Arem R, Rushford F E, Segal J, Robinson A, Grossman R G, Field J B
Am J Med. 1986 Jun;80(6):1217-24. doi: 10.1016/0002-9343(86)90692-3.
Intermittent hypernatremia following hypothalamic surgery or trauma is usually attributed to the triphasic dysfunction of vasopressin release (diabetes insipidus, inappropriate vasopressin release, and diabetes insipidus). A 39-year-old patient had hypodipsia and intermittent hypernatremia following hypothalamic surgery for a chromophobe adenoma. Mean arterial pressure fell by 25 percent during orthostasis testing and was associated with an increase in vasopressin levels from 1.3 microU/ml to 12 microU/ml. Plasma renin activity and aldosterone increased from 1.1 to 16 ng/ml per hour and from 6.7 to 39 ng/dl, respectively, and remained elevated for three and a half hours after tilt testing. Hypertonic saline infusion, on the other hand, increased serum osmolality from 290 to 304 mOsm/kg but did not result in a significant rise in vasopressin levels (all were less than 1 microU/ml). These results are consistent with a selective dysfunction of the osmoreceptor pathways of vasopressin release and intact volume receptor-mediated pathways. Patients with intermittent hypernatremia following hypothalamic surgery or trauma should be questioned specifically regarding thirst. If it is impaired or absent, these patients should be watched carefully, not only for the development of triphasic dysfunction of vasopressin release, but also for a selective osmoreceptor dysfunction associated with thirst deficits as found in patients with "essential hypernatremia."
下丘脑手术或创伤后出现的间歇性高钠血症通常归因于血管加压素释放的三相功能障碍（尿崩症、不适当的血管加压素释放和尿崩症）。一名39岁的患者在接受针对嫌色细胞瘤的下丘脑手术后出现了渴感减退和间歇性高钠血症。在直立位测试期间平均动脉压下降了25%，并伴有血管加压素水平从1.3微单位/毫升升高至12微单位/毫升。血浆肾素活性和醛固酮分别从每小时1.1纳克/毫升升至16纳克/毫升以及从6.7纳克/分升升至39纳克/分升，并且在倾斜测试后三个半小时内一直保持升高。另一方面，高渗盐水输注使血清渗透压从290毫摩尔/千克升至304毫摩尔/千克，但并未导致血管加压素水平显著升高（均低于1微单位/毫升）。这些结果与血管加压素释放的渗透压感受器途径存在选择性功能障碍以及容量感受器介导的途径完整一致。对于下丘脑手术或创伤后出现间歇性高钠血症的患者，应特别询问其口渴情况。如果口渴受损或缺失，不仅要密切观察这些患者血管加压素释放三相功能障碍的发生情况，还要观察是否存在与“原发性高钠血症”患者中发现的与口渴缺乏相关的选择性渗透压感受器功能障碍。
