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La hipofisitis autoinmune es un cuadro caracterizado por la infiltración linfocítica de la hipófisis que produce deficiencia de una o más hormonas, tanto de la adenohipófisis como de la neurohipófisis. Para el diagnóstico, es necesario un alto índice de sospecha, más aún considerando la relación temporal con el embarazoo el parto. Las características clínicas e imagenológicas sugieren el diagnóstico. A pesar que el diagnóstico definitivo es por biopsia, esta no se suele realizar por los potenciales efectos adversos del procedimiento. Presentamos un caso que describe la forma de manifestación de la enfermedad y las características imagenológicas típicas en la resonancia magnética nuclear.

Autoimmune hypophysitis is a condition characterized by lymphocytic infiltration of the pituitary resulting in deficiency of one or more hormones of both the adenohypophysis and the neurohypophysis. For diagnosis, a high index of suspicion is necessary, even more so considering the temporal relationship with pregnancy or childbirth. Clinical and imaging features are suggestive of the diagnosis. Although the definitive diagnosis is by biopsy, this is not usually performed because of the potential adverse effects of the procedure. We present a case describing the form of manifestation of the disease and the typical imaging features on magnetic resonance imaging.

RESUMO

A diabetes mellitus é uma endocrinopatia crônica que acomete principalmente cães e gatos de meia idade a idosos, tendo como fator predisponente o metabolismo inadequado da glicose, pela deficiência ou resistência ao hormônio insulina levando a hiperglicemia persistente. O objetivo desse estudo foi avaliar a epidemiologia da doença em uma população de cães atendidos no Hospital Veterinário Dr. Halim Atique, em São José do Rio Preto - SP, através da avaliação dos prontuários dos pacientes caninos atendidos entre janeiro de 2017 e janeiro de 2019. Os resultados demonstraram maior prevalência nas fêmeas (67%), nos cães sem raça definida (43%), com média de idade de 10 anos, apresentando principalmente os sinais clínicos de: polidipsia (21%), poliúria (18%), perda de peso (15%) e polifagia (3%). A suspeita diagnostica baseava-se nos sinais clínicos e a confirmação foi através hiperglicemia mais glicosúria. Essa pesquisa permitiu sugerir o perfil do paciente canino diabético.

Diabetes mellitus is a chronic endocrinopathy that mainly affects middle-aged to elderly dogs and cats, and its predisposing factor is inadequate glucose metabolism, due to a deficiency or resistance to the hormone insulin, leading to persistent hyperglycemia. The purpose of this study was to evaluate the epidemiology of the disease in a population of dogs attended at the Dr. Halim Atique Veterinary Hospital, in São José do Rio Preto - SP, through the evaluation of the medical records of canine patients attended between January 2017 and January 2019. The results showed a higher prevalence in females (67%), in mixed breed dogs (43%), with a mean age of 10 years, showing mainly the clinical signs of: polydipsia (21%), polyuria (18%), weight loss (15%) and polyphagia (3%). The diagnostic suspicion was based on clinical signs and confirmation was through hyperglycemia plus glycosuria. This research allowed us to suggest the profile of the diabetic canine patient.

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A diabetes mellitus é uma endocrinopatia crônica que acomete principalmente cães e gatos de meia idade a idosos, tendo como fator predisponente o metabolismo inadequado da glicose, pela deficiência ou resistência ao hormônio insulina levando a hiperglicemia persistente. O objetivo desse estudo foi avaliar a epidemiologia da doença em uma população de cães atendidos no Hospital Veterinário Dr. Halim Atique, em São José do Rio Preto - SP, através da avaliação dos prontuários dos pacientes caninos atendidos entre janeiro de 2017 e janeiro de 2019. Os resultados demonstraram maior prevalência nas fêmeas (67%), nos cães sem raça definida (43%), com média de idade de 10 anos, apresentando principalmente os sinais clínicos de: polidipsia (21%), poliúria (18%), perda de peso (15%) e polifagia (3%). A suspeita diagnostica baseava-se nos sinais clínicos e a confirmação foi através hiperglicemia mais glicosúria. Essa pesquisa permitiu sugerir o perfil do paciente canino diabético.(AU)

