I am not aware of nocturnal urinary bladder control being associated with the pituitary gland. You might ask the urologist or your son’s primary care physician to elaborate on that. As noted in abstract below there are reports of an association between ADHD and bed wetting at night and both associated with brainstem inhibition deficit, as noted below.
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Authors
Full Name Dieter Baeyens,* Herbert Roeyers, Piet Hoebeke, Inge Antrop,
Rainer Mauel and Johan Vande Walle
Institution Department of Psychology, Developmental Disorders, Ghent University
(DB, HR, IA) and Pediatric Uro/Nephrological Center, Ghent University
Hospital (DB, PH, RM, JVW), Ghent, Belgium
Title The Impact of Attention Deficit Hyperactivity
Disorders on Brainstem Dysfunction in Nocturnal Enuresis
Purpose In a specialized university setting the prevalence of attention deficit hyperactivity disorder in general and particularly the inattentive subtype attention deficit hyperactivity disorder of the predominantly inattentive subtype is highly increased. We replicated previous research findings that enuresis is associated with a brainstem deficit and investigated the impact of attention deficit hyperactivity disorder on this brainstem deficit in enuresis.
Materials and Methods Electromyography recorded startle eye blink modification with and without attentional modulation was used to measure brainstem functioning in 158 children between 6 and 12 years old. Performance in 3 enuresis groups, including children with enuresis, enuresis plus attention deficit hyperactivity disorder of the predominantly inattentive subtype and enuresis plus attention deficit hyperactivity disorder combined, respectively, was compared with that in normally developing controls and in children with attention deficit hyperactivity disorder subtypes without enuresis.
Results In an automatic attentional task the enuresis groups showed decreased brainstem inhibition compared to that in the control and attention deficit hyperactivity disorder groups (p _0.006). In a controlled attentional task children with and without enuresis who had attention deficit hyperactivity disorder of the predominantly inattentive subtype were unable to show attentional modulation in all age groups (p _0.02).
Conclusions Startle eye blink modification research reveals a brainstem inhibition deficit in children with enuresis, which could explain why they are unable to remain dry at night. When additional attention is allocated to specific trials in the task, children with attention deficit hyperactivity disorder of the predominantly inattentive subtype fail to optimize sensory gating. With respect to enuresis, this could result in an identification problem of bladder signals, leading to an inadequate or absent arousal effect in attention deficit hyperactivity disorder of the predominantly inattentive subtype.
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Some urologists are prone to function on bed wetting as a mechanical bladder dysfunction disorder, and it can be. But emotional health and emotions can also play a role and I would suggest that you seek a second opinion, if possible with a pediatric urologist who has a close working relationship with psychologists, also interested in the bed wetting problem. You would be most likely to find such a team at a university medical center.
It is a little surprising that the sleep study was normal in the presence of marked nasal obstruction. It is possible to have disturbed/abnormal sleep, in the absence of airway obstruction and if his sleep was at all abnormal, but not obstructive, that too could conceivably have an impact on bladder control. In this regard, there are reports that surgical removal of tonsils and adenoids can result in much better nocturnal bladder control, as has treatment of obstructive sleep apnea. It is unfortunate that this outcome was not achieved with your son’s adeno-tonsillectomy.
Nasal polyps can become very large and obstruct. When they do the explanation offered by your son’s allergist is very likely to be the case. In that circumstance, shrinkage of the polyps can sometimes be accomplished with short-term, high dose oral steroid administration, but in some situations surgical removal of the polyps may be necessary.
I would not rely upon or wait on immunotherapy to provide the answer to either his respiratory symptoms or the bed wetting.
Finally, the enlargement of his neck nodes is definitely not normal. You should ask his doctors if further studies should be done to determine the cause of this glandular enlargement that may or may not be related to his respiratory symptoms.
Good luck.
