腺性尿崩症患者非渗透性精氨酸加压素分泌保留导致的低钠血症:病例报告与文献综述。

IF 1.3 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
Endocrine journal Pub Date : 2024-11-01 Epub Date: 2024-08-07 DOI:10.1507/endocrj.EJ23-0643
Yasufumi Seki, Shun Sugawara, Saya Suzuki, Yulia Minakuchi, Kazuhisa Kusuki, Yuzo Mizuno
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引用次数: 0

摘要

阿糖尿(ADI)的特点是中枢性糖尿病和对高渗性的口渴反应受损,从而导致高钠血症。在ADI患者中观察到的低钠血症一直被认为是去氨加压素治疗的并发症。在此,我们介绍了一例在未接受去氨加压素治疗的情况下出现口渴感觉和精氨酸血管加压素(AVP)分泌受损的病例,该病例由于保留了非渗透性 AVP 分泌而出现了低钠血症。一名 53 岁的妇女患有垂体功能减退症,正在接受氢化可的松和左旋甲状腺素治疗,在未接受去氨加压素治疗的情况下,5 个月内出现了 3 次低钠血症。第一次低钠血症发作(120 mEq/L)因尿路感染并发,血浆 AVP 水平为 33.8 pg/mL。随后的低钠血症发作发生在服用抗精神病药后(124 mEq/L)和自发性低钠血症发作(125 mEq/L),血浆 AVP 水平未受抑制(分别为 1.3 和 1.8 pg/mL)。输注高渗盐水不会影响 AVP 或 copeptin 水平。在不使用去氨加压素的情况下,使用基于体重的滑动量表调节水摄入量可防止低钠血症复发。除感染期间外,血浆 AVP 水平(1.3 ± 0.4 pg/mL)与血清钠水平无明显相关性(rs = -0.04,p = 0.85)。总之,我们介绍了一例独特的口渴感觉和 AVP 分泌受损的病例,该病例在未接受去氨加压素治疗的情况下出现了低钠血症。保留的非渗透性 AVP 分泌可能受到糖皮质激素缺乏的刺激,从而导致 ADI 患者出现低钠血症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hyponatremia due to preserved non-osmotic arginine vasopressin secretion in adipsic diabetes insipidus: a case report with review of literature.

Adipsic diabetes insipidus (ADI) is characterized by central diabetes insipidus and an impaired thirst response to hyperosmolality, leading to hypernatremia. Hyponatremia observed in patients with ADI has been considered a complication of desmopressin therapy. Herein, we present a case of impaired thirst sensation and arginine vasopressin (AVP) secretion without desmopressin therapy, in which hyponatremia developed due to preserved non-osmotic AVP secretion. A 53-year-old woman with hypopituitarism, receiving hydrocortisone and levothyroxine, experienced hyponatremia three times over 5 months without desmopressin treatment. The first hyponatremic episode (120 mEq/L) was complicated by a urinary tract infection with a plasma AVP level of 33.8 pg/mL. Subsequent hyponatremia episodes occurred after administration of antipsychotic (124 mEq/L) and spontaneously (125 mEq/L) with unsuppressed plasma AVP levels (1.3 and 1.8 pg/mL, respectively). Hypertonic saline infusion did not affect AVP or copeptin levels. Regulating water intake using a sliding scale based on body weight prevented the recurrence of hyponatremia without the use of desmopressin. Except during infection, plasma AVP levels (1.3 ± 0.4 pg/mL) were not significantly correlated with serum sodium levels (rs = -0.04, p = 0.85). In conclusion, we present a unique case of impaired thirst sensation and AVP secretion in which hyponatremia developed without desmopressin therapy. Preserved non-osmotic AVP secretion, possibly stimulated by glucocorticoid deficiency, may contribute to the development of hyponatremia in patients with ADI.

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来源期刊
Endocrine journal
Endocrine journal 医学-内分泌学与代谢
CiteScore
4.30
自引率
5.00%
发文量
224
审稿时长
1.5 months
期刊介绍: Endocrine Journal is an open access, peer-reviewed online journal with a long history. This journal publishes peer-reviewed research articles in multifaceted fields of basic, translational and clinical endocrinology. Endocrine Journal provides a chance to exchange your ideas, concepts and scientific observations in any area of recent endocrinology. Manuscripts may be submitted as Original Articles, Notes, Rapid Communications or Review Articles. We have a rapid reviewing and editorial decision system and pay a special attention to our quick, truly scientific and frequently-citable publication. Please go through the link for author guideline.
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