Diabetes mellitus is a chronic endocrinopathy that mainly affects middle-aged to elderly dogs and cats, and its predisposing factor is inadequate glucose metabolism, due to a deficiency or resistance to the hormone insulin, leading to persistent hyperglycemia. The purpose of this study was to evaluate the epidemiology of the disease in a population of dogs attended at the Dr. Halim Atique Veterinary Hospital, in São José do Rio Preto - SP, through the evaluation of the medical records of canine patients attended between January 2017 and January 2019. The results showed a higher prevalence in females (67%), in mixed breed dogs (43%), with a mean age of 10 years, showing mainly the clinical signs of: polydipsia (21%), polyuria (18%), weight loss (15%) and polyphagia (3%). The diagnostic suspicion was based on clinical signs and confirmation was through hyperglycemia plus glycosuria. This research allowed us to suggest the profile of the diabetic canine patient.(AU)

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ABSTRACT Primary polydipsia, or psychogenic polydipsia, is a condition that results in considerable morbidity and mortality. In psychiatric patients, psychogenic polydipsia and the syndrome of inappropriate antidiuretic hormone secretion may cause hyponatremia. In the 1970s, it was recognized that antipsychotics such as tiotixene and haloperidol could impair the excretion of a free water load. There are also several case reports of drug-induced hyponatremia in patients using atypical drugs suggesting that these probably can also impair water balance and induce hyponatremia. Case report and review of relevant literature are reported in this article. Psychogenic polydipsia is a common cause of hyponatremia among individuals with chronic mental illness. A case of severe hyponatremia caused by psychogenic polydipsia is described involving a female patient with an adult lifelong history of chronic mental illness diagnosed as schizoaffective disorder. After switching her antipsychotic medication to clozapine water ingestion was normalized as well as sodium levels and her psychotic symptoms improved. Primary polydipsia occurs commonly with schizophrenia and other mental diseases and can cause hyponatremia. PPD may present as an acute psychotic state or as inexplicable emergence of seizures. Appropriate, timely clinical assessment with special attention to thirst, fluid intake, and urine output is essential. Proper treatment may include drug withdrawal and fluid and saline restriction. Once corrected, some pharmacological agents can be tried. The article illustrates the importance of the diagnosis of psychogenic polydipsia given its electrolyte disturbances and life threatening situations.

RESUMO A polidipsia primária ou polidipsia psicogênica (PDP) é uma condição que se traduz em altas taxas de morbilidade e mortalidade. Nos doentes psiquiátricos, a PDP e a síndrome da secreção inapropriada do hormônio antidiurético (SIADH) podem resultar em hiponatremia. Nos anos 1970, foi reconhecido que alguns antipsicóticos como o tiotixeno e o haloperidol podiam comprometer a excreção de água livre. Existem ainda diversos casos reportados de hiponatremia iatrogênica em pacientes medicados com antipsicóticos atípicos sugerindo que essa classe farmacológica pode igualmente resultar em hiponatremia. Um caso clínico e uma revisão sobre o tema são reportados neste artigo. A polidipsia psicogênica é uma causa comum de hiponatremia entre os indivíduos com doença mental crônica. Um caso de hiponatremia grave causada por polidipsia psicogênica é descrito envolvendo uma paciente do sexo feminino com antecedentes de perturbação esquizoafetiva. Após alteração da sua medicação antipsicótica para clozapina, observou-se normalização na ingestão hídrica bem como nos níveis de sódio e melhoria da sintomatologia psicótica. A PDP ocorre comumente em doentes esquizofrênicos ou com outras perturbações psiquiátricas e pode resultar em hiponatremia. Um correto diagnóstico com especial atenção a sede, ingestão hídrica e débito urinário é essencial. O tratamento pode incluir a retirada de fármacos e restrição hídrica e salina. Uma vez corrigida, alguns agentes farmacológicos podem ser utilizados.

