Mahiat Cédric, Capes Antoine, Duprez Thierry, Whenham Nicolas, Duck Lionel, Labriola Laura
Department of Oncology, Clinique Saint-Pierre, Ottignies, Belgium.
Department of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
J Oncol Pharm Pract. 2021 Jun;27(4):1040-1045. doi: 10.1177/1078155220961551. Epub 2020 Sep 29.
Central diabetes insipidus is a heterogeneous condition characterized by decreased release of antidiuretic hormone by the neurohypophysis resulting in a urine concentration deficit with variable degrees of polyuria. The most common causes include idiopathic diabetes insipidus, tumors or infiltrative diseases, neurosurgery and trauma. Temozolomide is an oral DNA-alkylating agent capable of crossing the blood-brain barrier and used as chemotherapy primarily to treat glioblastoma and other brain cancers.
Two men (aged 38 and 54 years) suddenly developed polyuria and polydispsia approximately four weeks after the initiation of temozolomide for a glioblastoma. Plasma and urine parameters demonstrated the presence of a urinary concentration defect.
The clinical and laboratory abnormalities completely resolved with intranasal desmopressin therapy, allowing the continuation of temozolomide. The disorder did not relapse after cessation of temozolomide and desmopressin and relapsed in one patient after rechallenge with temozolomide.
Our report highlights the importance of a quick recognition of this exceptional complication, in order to initiate promptly treatment with desmopressin and to maintain therapy with temozolomide.
中枢性尿崩症是一种异质性疾病，其特征为神经垂体抗利尿激素释放减少，导致尿液浓缩功能缺陷，并伴有不同程度的多尿。最常见的病因包括特发性尿崩症、肿瘤或浸润性疾病、神经外科手术和创伤。替莫唑胺是一种口服DNA烷化剂，能够穿过血脑屏障，主要用作化疗药物来治疗胶质母细胞瘤和其他脑癌。
两名男性（年龄分别为38岁和54岁）在因胶质母细胞瘤开始使用替莫唑胺治疗约四周后突然出现多尿和烦渴。血浆和尿液参数显示存在尿液浓缩功能缺陷。
经鼻去氨加压素治疗后，临床和实验室异常完全缓解，从而得以继续使用替莫唑胺。在停用替莫唑胺和去氨加压素后，该疾病未复发，但在一名患者再次使用替莫唑胺后复发。
我们的报告强调了快速识别这种特殊并发症的重要性，以便及时开始使用去氨加压素治疗并维持替莫唑胺治疗。
