Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Endocrinology and Diabetes Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Eur Urol Focus. 2022 Jan;8(1):52-59. doi: 10.1016/j.euf.2021.12.008. Epub 2022 Jan 5.
Salt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not consistently considered in primary care management of nocturia.
To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management.
Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT).
Twelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity <600 mOsm/l after overnight fluid avoidance.
Endocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia.
People with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.
盐和水的动态平衡受激素调节，因此多尿可由内分泌疾病直接引起，也可通过继发效应引起。这些机制在夜间多尿的初级保健管理中并未得到一致考虑。
对内分泌疾病中的夜间多尿进行系统评价（SR），并就初级保健管理达成专家共识。
从 2000 年 1 月至 2020 年 4 月，四个数据库进行了检索。共筛选出 4382 篇标题和摘要，对 36 篇全文进行了筛选，最终纳入 14 项研究进行分析。使用名义群体技术（NGT）达成专家和公众共识。
12 项研究侧重于夜间多尿的发生机制，而 2 项研究评估了治疗选择；没有一项研究在初级保健环境中进行。NGT 共识确定了关键的临床评估主题，包括口渴的存在、糖尿病或尿崩症的医学背景、甲状腺疾病、雌激素状态、药物（液体流失或口干）以及包括体重指数在内的一般检查。建议的检查包括膀胱日记、肾功能和甲状腺功能、钙和糖化血红蛋白。如果在液体建议后持续出现 >2.5 l/24 h 的多尿，且在限制液体后尿液浓缩度 >600 mOsm/l，则应检查晨尿渗透压，排除尿崩症。治疗应包括教育，包括尽可能调整生活方式和药物。应根据当地指南治疗任何潜在的内分泌疾病。如果存在甲状腺功能亢进症、甲状旁腺功能亢进症或在夜间避免饮水后晨尿渗透压 <600 mOsm/l，则应将患者转至内分泌科。
内分泌疾病可通过多种盐和水调节途径引起夜间多尿。管理的目的是识别和治疗病因，但继发效应会限制夜间多尿的改善。
由于控制水盐水平的问题导致需要排尿，激素功能改变的人可能会遭受严重的睡眠障碍。一个专家小组根据现有最新研究数量较少的情况，就评估和治疗这些问题的最佳方法提出了建议。