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A rabdomiólise é caracterizada por destruição de tecido muscular esquelético, sendo as suas principais causas o trauma, os tóxicos e os distúrbios hidroeletrolíticos. Entre esses últimos, inclui-se a rabdomiólise induzida por hiponatremia, uma situação rara, que ocorre principalmente em doentes com polidipsia psicogênica. Esta acomete maioritariamente doentes com esquizofrenia, cursando com hiponatremia em quase 25% dos casos. É também nesse contexto que a rabdomiólise secundária a hiponatremia ocorre mais frequentemente. Neste artigo, descreveu-se o caso de um homem de 49 anos, com antecedentes de esquizofrenia, medicado com clozapina, trazido ao serviço de urgência por quadro de coma e convulsões. Foi objetivada hiponatremia hiposmolar grave, com edema cerebral em tomografia computorizada, sendo feito posteriormente o diagnóstico de hiponatremia secundária à polidipsia psicogênica. Foi iniciada terapêutica de correção de hiponatremia e internado em unidade de terapia intensiva. Feita correção de hiponatremia, contudo apresentou analiticamente marcada rabdomiólise, de agravamento crescente, com creatinofosfoquinase de 44.058UI/L no 3º dia de internação. Houve posterior redução progressiva com a terapêutica, sem ocorrência de lesão renal. Este caso alerta para a necessidade de monitorização dos marcadores de rabdomiólise na hiponatremia grave, ilustrando um quadro de rabdomiólise secundária à hiponatremia induzida por polidipsia psicogênica, situação a considerar em doentes sob terapêutica com neurolépticos.

Rhabdomyolysis is characterized by the destruction of skeletal muscle tissue, and its main causes are trauma, toxic substances and electrolyte disturbances. Among the latter is hyponatremia-induced rhabdomyolysis, a rare condition that occurs mainly in patients with psychogenic polydipsia. Psycogenic polydipsia mostly affects patients with schizophrenia, coursing with hyponatremia in almost 25% of the cases. It is also in this context that rhabdomyolysis secondary to hyponatremia occurs most often. In this article, the case of a 49-year-old male with a history of schizophrenia, medicated with clozapine, and brought to the emergency room in a state of coma and seizures is described. Severe hypoosmolar hyponatremia with cerebral edema was found on a computed tomography examination, and a subsequent diagnosis of hyponatremia secondary to psychogenic polydipsia was made. Hyponatremia correction therapy was started, and the patient was admitted to the intensive care unit. After the hyponatremia correction, the patient presented with analytical worsening, showing marked rhabdomyolysis with a creatine phosphokinase level of 44.058UI/L on day 3 of hospitalization. The condition showed a subsequent progressive improvement with therapy, with no occurrence of kidney damage. This case stresses the need for monitoring rhabdomyolysis markers in severe hyponatremia, illustrating the condition of rhabdomyolysis secondary to hyponatremia induced by psychogenic polydipsia, which should be considered in patients undergoing treatment with neuroleptics.

