Ochsner Journal最新文献

{"title":"Recurrent Seizure-Like Events in a Toddler With BMPR2-Related Pulmonary Arterial Hypertension.","authors":"Nur Sena Cagatay, Neha Ahluwalia, Aimee Luat","doi":"10.31486/toj.25.0109","DOIUrl":"10.31486/toj.25.0109","url":null,"abstract":"<p><strong>Background: </strong>Seizure-like episodes are common in children, but many spells are not true epileptic seizures. Cardiac or pulmonary conditions such as pulmonary arterial hypertension can be the cause of the seizure-like episodes, particularly when the events persist despite administration of antiseizure medications.</p><p><strong>Case report: </strong>A 2-year-old male presented with recurrent seizure-like episodes that persisted despite administration of 2 antiseizure medications. Spells consisted of a sudden collapse followed by body jerking. Electroencephalogram and brain imaging were normal. Given the atypical features and lack of medication response, a cardiology evaluation was pursued. Echocardiography revealed severe pulmonary arterial hypertension with markedly elevated right heart pressures. Genetic testing confirmed the presence of a pathogenic bone morphogenetic protein receptor type 2 (BMPR2) gene. Despite initiation of sildenafil, bosentan, and prostacyclin therapy, the patient's condition worsened with recurrent syncopal and cyanotic episodes. He suffered a cardiac arrest requiring prolonged resuscitation and extracorporeal membrane oxygenation support, complicated by hypoxic-ischemic encephalopathy and multiorgan failure. Following discussions with the family, care was redirected to comfort measures, and the patient died.</p><p><strong>Conclusion: </strong>This case illustrates how pulmonary arterial hypertension may mimic drug-resistant epilepsy. Rather than seizures, the patient's events were syncope resulting from decreased cerebral perfusion caused by low cardiac output. BMPR2 mutations are the most common genetic cause of heritable pulmonary arterial hypertension and are associated with earlier onset, more severe disease, and poor response to therapy compared to pulmonary arterial hypertension without BMPR2 mutations. To our knowledge, this case is the first report of BMPR2-related pulmonary arterial hypertension initially presenting as seizure-like episodes in a child. Children with atypical presentations should be evaluated for cardiopulmonary causes. Early recognition of pulmonary arterial hypertension is essential, as delayed diagnosis limits treatment opportunities.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"179-182"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revumenib-Induced QTc Prolongation Leading to Multiple Episodes of Torsades de Pointes and Ventricular Arrhythmias.","authors":"Casey L Keller, Kristina C Hermanson, John C Tawwater, Ryan M Schuller, Diane J St Pierre, Harris V Naina, Saeed K Alzghari","doi":"10.31486/toj.25.0100","DOIUrl":"10.31486/toj.25.0100","url":null,"abstract":"<p><strong>Background: </strong>Revumenib is the only oral menin inhibitor approved for the treatment of relapsed/refractory acute leukemia with menin-lysine methyltransferase 2A (KMT2A) rearrangement in adults and pediatric patients aged >1 year. Revumenib was granted US Food and Drug Administration approval under the accelerated approval pathway, receiving both breakthrough therapy and orphan drug designations because of its potential to address a significant unmet need for patients with relapsed/refractory acute leukemia with a KMT2A translocation. While revumenib has no absolute contraindications, the package insert carries warnings, including the risk of corrected QT (QTc) prolongation.</p><p><strong>Case report: </strong>A 76-year-old male with relapsed/refractory acute myeloid leukemia received revumenib after exhausting all other treatment options because of failure or intolerance. During treatment, the patient experienced multiple episodes of torsades de pointes and ventricular arrhythmias. Given the gravity of the patient's disease and the lack of alternative therapeutic options beyond hospice, a multidisciplinary team implemented aggressive measures to mitigate arrhythmic risk: placement of a permanent pacemaker following the initial torsades de pointes episode, meticulous electrolyte management, medication adjustments to limit QTc prolongation and drug-drug interactions, and use of a wearable cardioverter defibrillator. Despite a subsequent episode of torsades de pointes, the patient continued revumenib for an additional 29 days without further arrhythmias until discontinuation because of worsening acute myeloid leukemia shown by bone marrow biopsy.