Trust P M, Brown J J, Chinn R H, Lever A F, Morton J J, Padfield P L, Robertson J I, Ireland J T, Melville I D, Thomson W S
J Clin Endocrinol Metab. 1975 Aug;41(2):346-53. doi: 10.1210/jcem-41-2-346.
A 20-yr-old male was found to have diabetes insipidus is association with panhypopituitarism but without any focal neurological lesion being identified. He was initially treated with steroid supplements, the features of diabetes insipidus being controlled with a thiazide diuretic. Eighteen months later the patient lost thirst sensation and stopped treatment, subsequently being re-admitted with severe dehydration, oliguria and focal neurological signs. Further investigation, including brain biopsy, confirmed the presence of an atypical pinealoma which was considered inoperable. Measurements of plasma antidiuretic hormone (ADH) and angiotensin II (AII) concentrations during the severe dehydration showed very high levels of AII, but inappropriately low plasma ADH levels for the severity of dehydration. We consider that the evidence obtained from this case supports the view that the oliguria with hypertonic urine present during severe dehydration was due to a direct renal action of the very high AII levels, possibly supplemented by the residual ADH secretion.
一名20岁男性被发现患有尿崩症，伴有全垂体功能减退，但未发现任何局灶性神经病变。他最初接受类固醇补充治疗，尿崩症症状通过噻嗪类利尿剂得到控制。18个月后，患者失去口渴感并停止治疗，随后因严重脱水、少尿和局灶性神经体征再次入院。进一步检查，包括脑活检，证实存在非典型松果体瘤，被认为无法手术切除。在严重脱水期间测量血浆抗利尿激素（ADH）和血管紧张素II（AII）浓度，结果显示AII水平非常高，但就脱水的严重程度而言，血浆ADH水平却异常低。我们认为，从该病例获得的证据支持这样一种观点，即严重脱水期间出现的少尿伴高渗尿是由于非常高的AII水平对肾脏的直接作用，可能还伴有残余的ADH分泌。