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Background: Diabetes insipidus (DI) is a rare endocrine disorder in dogs altering the mechanism of retention and excretion of water, with concomitant polyuria and polydipsia (PU/PD), and low urine specific gravity. The water deprivation test followed by response to application of desmopressin is the diagnostic test for the disease. However, the literature is still scarce about laboratorial and clinical aspects of DI in small animals. Thus, the aim of this study is to report a case of DI in a canine, emphasizing its diagnosis through the water deprivation test. Case: A male mongrel dog, 5 years-old, not neutered, 13kg of body weight, was presented with intense PU/PD (500mL/kg/day of water consumption). Physical examination showed normal routine clinical parameters. Additional tests were asked (abdominal ultrasound, blood count, serum biochemical (creatinine, alanine aminotransferase (ALT), total cholesterol, alkaline phosphatase (ALP) and glucose) and dexamethasone suppression test), but they showed no significant changes. Thus, it was suspected that the animal had an uncommon endocrinopathy, DI. For its confirmation, it was made the water deprivation test with application of desmopressin acetate. The patient remained without access to water and without fluidtherapy with urethral sounding and bladder emptying. The measurement of urinary gravity and volume were made every hour for 12 h. After 8 h from the start of the test, it was made the application of desmopressin acetate (three drops in the conjunctival sac), because the animal began to exhibit tremors and muscle weakness (urine specific gravity: 1005). In this period, their body weight decreased 11.6%. After application of desmopressin, urine specific gravity increased gradually every hour, ending with urine specific gravity measurements of 1023, confirming the diagnosis of central DI. Discussion: The diagnosis of DI can be a challenge to the veterinary practitioner since it is a rare disease in small animals, and often is not included in the differential diagnoses. Furthermore, additional tests such as common hematological, biochemical and electrolyte profiles usually have normal results, or secondary influences of dehydration. The water deprivation test confirms the inability of the animal to concentrate urine in DI. However, this test is potentially dangerous because of the serious consequences of dehydration, requiring constant monitoring. In DI of central origin (DIC), the urinary concentration usually starts 1 to 3 h after administration of desmopressin acetate, and tends to be within the normal reference value, as can be observed in this case. Because there were not neurological signs, the final diagnosis of the animal was acquired DIC. DIC is acquired by the destruction of cells of supraoptic and paraventricular nuclei of the hypothalamus, or even, loss of the ducts that carry the anti-diuretic hormone (ADH) by the pituitary for secretion and storage. Desmopressin acetate (dDAVP), a synthetic analogue of vasopressin, was used for the initial treatment (three drops in the conjunctival sac, once a day) which controlled the PU/PD of the animal. After four months of treatment initiation, the animal has moved to a drop of the drug, twice a day. The dog of the present case has reported good prognosis, since small animals with acquired DIC become relatively asymptomatic in response to appropriate therapy.

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La diabetes insípida es una rara entidad, que se caracteriza por la incapacidad total o parcial del riñón para concentrar la orina. El objetivo del presente trabajo es analizar las características clínico-epidemiológicas de los pacientes con diagnóstico de diabetes insípida, desde agosto de 1985 hasta enero de 2011. Se realizó un estudio descriptivo y transversal con 22 pacientes. Se revisaron las historias clínicas y se recogieron los siguientes datos: edad del debut, signos y síntomas predominantes, sexo, raza, peso, talla, estado nutricional y complicaciones. El grupo de edad más afectado fue el de cero a cuatro años, con predominio masculino y de la raza blanca, para ambos sexos. La desnutrición predominó en toda la muestra con mayor incidencia en la forma nefrogénica. La poliuria, polidipsia, pérdida de peso y la fiebre prolongada, por ese orden, fueron los síntomas más frecuentes al debut, con mayor afectación en los casos con la forma nefrogénica. La diabetes insípida aparece a edades tempranas de la vida y predomina en la raza blanca con afectación del estado nutricional (AU)

La diabetes insípida es una rara entidad, que se caracteriza por la incapacidad total o parcial del riñón para concentrar la orina. El objetivo del presente trabajo es analizar las características clínico-epidemiológicas de los pacientes con diagnóstico de diabetes insípida, desde agosto de 1985 hasta enero de 2011. Se realizó un estudio descriptivo y transversal con 22 pacientes. Se revisaron las historias clínicas y se recogieron los siguientes datos: edad del debut, signos y síntomas predominantes, sexo, raza, peso, talla, estado nutricional y complicaciones. El grupo de edad más afectado fue el de cero a cuatro años, con predominio masculino y de la raza blanca, para ambos sexos. La desnutrición predominó en toda la muestra con mayor incidencia en la forma nefrogénica. La poliuria, polidipsia, pérdida de peso y la fiebre prolongada, por ese orden, fueron los síntomas más frecuentes al debut, con mayor afectación en los casos con la forma nefrogénica. La diabetes insípida aparece a edades tempranas de la vida y predomina en la raza blanca con afectación del estado nutricional (AU)