</p><p><strong>Conclusion: </strong>Although current guidance recommends discontinuation of revumenib in the setting of life-threatening arrhythmias, this case highlights the importance of individualized risk-benefit assessment and supportive strategies when treatment is pursued as a last resort.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"167-172"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Obesity, Overweight, and Attempted Weight Loss Among United States High School Students.","authors":"Jack Yang, Emily Krill, Cheila Llorens, Alan Kunz-Lomelin, Charles H Hennekens, Panagiota Kitsantas","doi":"10.31486/toj.25.0111","DOIUrl":"10.31486/toj.25.0111","url":null,"abstract":"<p><strong>Background: </strong>In the United States (US), obesity and overweight among adolescents present growing clinical and public health challenges. In this study, we examined trends in obesity, overweight, and attempted weight loss in a national sample of US adolescents.</p><p><strong>Methods: </strong>Data from the 2013 to 2023 Youth Risk Behavior Survey (YRBS) were used to explore these issues in a large sample of US high school students. Percentages were used as effect measures, and 95% confidence intervals were used to test statistical significance. Overall data are presented, as well as subgroup analyses by sex, race/ethnicity, and grade level.</p><p><strong>Results: </strong>Between 2013 and 2023, obesity rates increased from 13.7% to 15.9% (<i>P</i><0.01), with the highest rates among Black and Hispanic/Latino adolescents and the lowest rate among Asian adolescents. In contrast, the percentage of overweight US high school students declined significantly from 16.6% to 14.7% (<i>P</i><0.01), with a more notable decrease among male adolescents compared to female adolescents. The overall percentage of adolescents engaging in weight loss efforts declined from 47.7% in 2013 to 44.5% in 2023 (<i>P</i><0.01). Declines were most notable among 10th and 12th graders. Female high school students reported higher rates of weight loss attempts than males.</p><p><strong>Conclusion: </strong>Data from the YRBS showed significant increases in obesity, declines in overweight, and fewer adolescents trying to lose weight. Although further research is necessary, these findings underscore the need for targeted clinical and public health strategies to reduce rising obesity rates and promote healthy behaviors among US high school students.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"9-15"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Student Screening of Social Determinants of Health in Urogynecology Surgical Patients.","authors":"Isabel K Anderson, Erin Biggs, Meenakshi Mishra, Hannah H Jordan, Leise R Knoepp","doi":"10.31486/toj.25.0096","DOIUrl":"10.31486/toj.25.0096","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence documents the impacts that social determinants of health (SDoH) can have on medical and surgical outcomes, but many physicians report lacking the time to screen and address patients' SDoH. This gap creates an opportunity for medical students to apply their knowledge of SDoH in a clinical setting, actively participate as members of the medical team, and address a critical aspect of patient care.</p><p><strong>Methods: </strong>In a pilot project, medical students rotating on the urogynecology surgical service were tasked with calling patients the day prior to their surgical encounter and asking them SDoH screening questions. To evaluate the completion of SDoH screening by medical students, a data analysis team determined if medical students added or updated patients' SDoH data in the medical record within 72 hours preoperatively or by 24 hours postoperatively.</p><p><strong>Results: </strong>Between May 21 and October 31, 2024, 18 medical students screened 44 patients for social risk factors. Excluding tobacco use and transportation needs screening, medical students conducted at least 90% of the SDoH screenings for these patients.</p><p><strong>Conclusion: </strong>This project demonstrates that medical students are a resource that can be used to increase the rates of patient SDoH screening, particularly for factors that are not routinely screened. In addition, this project demonstrates how SDoH screening can be efficiently implemented on a busy surgical service without interrupting patient flow.