Rampazzo A
Medicina (Firenze). 1989 Apr-Jun;9(2):196-8.
In our recent experience, the posttraumatic diabetes insipidus (PT.DI) and idiopathic (I.DI) are the most common forms of central diabetes insipidus (C.DI) in adult patients. The hypothalamo-pituitary function in these patients may be quite heterogeneous. We evaluated this aspect in 32 patients with different forms of C.DI (19 males and 13 females; aged 16-55 yrs): 12 with previous severe cranial or general trauma; 8 with CNS lesion due to Tuberculosis, Sarcoidosis, Histiocytosis X or to other pathogenic noxa (Secondary DI); 12 with idiopathic form. In all we measured ACTH, TSH, FSH, LH, PRL and target hormones (pl. cortisol, T3 T4, Testosterone) in baseline conditions with and without substitutive DDAVP therapy. In all cases the hormonal pattern was within the normal range. In several patients stimulation test with specific releasing factors (TRH, LHRH, oCRH) were carried out. Although basal anterior pituitary function is usually normal in patients with central DI (post-traumatic, idiopathic or secondary), an isolated subclinical secondary or tertiary hypothyroidism can be observed in some cases. Thus, a more accurate, periodical, and complete hormonal evaluation is indicated in some patients. The maintained response of ACTH to CRH (even increased after acute withdrawal therapy) indicated that AVP is not necessary to ensure normal function to the CRH-ACTH axis.
根据我们最近的经验，创伤后尿崩症（PT.DI）和特发性尿崩症（I.DI）是成年患者中枢性尿崩症（C.DI）最常见的形式。这些患者的下丘脑 - 垂体功能可能差异很大。我们评估了32例不同形式C.DI患者（19例男性和13例女性；年龄16 - 55岁）的这一方面情况：12例有既往严重颅脑或全身创伤史；8例因结核病、结节病、组织细胞增多症X或其他致病因素导致中枢神经系统病变（继发性尿崩症）；12例为特发性形式。我们在所有患者基线状态下，测量了促肾上腺皮质激素（ACTH）、促甲状腺激素（TSH）、促卵泡激素（FSH）、促黄体生成素（LH）、催乳素（PRL）及靶激素（血浆皮质醇、T3、T4、睾酮），部分患者接受了去氨加压素（DDAVP）替代治疗。所有病例的激素水平均在正常范围内。对部分患者进行了特定释放因子（促甲状腺激素释放激素（TRH）、促黄体生成素释放激素（LHRH）、促肾上腺皮质激素释放激素（oCRH））刺激试验。尽管中枢性尿崩症（创伤后、特发性或继发性）患者的垂体前叶基础功能通常正常，但在某些情况下仍可观察到孤立的亚临床继发性或三发性甲状腺功能减退。因此，对于部分患者，需要更准确、定期和全面的激素评估。促肾上腺皮质激素对促肾上腺皮质激素释放激素的反应持续存在（甚至在急性撤药治疗后增强），表明精氨酸加压素（AVP）并非确保促肾上腺皮质激素释放激素 - 促肾上腺皮质激素轴正常功能所必需。
