Matsumoto K, Kakita K, Fukuma S
Department of Neurosurgery, Kyoto First Red Cross Hospital, Japan.
No Shinkei Geka. 1989 Mar;17(3):267-71.
A case of a patient with the syndrome of chronic hypernatremia and hypodispia due to hypothalamic tumor was studied to evaluate the change of ADH response to plasma osmolality during the clinical course. A 23-year-old man was admitted for investigation of anorexia, hypodipsia and gait disturbance. Examination showed memory disturbance and generalized muscle weakness. Investigation showed marked hypernatremia (177 mEq/l) and hypopituitarism. Water loading test showed that ADH was not stimulated by hyperosmolality but continued to be secreted at a more or less constant level approximating normal basal state. CT scan revealed hypothalamic tumor. The tumor was suspected to be germinoma due to its radiosensitivity and high serum hCG level. After irradiation, the tumor lesion disappeared. ADH secretion came to be responsive to changes in osmolality but the response of the system was markedly reduced compared with the normal response, and hypodipsia and hypernatremia still remained. We conclude that the adipsia and complete destruction of the osmoreceptor in the patient caused marked hypernatremia and the destruction of ADH osmostat improved partially after irradiation. We believe it very useful for analyzing the disturbance of osmoregulatory system to evaluate the relationship of plasma ADH to plasma osmolality.
对一例因下丘脑肿瘤导致慢性高钠血症和低渴感综合征的患者进行了研究，以评估临床过程中抗利尿激素（ADH）对血浆渗透压反应的变化。一名23岁男性因厌食、低渴感和步态障碍入院检查。检查发现有记忆障碍和全身肌肉无力。检查显示明显的高钠血症（177 mEq/l）和垂体功能减退。水负荷试验表明，高渗状态未刺激ADH分泌，而是以接近正常基础状态的大致恒定水平持续分泌。CT扫描显示下丘脑肿瘤。由于其对放射的敏感性和高血清人绒毛膜促性腺激素（hCG）水平，怀疑该肿瘤为生殖细胞瘤。放疗后，肿瘤病灶消失。ADH分泌开始对渗透压变化产生反应，但与正常反应相比，该系统的反应明显降低，低渴感和高钠血症仍然存在。我们得出结论，该患者的渴感缺失和渗透压感受器的完全破坏导致了明显的高钠血症，放疗后ADH渗透压调节机制的破坏得到了部分改善。我们认为评估血浆ADH与血浆渗透压之间的关系对于分析渗透压调节系统的紊乱非常有用。