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"16-22"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of the iStent infinite Trabecular Micro-Bypass Device for Glaucoma: A Systematic Review and Meta-Analysis.","authors":"Ryan Fischer, Christopher Duncombe, Chinwendu Okolie, Lily Caglianone","doi":"10.31486/toj.26.0015","DOIUrl":"10.31486/toj.26.0015","url":null,"abstract":"<p><strong>Background: </strong>The iStent infinite (Glaukos Corporation) is a third-generation trabecular micro-bypass device approved for stand-alone use in patients with inadequately controlled open-angle glaucoma, but overall efficacy and safety estimates have not been quantitatively synthesized via meta-analysis. Our objective was to evaluate the 12-month efficacy and safety of iStent infinite device implantation by examining intraocular pressure reduction and glaucoma medication reduction.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines after registering the review protocol with the International Prospective Register of Systematic Reviews (PROSPERO). We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception through November 2025 for studies reporting 12-month outcomes after iStent infinite device implantation (stand-alone or combined with phacoemulsification). Pooled mean changes in intraocular pressure and medications were calculated, heterogeneity was assessed with I², and surgical approach (stand-alone vs combined with phacoemulsification) was evaluated via meta-regression.</p><p><strong>Results: </strong>Three nonrandomized studies comprising 199 eyes with 12-month follow-up were included. The pooled mean intraocular pressure reduction at 12 months was 4.48 mm Hg (95% CI 3.04 to 5.92; <i>P</i><0.0001) with high heterogeneity (I²=83.4%). Meta-regression showed greater intraocular pressure reduction with stand-alone implantation vs phacoemulsification-combined procedures (an additional 2.16 mm Hg; 95% CI 0.52 to 3.81; <i>P</i>=0.010), explaining 88.4% of heterogeneity. The pooled mean reduction in glaucoma medications was 0.48 (95% CI 0.29 to 0.67; <i>P</i><0.0001) with moderate heterogeneity (I²=45.0%) and no significant difference by surgical approach (<i>P</i>=0.65).</p><p><strong>Conclusion: </strong>iStent infinite device implantation was associated with clinically meaningful 12-month reductions in intraocular pressure, a modest reduction in medication burden, and a favorable short-term safety profile.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"227-236"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial Carcinoma Unveiling Breast Carcinoma in a Postmenopausal Female: A Case of Synchronous Malignancy.","authors":"Kalyan Chakradhar Polavarapu, Mada Pooja, Renuka Sri Sai Peddireddi, Suresh K Alahari","doi":"10.31486/toj.25.0116","DOIUrl":"10.31486/toj.25.0116","url":null,"abstract":"<p><strong>Background: </strong>The ability to detect multiple primary malignancies in a single patient has improved because of modern cancer screening and imaging technologies. While both endometrial and breast carcinomas are common in postmenopausal women, concomitant presentation is uncommon.</p><p><strong>Case report: </strong>A 61-year-old postmenopausal female initially presented with abdominal pain and postmenopausal bleeding. Positron emission tomography/computed tomography revealed fluorodeoxyglucose-avid lesions in the left breast and axilla, although mammography showed Breast Imaging Reporting and Data System category 1. Clinical breast and axillary examinations were unremarkable. Immunohistochemistry demonstrated GATA binding protein 3 and human epidermal growth factor receptor 2 positivity in the axillary lymph nodes, suggestive of breast carcinoma, while positivity for paired box gene 8, estrogen receptors, and progesterone receptors supported an endometrial tumor. Genetic testing panel results were negative. After undergoing neoadjuvant chemotherapy, the patient had marked regression in the endometrial lesion and a pathologic complete response in the breast lesion.</p><p><strong>Conclusion: </strong>Because of the infrequency and clinical complexity associated with synchronous malignancies, this case highlights the importance of a multidisciplinary approach, advanced imaging, and molecular profiling for accurate diagnosis and personalized treatment planning.