Adipsic Diabetes Insipidus In The Classification Of Craniopharyngiomas Based On The Tumour Location And Growth Pattern

BackgroundAdipsic diabetes insipidus(ADI)is a rare disorder,characterized by impaired sense of thirst and absent vasopressin secretion with diabetes insipidus.It can occur after transcranial surgery for craniopharyngeoma,suprasellar pituitary adenoma and anterior communicating artery aneurysm but also with head trauma,neurosarcoidosis and toluene exposure.Craniopharyngiomas account for approximately 3%of' all intracranial tumours but are the commonest tumours to involve the hypothalamo-pituitary region.Previously,it was shown that neurons in several circumventricular organs of the hypothalamus are activated by thirst-inducing conditions.Recently some experts identify two distinct,genetically separable neural populations in the subfornical organ that trigger or suppress thirst.Craniopharyngiomas may also directly af-f'ect the thirst centre of the hypothalamus.In our preliminary study,the classification of CPs based on growth pattern may elucidate tumor location and the relationship of the tumor to the third ventricle floor and the pituitary stalk.Our study speculate there is a high incidence of adipsic diabetes insipidus following surgery for craniopharyngioma,especially in Type T tumors based on the tumour location and growth pattern.Professor Qi Songtao put forward that the classification of craniopharyngiomas may enhance its positive clinical practicality.Thompson and colleagues suggest that after surgery for craniopharyngioma there is a higher incidence of adipsic diabetes insipidus compared to other pituitary tumours.One study of 16 patients showed that aggressive surgery for craniopharyngioma was associated with the development of postoperative adipsic diabetes insipidus in 19%of cases.The aim of this study was to identify the incidence of postoperative adipsic diabetes insipidus in the classification of craniopharyngiomas based on the tumour location and growth pattern,the classification of craniopharyngioma patients with ADI was analyzed.We also hope to evaluate related factors of the occur of adipsic diabetes insipidus after total resection of craniopharyngioma.The first part,Adipsic diabetes insipidus in the classification of craniopharyngiomas based on the tumour location and growth patternObjective Adipsic diabetes insipidus(ADI)is characterised by deficient or absent thirst and defective arginine vasopressin(AVP)secretion.The aim of the present study was to describe the frequency and characteristics of craniopharyngiomas(CPs)with ADI based on their origin and growth pattern,the(Q,S,T)classification of craniopharyngioma patients with ADI was analyzed.Design Arginine vasopressin responses to hyperosmolality were recorded during hypertonic saline infusion(HIS)for at least 3 weeks after surgery.Patients in this study were recruited from among patients with craniopharyngioma(CP)who were admitted to the Nanfang Hospital of the Southern Medical University between the years 2010 and 2015.We recruited 158 craniopharyngioma patients and 20 healthy control volunteers for the hypertonic saline infusion study.Results Hypertonic saline infusion identified deficient or absent thirst responses in 1 of the 55 craniopharygioma patients belonging to Type Q tumors(1.8%),3 of the 44 craniopharygioma patients belonging to Type S tumors(6.8%),14 of the 59 craniopharygioma patients belonging to Type T tumors(23.7%).There was significant difference between Type Q or Type S tumors group and Type T tumors group by chi square test.The incidence of Type T tumors with absent thirst was significantly higher than the other two groups.Conclusion This study confirms there is a high incidence of adipsic diabetes insipidus following surgery for craniopharyngioma,especially in Type T tumors based on the tumour location and growth pattern.Professor Qi Songtao put forward that the classification of craniopharyngiomas enhances its positive clinical practicality.The second part,related factors of the occur of adipsic diabetes insipidus(ADI)after total resection of craniopharyngiomaObjective To evaluate related factors of the occur of adipsic diabetes insipidus(ADI)after total resection of craniopharyngioma.Methods The clinical data of 158 patients were collected from the Nanfang Hospital of the Southern Medical University between the years January 2010 and December 2015,including age,sex,tumor size,classification,pathology,surgical procedure,hydrocephalus,the number of operations.Results The multivariate logistic stepwise regression regression equation was used to analyze the influencing factors in the univariate analysis,the classification(P=0.027)and tumor pathology(P = 0.021)were the predictor of the occur of adipsic diabetes insipidus.Conclusion The classification and tumor pathology may play an important role in the occur of adipsic diabetes insipidus(ADI)after total resection of craniopharyngioma.