Iwasaki Y, Oiso Y, Yamauchi K, Takatsuki K, Kondo K, Hasegawa H, Itatsu T, Niinomi M, Tomita A
First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
J Clin Endocrinol Metab. 1989 Mar;68(3):560-5. doi: 10.1210/jcem-68-3-560.
We studied neurohypophyseal function in 12 women with postpartum hypopituitarism (Sheehan's syndrome) by measuring plasma arginine vasopressin concentrations during 5% hypertonic saline infusions. All patients had a history of obstetric shock or massive bleeding, and were receiving cortisol and/or L-T4 replacement therapy. None had any symptoms of diabetes insipidus. The mean basal plasma vasopressin level in the patients [0.6 +/- 0.1 (+/- SE) pmol/L] was significantly lower (P less than 0.01) than that in normal adults (2.5 +/- 0.5 pmol/L; n = 12), whereas mean plasma osmolality values were similar in the two groups. During hypertonic saline infusion, the 10 hypopituitary patients had varying degrees of subnormal arginine vasopressin responses to the increase in plasma osmolality. Urine-concentrating ability after dehydration also was lower in the patients, although overt polyuria was absent at the time of this study. These results indicate that the osmoregulation of arginine vasopressin secretion is frequently impaired in postpartum hypopituitarism, suggesting neurohypophyseal damage.
我们通过在输注5%高渗盐水期间测量血浆精氨酸加压素浓度，研究了12例产后垂体功能减退（希恩综合征）女性的神经垂体功能。所有患者均有产科休克或大出血病史，且正在接受皮质醇和/或左甲状腺素替代治疗。无一例有尿崩症症状。患者的平均基础血浆加压素水平[0.6±0.1（±标准误）pmol/L]显著低于正常成年人（2.5±0.5 pmol/L；n = 12）（P<0.01），而两组的平均血浆渗透压值相似。在输注高渗盐水期间，10例垂体功能减退患者对血浆渗透压升高的精氨酸加压素反应存在不同程度的异常。脱水后的尿液浓缩能力在患者中也较低，尽管在本研究时未出现明显多尿。这些结果表明，产后垂体功能减退时精氨酸加压素分泌的渗透压调节常受损，提示神经垂体受损。