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"256-261"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Cost 3D-Printed Temporal Bone Models for Surgical Simulation: A Pilot Study.","authors":"Kaitlyn Tholen, Colin Curtis, Korak Sarkar, Gauri Mankekar","doi":"10.31486/toj.26.0035","DOIUrl":"10.31486/toj.26.0035","url":null,"abstract":"<p><strong>Background: </strong>Surgical simulation requires realistic models for proper surgical preparation. To address the scarcity, storage complexity, and cost of cadaver specimens, alternative approaches such as three-dimensional (3D)-printed models have been developed, but 3D-printed models can be expensive and require specialized equipment and expertise. We developed and tested 3D-printed temporal bone models made with accessible, affordable materials and evaluated their use as training replacements.</p><p><strong>Methods: </strong>Using computed tomography scans of 1 adult patient and 1 pediatric patient, we 3D-printed 4 adult and 4 pediatric temporal bone models with the following materials: acrylonitrile butadiene styrene, polylactic acid, high-impact polystyrene, and Formlabs white resin (Formlabs Inc). Eight otolaryngology residents with prior experience with temporal bone drilling participated in the study. Residents were randomized to either an adult or pediatric bone and blinded to the 3D-print material used. Immediately after drilling the 3D models, the participants completed an 8-item Likert scale questionnaire that evaluated the value, ease of use, safety, and similarity of the 3D-printed temporal bones compared to cadaver temporal bones.</p><p><strong>Results: </strong>Residents rated the models as similar to cadaver bones in terms of training value but rated the bony anatomy of the models as suboptimal, specifically the mastoid air cells and dust from drilling. Statistical analysis found no significant differences across materials or residency levels (<i>P</i>>0.05). The total cost of the materials was $33.88 (US dollars), with pediatric models ranging from $2.58 to $3.03 and adult models ranging from $4.42 to $8.19.</p><p><strong>Conclusion: </strong>With improvements to the bony anatomy of our models and further optimization of the low-cost materials to improve haptic realism, 3D-printed temporal bones may provide comparable training alternatives to cadaver bones that are less costly per model and require no costly storage. Future studies should evaluate 3D-printed temporal bone models in larger within-subject cohorts and assess cost-effectiveness to determine their value relative to cadaver specimens.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"205-213"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excessive Ingestion of Almond Milk Causes Severe Hypercalcemia and Acute Kidney Injury in a Patient With Chronic Kidney Disease.","authors":"Ahmad Bouhuwaish, Elgassi Ehnisch, Ahmed Abdullah Husayn Arhaym, Muner M B Mohamed, Juan Carlos Q Velez","doi":"10.31486/toj.24.0067","DOIUrl":"10.31486/toj.24.0067","url":null,"abstract":"<p><strong>Background: </strong>Almond milk has a higher calcium content than cow's milk. Hypercalcemia after consuming almond milk has been reported in infants, but to our knowledge, we report the first case of almond milk-induced severe hypercalcemia in an adult.</p><p><strong>Case report: </strong>A 66-year-old male with a history of diabetes and chronic kidney disease was referred to the emergency department because of laboratory results that showed severe hypercalcemia and acutely elevated serum creatinine. The family member who brought the patient to the hospital reported that he had displayed intermittent confusion. History revealed that 4 weeks prior, the patient had stopped his habit of consuming a gallon of cow's milk every day because of hyperglycemia. He switched to consuming a gallon of unsweetened almond milk every day, leading to severe hypercalcemia. Other causes of hypercalcemia were ruled out. Treatment with intravenous fluids and calcitonin normalized the patient's serum calcium level and improved his kidney function.</p><p><strong>Conclusion: </strong>The consumption of almond milk in large quantities is associated with the potential risk of hypercalcemia, especially in patients with chronic kidney disease. Careful consideration of the mineral content is recommended.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"64-66"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Machine Learning to Identify Geographic and Socioeconomic Disparities in Dialysis Facility Outcomes Across the United States.","authors":"Ziad M Ashkar, Raju Gottumukkala","doi":"10.31486/toj.25.0040","DOIUrl":"10.31486/toj.25.0040","url":null,"abstract":"<p><strong>Background: </strong>Despite progress in dialysis care, the patient outcomes of mortality, hospitalization, and readmission rates remain unsatisfactory because of complex clinical, demographic, and socioeconomic interactions. For this study, we used unsupervised machine learning to identify clusters of dialysis facilities based on quality metrics and sociodemographic factors, with attention to racial and geographic disparities.