Palumbo Claudia, Nicolaci Nora, La Manna Andrés A, Branek Natalia, Pissano María N
Servicio de Nefrología, Clínica Ciudad de la Vida, Buenos Aires, Argentina. E-mail:
Servicio de Neurología, Clínica Ciudad de la Vida, Buenos Aires, Argentina.
Medicina (B Aires). 2018;78(2):127-130.
Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.
中枢性尿崩症是一种罕见的下丘脑和神经垂体疾病。在成年2型糖尿病患者中极为罕见。其表现为烦渴多尿综合征，必须与控制不佳的2型糖尿病相鉴别。鉴于这两种情况的相似性及其共存的不寻常性质，很难对它们进行怀疑。本文介绍了一例72岁男性2型糖尿病患者，胰岛素控制不佳（空腹血糖大于180mg/dl），长期存在多尿综合征。高钠血症和血浆渗透压升高，同时尿渗透压降低，导致怀疑尿崩症，随后通过禁水-加压素试验及皮下注射去氨加压素得到证实。皮下注射去氨加压素1小时后，计算出的尿渗透压增加61%，诊断为中枢性尿崩症。核磁共振显示神经垂体有一个亮点，有助于特发性尿崩症的诊断。
