Section of Diabetes and Endocrinology, Department of Medicine, Caerphilly Miners' and YYF Hospitals, Hengoed, Wales, UK.
Clin Med (Lond). 2013 Aug;13(4):407-10. doi: 10.7861/clinmedicine.13-4-407.
Lithium (Li) may cause multiple endocrinopathies, including hypercalcaemia, thyroid dysfunction and nephrogenic diabetes insipidus (NDI), but rarely in the same patient. The management of NDI remains a challenge. We report on a patient on long-term Li who had simultaneous NDI (paired serum and urine samples had abnormal osmolalities, typical of NDI, and treatment with parenteral desmopressin failed to affect urinary volume and serum osmolality), 'destructive' thyroiditis (hyperthyroidism, absent radioiodine uptake and absent thyrotrophin receptor antibodies) and primary hyperparathyroidism (compatible biochemistry, urine calcium excluding 'set point' anomalies and hypocalciuric hypercalcaemia, and normal parathyroid imaging). The thyroiditis resolved spontaneously and hypercalcaemia responded to reduction of Li dose. The NDI was unresponsive to amiloride, thiazides and ibuprofen in combination. However, urine output was reduced by 50% when a high dose of oral desmopressin was given. We conclude that Li-induced multiple endocrinopathy remains rare and, although NDI is difficult to manage, high dose oral desmopressin should be tried when other medications fail.
锂（Li）可能导致多种内分泌疾病，包括高钙血症、甲状腺功能障碍和肾性尿崩症（NDI），但在同一患者中很少见。NDI 的治疗仍然是一个挑战。我们报告了一例长期接受 Li 治疗的患者同时患有 NDI（配对的血清和尿液样本具有异常的渗透压，典型的 NDI，并且给予静脉内去氨加压素治疗未能影响尿量和血清渗透压）、破坏性甲状腺炎（甲状腺功能亢进症，无放射性碘摄取和无促甲状腺素受体抗体）和原发性甲状旁腺功能亢进症（生化检查结果相符，尿钙无“设定点”异常和钙性高钙血症，甲状旁腺成像正常）。甲状腺炎自发缓解，高钙血症对 Li 剂量减少有反应。NDI 对阿米洛利、噻嗪类药物和布洛芬联合治疗无反应。然而，当给予高剂量口服去氨加压素时，尿量减少了 50%。我们得出结论，锂诱导的多种内分泌疾病仍然很少见，尽管 NDI 难以治疗，但在其他药物治疗失败时，应尝试使用高剂量口服去氨加压素。