</p><p><strong>Methods: </strong>We sourced facility-level data from data.cms.gov and sourced ZIP Code Tabulation Area-level sociodemographic data from the 2021 American Community Survey via the US Census Bureau application programming interface. Datasets were linked by ZIP code, standardized, and analyzed using principal component analysis and k-means clustering. We examined geographic patterns by US Census Bureau regions. Analyses were conducted in Python version 3.11.6 (Python Software Foundation) with the following libraries: pandas for data manipulation, scikit-learn for machine learning and principal component analysis, Matplotlib and Seaborn for data visualization, and GeoPandas for geographic mapping and spatial analysis.</p><p><strong>Results: </strong>Two facility clusters emerged: Cluster 0 (n=4,609) and Cluster 1 (n=2,857). Cluster 1 was characterized by poorer outcomes (higher mortality, hospitalization, readmission, anemia, catheter use, and hyperphosphatemia); lower rates of fistula use; and lower dialysis adequacy compared to Cluster 0. Cluster 1 facilities were more prevalent in regions with lower income, higher unemployment, and lower college education, and they served populations with greater proportions of Black and Hispanic residents. Geographically, Cluster 1 facilities were concentrated in the southern and western United States. Compared to Cluster 0, a larger share of Cluster 1 facilities were for-profit facilities (91.4% vs 88.5%).</p><p><strong>Conclusion: </strong>This study highlights a distinct cluster of underperforming dialysis clinics serving socioeconomically disadvantaged and racially diverse populations. Addressing these disparities requires multifaceted strategies including patient-level, institutional, and policy-level interventions.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"170-180"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Arginine Vasopressin Deficiency With Mild and Reversible Hypercalcemia.","authors":"Aayush Malik, Alpesh Goyal, Rahul Gupta, Abhinav Bhagat","doi":"10.31486/toj.24.0089","DOIUrl":"10.31486/toj.24.0089","url":null,"abstract":"<p><strong>Background: </strong>Arginine vasopressin deficiency (central diabetes insipidus) results from impaired hypothalamic-neurohypophyseal secretion of arginine vasopressin and leads to hypotonic polyuria and polydipsia. Common causes of arginine vasopressin deficiency include head trauma, pituitary surgery, neoplasms, and inflammatory stalk lesions; however, 25% to 50% of cases are idiopathic. Hypercalcemia can result in arginine vasopressin resistance (nephrogenic diabetes insipidus) and is an important differential in the evaluation of patients with hypotonic polyuria-polydipsia syndrome.</p><p><strong>Case report: </strong>A 32-year-old male presented with polyuria (24-hour urine output of 144 mL/kg), polydipsia (24-hour fluid intake of 130 mL/kg), and nocturia of 6 months' duration. Baseline investigations revealed normal liver, renal, serum potassium, and blood glucose levels. After overnight dehydration, serum osmolality increased to 317 mOsm/kg, while urine osmolality remained inappropriately low at 156 mOsm/kg. Mild hypercalcemia (serum calcium of 11.1 mg/dL) was noted. Upon arginine vasopressin challenge, urine osmolality increased by nearly 300%, suggesting complete arginine vasopressin deficiency. Evaluation for secondary causes was unremarkable. Magnetic resonance imaging of the pituitary revealed a normal anterior pituitary and pituitary stalk with an absent posterior pituitary bright spot. Idiopathic arginine vasopressin deficiency was diagnosed. The patient responded to oral desmopressin replacement, and normocalcemia was documented in multiple samples repeated when the patient was in a hydrated state.</p><p><strong>Conclusion: </strong>Patients with arginine vasopressin deficiency can manifest concomitant mild and reversible dehydration-related hypercalcemia. A brisk increase in urine osmolality following subcutaneous arginine vasopressin injection and normal serum calcium levels after desmopressin therapy can establish that hypercalcemia is the effect and not the cause of the primary disorder.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"67-72"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}