糖皮质激素显露隐性中枢性尿崩症:3例病例分析合并文献复习

发布时间：2019-07-20 06:35

【摘要】：目的:提高临床医师对隐性中枢性尿崩症的认识。方法:对3例腺垂体功能减退使用糖皮质激素后出现尿崩症的患者进行病例分析,同时查询中国知网、维普以及Pub Med等中英文数据库,找到相关病例,总结其临床特点。结果:3例患者均存在HPA轴、甲状腺轴以及性腺轴功能减退,给予糖皮质激素替代后,均出现尿量、血钠、血氯、血渗透压明显升高,尿比密明显下降,其中2例完成禁水加压素试验,尿渗透压较推药前上升超过9%,另1例给予醋酸去氨加压素后尿量明显减少。同时,通过文献检索发现了9篇相关病例报道,并就各自临床特点进行了汇总。结论:隐性中枢性尿崩症在临床上较为罕见,典型症状因为糖皮质激素缺乏而被隐藏,当腺垂体功能减退患者在给予糖皮质激素治疗后若出现明显多尿以及低比重尿时,应考虑合并中枢性尿崩症。
[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.
【作者单位】：重庆医科大学附属第一医院内分泌内科;
【基金】：国家临床重点专科建设资助项目(编号:财社[2011]170号)
【分类号】：R584.3

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