| Objective:Retrospective analysis of the etiology,symptoms,laboratory examination and imaging and other clinical data of patients with diabetes insipidus,to explore the clinical characteristics of diabetes insipidus treated in our hospital,to increase the recognition of diabetes insipidus,so as to improve the level of diagnosis and treatment of diabetes insipidus.Methods: Patients with diabetes insipidus who were hospitalized in the First Affiliated hospital of Dalian Medical Uiversity from January 2014 to December 2019 were selected.The clinical information about the subjects were recorded,including gender,age,symptoms,other diseases,urinary output,density,urinary osmolality,blood electrolytes,renal function,low density,lipoprotein-cholesterol,triglyceride,anterior pituitary functions,the results of the water deprivation test followed by vasopressin administration,pituitary magnetic resonance imaging(MRI).To analyze the sex and age distribution of diabetes insipidus and the etiological composition of central diabetes insipidus,to compare the differences of symptoms,electrolytes and dyslipidemia between idiopathic and secondary CDI,to compare the differences of electrolyte,dyslipidemia,and water deprivation-vasopressin test data between partial and complete CDI,to analyze the characteristics of anterior pituitary dysfunction between idiopathic and secondary CDI,and to enumerate the pituitary MRI manifestations of CDI and the application and effect of therapeutic drugs.Results:1.There were 92 patients with diabetes insipidus,including 44 males(47.80%)and 48 females(52.2%);There were 89 patients with CDI(96.70%)and 3 patients with renal diabetes insipidus(3.30%).The age of onset ranged from 1 to 78 years old,the average age was 40.5(20.25,5.75)years,and the average urinary output was 5.5(4,8)L.2.Among the 89 patients with CDI,9 cases were idiopathic(10.10%)and 80 cases were secondary(89.90%).The most common cause of secondary CDI was sellar tumors(24.72%).3.Compared with idiopathic CDI,LDL-C(P=0.001)was significantly increased and serum potassium(P=0.010)tdecreased significantly in patients with secondary CDI.There was no significant difference in serum sodium,serum creatinine,serum uric acid and TG between the two groups(P>0.05).There was no significant dfference in serum potassium,serum sodium,serum creatinine,serum uric acid,TG and LDL-C between partial and complete CDI.There was no significant difference in the incidence of hypokalemia,hypernatremia,hyperuricemia and lipid metabolic disorder between idiopathic and secondary CDI(P>0.05),and there was no significant difference between partial and complete CDI(P>0.05).4.Thirty patients had complete results of water deprivation test followed by vasopressin administration,including 17 cases of partial CDI(56.7%)and 13 cases of complete CDI(43.3%).There was no significant difference in urinary density,urinary osmolality,and blood osmolality between partial CDI and complete CDI(P> 0.05).The time needed for complete CDI to reach plateau stage was significantly lower than that of partial CDI(P=0.01).The urinary osmolality of platform stage was significantly lower than that of partial CDI(P<0.001).There was no significant difference in blood osmolality of platform stage between partial CDI and complete CDI(P>0.05).The urinary density(P=0.010),urinary osmolality(P=0.020)of partial CDI were higher thanthose of complete CDI one hour after vasopressin injection.The urinary osmolality in patients with partial CDI was significantly higher than that in patients with complete CDI two hours after vasopressin injection(P=0.01),and the increase rate of urinary osmolality in patients with complete CDI was significantly higher than that in patients with partial CDI(P<0.001).There was no significant difference in urinary osmolality and blood osmolality(P> 0.05).5.Anterior pituitary related hormones was examined in 65 patients,including 9cases of primary CDI and 56 cases of secondary CDI.The proportion of hypofunction of gonadal axis(P<0.001),adrenal axis(P<0.001)and thyroid axis(P=0.01)in secondary CDI was significantly higher than in idiopathic CDI.The proportion of hypofunction of gonadal axis function(63.33%)was significantly higher than that of adrenal axis(37.92%)(P=0.006),and also significantly higher than that of thyroid axis(39.2%)(P=0.001).There was no significant difference in the proportion of hypothyroidism and adrenal axis hypofunction(P>0.05).6.Pituitary MRI is one of the important auxiliary examinations for the diagnosis of the etiology of CDI.For those who are temporarily unclear about the cause,pituitary MRI should be reviewed regularly.7.Desmopression is the first choice for CDI treatment as it is safe and effective.There are individual differences in the dosage,and it can be adjusted according to the patient's condition,urinary output,urinary osmolality,blood electrolytes and blood pressure.Conclusions:1.Most diabetes insipidus patients admitted in our hospital are CDI.Secondary diabetes insipidus has a higher morbidity of idiopathic diabetes insipidus.The most common causes of secondary CDI is sellar tumors.2.Compared with partial CDI,the complete CDI has a shorter time to reach the plateau in water deprivation test followed by vasopressin administration,urinary osmolality and urinary osmolality were lower during plateau and after vasopressin injection,but the increase rate of urinary osmolality was higher after injection of vasopressin.3.The proportion of anterior pituitary-target gland hypofunction in CDI is gonad axis > adrenal axis,gonad axis > thyroid axis,there was no significant difference in theincidence of hypofunction between thyroid axis and adrenal axis.Secondary CDI patients are more likely to have hypopituitary hypofunction than i DIopathic CDI.4.The disappearance of the posterior pituitary high signal is the most common MRI manifestation of diopathic CDI.Polyuria can be effectively relieved after oral administration of desmopressin in patients with CDI. |
PDF Full Text Request