Clinical Analysis Of 389 Cases Of Diabetes Insipidus

Background:Diabetes insipidus?DI?is divided into central diabetes insipidus?CDI?and renal diabetes insipidus?NDI?according to different causes.Various hypothalamic pituitary lesions can lead to CDI and it is very important to accurately distinguish the different causes.The water deprivation and vasopressin test is an important method for clinical diagnosis of DI.At present,there are many clinical reports of DI in China and abroad.However,due to the low incidence of DI,the comprehensive analyses of large samples of DI are still rare.Object:To analyze the clinical manifestations,imaging findings,hypopituitarism,and water deprivation and vasopressin test of diabetes insipidus caused by different etiologies,and to observe the clinical efficacy of desmopressin,so as to provide more ideas for the diagnosis and treatment of DI.Method:A retrospective case study was used for clinical analysis of 389 patients with DI.The clinical data was collected,such as gender,age,trauma history,medical history,family history,course of disease,24 hour urine volume,urine specific gravity,urine osmotic pressure,blood electrolytes,blood osmotic pressure,magnetic resonance imaging?MRI?of saddle area,urinary doppler ultrasonography and pathological results,results of adenohypophysis and target glands examination?ACTH,cortisol,24h urine free cortisol,thyroid function,sex hormones,growth hormone?,water deprivation and vasopressin test,and therapeutic measures and curative effect.Data were analyzed using SPSS 21.0 statistical software,including Chi-square test,independent samples t-test,and Mann-Whitney U test.P<0.05 was considered statistically significant.Results:1.The percentage of CDI in total was 96%,and NDI was 4%.The etiology of CDI:idiopathic CDI accounted for 59%?222/374 cases?,acquired CDI 40%?150/374cases?,and hereditary CDI 1%?2/374 cases?.The first three causes of acquired CDI were sellar tumors,craniocerebral operation and head trauma.2.The average time required to reach the plateau in water deprivation test was 5±2 hours for complete CDI,7±3 hours for partial CDI,and 6±2 hours for NDI.In water deprivation test,the average urine osmolarity before injection of pituitrin was204±63mOsm/kg H₂O for complete CDI,424±98mOsm/kg H₂O for partial CDI,and233±141mOsm/kg H₂O for NDI.The maximum urine osmolarity after injection of pituitrin was 536±83mOsm/kg H₂O for complete CDI,615±122mOsm/kg H₂O for partial CDI,and 251±148mOsm/kg H₂O for NDI.3.The maximum urine osmolality of partial CDI in water deprivation test was675mOsm/kg H₂O.In some patients,the urinary specific gravity and urinary osmolality was significantly inconsistent.When the urine specific gravity reached1.020 in water deprivation test,diabetes insipidus could not be excluded.The injection of pituitrin 5U in underweight adults caused cerebral edema.4.The incidence of hypopituitarism in CDI patients:gonadal axis was 30%,thyroid axis 15%,adrenal axis 14%.Compared with idiopathic CDI,the acquired CDI had a higher rate of hypopituitarism?P<0.05?.5.The common imaging findings of CDI were the absence of high signal in posterior pituitary?311/366 cases?and thickened pituitary stalks?73/366 cases?.The urinary doppler ultrasonography revealed urinary tract dilation in 13/15 NDI patients.6.The efficacy of oral desmopressin formulations in CDI patients was definite.The use of hydrochlorothiazide combined with potassium chloride in NDI patients could effectively relieve symptoms of polyuria.Conclusions:1.Idiopathic CDI was the most common,but the MRI of saddle area should be reviewed regularly.Tumor,surgery and trauma were the most common causes of acquired CDI.2.The MRI of saddle area combined with pathological examination was the crucial measure for etiological diagnosis of CDI patients.3.The maximum urinary osmolality of partial CDI in water deprivation test was675mOsm/kg H₂O.Compared with urine specific gravity,the urine osmotic pressure was more valuable in diagnosis of DI.4.The dosage of pituitrin or vasopressin in underweight adults should be moderately reduced in vasopressin test or treatment in case cerebral edema occurred.