Department of Paediatric Endocrinology, Great North Children's Hospital, Newcastle-upon-Tyne, UK.
Pituitary. 2011 Dec;14(4):307-11. doi: 10.1007/s11102-011-0294-3.
Adipsic diabetes insipidus (ADI) is characterised by impaired thirst and defective AVP secretion. We have assessed the thirst response to graded osmotic stimulation using a visual analog scale (VAS) in patients with a history of ADI following surgery for a craniopharyngioma. The patients were thought to be regaining their thirst response but we wanted to confirm that this was the case objectively before relaxing their strict fluid balance regimen. Three patients with adipisa in the presence of hypernatremia following surgery for a craniopharyngioma are described. Their median age at surgery was 13 years (range 11-15 years). All patients had previously demonstrated no desire to drink despite a serum osmolality in excess of 300 mOsmol/kg. Fluid balance was maintained postoperatively with a regimen involving a fixed daily fluid intake and DDAVP dose together with daily weights and regular assessment of capillary sodium concentrations. Patients were thought to be regaining thirst sensation and so were assessed by hypertonic saline infusion (HSI) with thirst measured using a VAS. Patients underwent a HSI test 4, 6 and 9 months post surgery. All had abnormally low AVP production at raised plasma osmolalities but the visual analogue scale confirmed partial or complete thirst recovery. The intensive regimen used to maintain stable serum sodium concentrations was relaxed without the patients subsequently developing a significant hyperosmolar state. We have shown objective recovery of thirst perception in patients with adipsia within 9 months of surgery, despite persistence of cranial diabetes insipidus. These observations indicate that both osmoreceptors regulating thirst and their efferent pathways demonstrate more plasticity than those regulating AVP production. The HSI and thirst VAS are an objective way of assessing patients known to have ADI who are thought to be recovering thirst perception.
尿崩症（ADI）的特点是口渴感缺失和精氨酸加压素（AVP）分泌缺陷。我们使用视觉模拟量表（VAS）评估了颅咽管瘤手术后有 ADI 病史患者对分级渗透刺激的口渴反应。这些患者被认为正在恢复他们的口渴反应，但我们希望在放松他们严格的液体平衡方案之前客观地确认这一点。描述了 3 例手术后由于颅咽管瘤而存在肥胖症和高钠血症的患者。他们的中位手术年龄为 13 岁（范围 11-15 岁）。尽管血清渗透压超过 300 mOsmol/kg，但所有患者以前都没有表现出想要喝水的愿望。术后通过涉及固定每日液体摄入量和 DDAVP 剂量以及每日体重和定期评估毛细血管钠浓度的方案来维持液体平衡。患者被认为正在恢复口渴感，因此通过高渗盐水输注（HSI）进行评估，并使用 VAS 测量口渴感。患者在手术后 4、6 和 9 个月接受了 HSI 测试。所有患者在升高的血浆渗透压下均存在异常低的 AVP 产生，但视觉模拟量表证实了部分或完全口渴恢复。用于维持稳定血清钠浓度的强化方案被放宽，而患者随后并未出现明显的高渗状态。我们已经表明，尽管存在颅神经糖尿病，但在手术后 9 个月内，患者的口渴感知能力得到了客观恢复。这些观察结果表明，调节口渴的渗透压感受器及其传出途径比调节 AVP 产生的感受器具有更大的可塑性。HSI 和口渴 VAS 是评估已知患有 ADI 且被认为正在恢复口渴感知的患者的一种客观方法。
