【摘要】：目的:提高臨床醫(yī)師對隱性中樞性尿崩癥的認識。方法:對3例腺垂體功能減退使用糖皮質激素后出現尿崩癥的患者進行病例分析,同時查詢中國知網、維普以及Pub Med等中英文數據庫,找到相關病例,總結其臨床特點。結果:3例患者均存在HPA軸、甲狀腺軸以及性腺軸功能減退,給予糖皮質激素替代后,均出現尿量、血鈉、血氯、血滲透壓明顯升高,尿比密明顯下降,其中2例完成禁水加壓素試驗,尿滲透壓較推藥前上升超過9%,另1例給予醋酸去氨加壓素后尿量明顯減少。同時,通過文獻檢索發(fā)現了9篇相關病例報道,并就各自臨床特點進行了匯總。結論:隱性中樞性尿崩癥在臨床上較為罕見,典型癥狀因為糖皮質激素缺乏而被隱藏,當腺垂體功能減退患者在給予糖皮質激素治療后若出現明顯多尿以及低比重尿時,應考慮合并中樞性尿崩癥。
[Abstract]:Objective: to improve clinicians' understanding of occult central diabetes insipidus. Methods: the cases of diabetes insipidus after the use of glucocorticoid in 3 patients with hypophysis were analyzed. At the same time, the Chinese knowledge network, Weipu and Pub Med were queried to find the relevant cases and summarize their clinical characteristics. Results: the function of HPA axis, thyroid axis and gonadal axis decreased in all 3 patients. after glucocorticoid replacement, urine volume, blood sodium, blood chlorine, blood osmotic pressure and urine specific density decreased significantly. Among them, 2 cases completed water-free vasopressin test, urine osmotic pressure increased by more than 9% compared with that before administration, and urine volume decreased significantly after administration of deaminopressin acetate. At the same time, 9 related case reports were found through literature retrieval, and their clinical characteristics were summarized. Conclusion: occult central diabetes insipidus is rare in clinic, and the typical symptoms are hidden because of glucocorticoid deficiency. When patients with hypophysis have obvious polyuria and low specific gravity urine after glucocorticoid treatment, central diabetes insipidus should be considered.
【作者單位】： 重慶醫(yī)科大學附屬第一醫(yī)院內分泌內科;
【基金】：國家臨床重點�？平ㄔO資助項目(編號:財社[2011]170號)
【分類號】：R584.3

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