had external pituitary radiotherapy, and replacement hydrocortisone and thyroxine. She was well for 12 months when she developed progressive weakness and numbness of both legs. Examination suggested spinal cord compression at the level of T2 where MRI scanning showed an intradural enhancing mass. This spinal tumour was removed and her neurological symptoms disappeared. Nine months after this she developed facial pain and nasal obstruction. CT scan showed tumour growth into the sphenoid sinus and nasal cavities. A right Cauldwell-Luc operation was done and residual tumour in the nasal passages was treated by fractionated external radiotherapy and Prednisolone. Histological examination of the specimens from pituitary, spinal mass, and nasal sinuses showed Rosai-Dorfman disease, a rare entity characterized by histiocytic proliferation, emperipolesis (lymphophagocytosis) and lymphadenopathy. Aged 48 she developed cranial diabetes insipidus. Although Rosai-Dorfman syndrome is rare, it is being reported with increasing frequency, and should be borne in mind as a possible cause of a pituitary tumour.
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PMID:Rosai-Dorfman disease presenting as a pituitary tumour. 1034 67

During the past 11 years 69 patients underwent transsphenoidal surgery for symptomatic intra- and suprasellar non-neoplastic cysts in our department. Eighteen of them harbored intra- and suprasellar colloid cysts. The most frequent presenting symptoms were oligomenorrhea, galactorrhea, and headaches. One patient presented with polydipsia. One male patient complained about mild hypogonadism and oligospermia. Two male patients presented with symptoms of panhypopituitarism. Endocrine assessment revealed hyperprolactinaemia in 72% of the female patients. Hypogonadism was found in 72%. Panhypopituitarism was found in two cases. During transsphenoidal surgery, a circumscribed collection of colloid material was removed in each case. Additional tumorous tissue was encountered in three cases that harbored a concomitant pituitary adenoma. Biopsies confirmed the surrounding tissue to be normal pituitary tissue. Postoperatively, regular menstrual cycles were found in 82% of the female patients with oligomenorrhea and headaches improved in 80%. Serum prolactin levels were restored in 92%, galactorrhea ceased in 89%. Only in one case deterioration of pituitary function occurred (diabetes insipidus). Symptomatic SIADH occurred in another one. There were no other post-operative complications. We conclude, that transsphenoidal surgery is a safe therapy for treating symptomatic intra- and suprasellar colloid cysts. Surgery is mainly indicated for female patients in childbearing age to restore fertility and to prevent further deterioration of pituitary function. The differential diagnosis is often unclear preoperatively, but a non-enhancing mass on MRI between anterior and posterior lobe may suggest the presence of an intra- and suprasellar colloid cyst.
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PMID:Intra- and suprasellar colloid cysts. 1108 Nov 62

A 46-year-old man complained fever, headache, and vertigo after he was given steroid for sudden deafness. He was diagnosed as miliary tuberculosis by his chest CT findings. After admission, 4 anti-tuberculous drugs (INH, RFP, SM, and PZA) were prescribed but his laboratory findings showed SIADH, which was difficult to treat, and steroid was readministered. Brain MRI, examined 2 months after admission, showed brain tuberculomas, and examination of cerebrospinal fluid revealed a diagnosis of tuberculous meningitis. Three months later, meningitis deteriorated transiently, however symptoms and findings improved by increasing steroid. Later, miliary tuberculosis and SIADH were cured, however, some tuberculomas grew larger gradually on brain MRI, and spinal MRI showed tuberculomas in the spinal cord. LVFX, high concentration in CSF, was added. At present (2 yrs after beginning the therapy), lesions in the brain and spinal cord improved but remain with the sequelae.
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PMID:[A case of miliary tuberculosis complicated with SIADH, brain tuberculoma, and tuberculous meningitis]. 1190 30

Six cases of scrub typhus (tsutsugamushi disease) were reported to the Shizuoka Prefecture Hamamatsu City public health center during the seven years from 2001 to 2007. The content of the clinical record of the five cases were investigated. High serum titers of antibody to Gilliam-type Orientia tsutsugamushi were detected by immunofluorescense assay in most of these patients. Fever, rash, headache and relative bradycardia seen at a high frequency. On peripheral blood smear examination, atypical lymphocytes were detected in 3 cases. Serum electrolyte examination revealed hyponatremia in 4 (80%) patients; SIADH was suspected in one of these cases. All the patients improved promptly following start of therapy with intravenous or oral minocycline.
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PMID:[Tsutsugamushi disease during the last seven years in the past in Hamamatsu City, Shizuoka Prefecture--including evaluation of hyponatremia in scrub typhus]. 1869 86

Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of sinonasal tract, derived from olfactory epithelium. Unilateral nasal obstruction, epistaxis, sinusitis, and headaches are common symptoms. Olfactory neuroblastoma shows neuroendocrine differentiation and similarly to other neuroendocrine tumors can produce several types of peptic substances and hormones. Excess production of these substances can be responsible for different types of endocrinological paraneoplastic syndromes (PNS). Moreover, besides endocrinological, in ONB may also occur neurological PNS, caused by immune cross-reactivity between tumor and normal host tissues in the nervous system. Paraneoplastic syndromes in ONB include: syndrome of inappropriate ADH secretion (SIADH), ectopic ACTH syndrome (EAS), humoral hypercalcemia of malignancy (HHM), hypertension due to catecholamine secretion by tumor, opsoclonus-myoclonus-ataxia (OMA) and paraneoplastic cerebellar degeneration. Paraneoplastic syndromes in ONB tend to have atypical features, therefore diagnosis may be difficult. In this review, we described initial symptoms, patterns of presentation, treatment and outcome of paraneoplastic syndromes in ONB, reported in the literature.
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PMID:Paraneoplastic syndromes in olfactory neuroblastoma. 2619 64

Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (<6 hours) and ultra-endurance events (>6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome.
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PMID:Physiopathological, Epidemiological, Clinical and Therapeutic Aspects of Exercise-Associated Hyponatremia. 2623 2

A previously healthy 24-year-old female underwent an emergent caesarean section without a major bleeding described. During the first post-operative days (POD) she complained of fatigue, headache and a failure to lactate with no specific and conclusive findings on head CT. On the following days, fever rose with a suspicion of an obstetric surgery-related infection, again with no evidence to support the diagnosis. On POD5 a new-onset hyponatremia was documented. The urine analysis suggested SIADH, and following a treatment failure, further investigation was performed and demonstrated both central hypothyroidism and adrenal insufficiency. The patient was immediately treated with hydrocortisone followed by levothyroxine with a rapid resolution of symptoms and hyponatremia. Further laboratory investigation demonstrated anterior hypopituitarism. The main differential diagnosis was Sheehan's syndrome vs lymphocytic hypophysitis. Brain MRI was performed as soon as it was available and findings consistent with Sheehan's syndrome confirmed the diagnosis. Lifelong hormonal replacement therapy was initiated. Further complaints on polyuria and polydipsia have led to a water deprivation testing and the diagnosis of partial central insipidus and appropriate treatment with DDAVP. Learning points: Sheehan's syndrome can occur, though rarely, without an obvious major post-partum hemorrhage. The syndrome may resemble lymphocytic hypophysitis clinically and imaging studies may be crucial in order to differentiate both conditions. Hypopituitarism presentation may be variable and depends on the specific hormone deficit. Euvolemic hyponatremia workup must include thyroid function test and 08:00 AM cortisol levels.
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PMID:A rare cause of postpartum acute hyponatremia. 3087 79