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La diabetes insípida es una rara entidad, que se caracteriza por la incapacidad total o parcial del riñón para concentrar la orina. El objetivo del presente trabajo es analizar las características clínico-epidemiológicas de los pacientes con diagnóstico de diabetes insípida, desde agosto de 1985 hasta enero de 2011. Se realizó un estudio descriptivo y transversal con 22 pacientes. Se revisaron las historias clínicas y se recogieron los siguientes datos: edad del debut, signos y síntomas predominantes, sexo, raza, peso, talla, estado nutricional y complicaciones. El grupo de edad más afectado fue el de cero a cuatro años, con predominio masculino y de la raza blanca, para ambos sexos. La desnutrición predominó en toda la muestra con mayor incidencia en la forma nefrogénica. La poliuria, polidipsia, pérdida de peso y la fiebre prolongada, por ese orden, fueron los síntomas más frecuentes al debut, con mayor afectación en los casos con la forma nefrogénica. La diabetes insípida aparece a edades tempranas de la vida y predomina en la raza blanca con afectación del estado nutricional (AU)

Insipidus diabetes is a rare condition characterized by the total or partial inability of the kidney to concentrate urine. The aim of this work is to analyze the clinic- epidemiological characteristics of patients with a diagnosis of insipidus diabetes in the period from August 1985 to January 2011. A descriptive and cross-sectional study was carried out on 22 patients. The health histories of these patients were revised and data such as: age at the onset of the illness, predominant signs and symptoms, sex, race, weight, height, nutritional state and complications were summarized. The most affected age group was that from 0 to 4 years old with prevalence of the masculine sex and the white race in both sexes. Malnutrition prevailed in the whole sample with more incidences in the nephrogenic form. Polyuria, polydipsia, loss of weight and prolonged fever, in that order, were the most frequent symptoms at the onset of the illness, with more affectation in the cases with the nephrogenic form. Insipidus diabetes appears in the early stages of life and it prevails in the white race affecting the nutritional state (AU)

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Two four-year-old male Brasileiro de Hipismo breed horses presenting signs of polyuria-polydipsia, were submitted to a complete clinical evaluation as well as having blood and urine samples collected for laboratory analysis. No clinical, hematological or biochemical abnormalities were observed, but a significant decrease in urine specific gravity was detected in both horses. One of the horses presented 1,009 and the other 1,008. A 24-hour water deprivation test was carried out and, during this period, the urine specific gravity gradually increased reaching the normal values of 1,028 and 1,026. The abnormal behavior occured as a consequence of an excessive confinement. The clinical and laboratory results associated to the 24-hour water deprivation test indicated a diagnosis of psychogenic polydipsia.

Dois eqüinos da raça Brasileira de Hipismo, machos, quatro anos de idade, apresentando sinais de poliúria-polidipsia, foram submetidos a completa avaliação clínica e a exames de sangue e urina. Não foram observadas alterações clínicas, hematológicas ou bioquímicas, a não ser um decréscimo na gravidade específica da urina de ambos os animais (1,009 e 1,008). Realizou-se um teste de privação de água de 24 horas e durante esse período a gravidade especifica da urina subiu gradualmente até atingir a normalidade (1,028 e 1,026, respectivamente). O comportamento anormal ocorreu por confinamento excessivo. Os resultados clínicos e de laboratório e o teste de privação de água indicam o diagnóstico de polidipsia psicogênica.