Fargouche Zayd, Manderlier Martin, Meert Anne-Pascale, Wolff Louis, Ilzkovitz Maxime
Department of Internal Medicine, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium.
Department of Radiotherapy, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium.
Eur J Case Rep Intern Med. 2025 May 27;12(6):005463. doi: 10.12890/2025_005463. eCollection 2025.
Temozolomide (TMZ), an alkylating agent used in glioblastoma multiforme and anaplastic astrocytoma treatment, is generally associated with side effects like myelosuppression and nausea. This case report describes a rare occurrence of nephrogenic diabetes insipidus (NDI) in a 45-year-old male with grade IV astrocytoma undergoing TMZ therapy. Following TMZ discontinuation due to haematological toxicity, the patient developed significant polyuria and hypernatremia. Central diabetes insipidus was initially suspected, but limited improvement with desmopressin and normal endocrine investigations suggested renal involvement. The diagnosis of partial NDI was made and linked to TMZ-induced acute tubulointerstitial nephropathy (ATN). Despite symptom onset coinciding with TMZ administration, recovery was delayed after discontinuation, implicating possible lasting tubular damage. Although the precise pathogenesis remains uncertain, it may involve TMZ-induced renal tubule inflammation, affecting aquaporin-2 expression and water retention. In this case, management of NDI included adequate intravenous hydration, oral fluid restriction, and progressive resolution of polyuria without the need for diuretic or non-steroidal anti-inflammatory drug. This case emphasizes the need for vigilance regarding renal complications, particularly NDI, in patients receiving TMZ, warranting careful monitoring of electrolytes, renal function and diuresis to ensure prompt identification and management of this rare but serious side effect.
Temozolomide can in rare cases cause diabetes insipidus and, even more exceptionally, nephrogenic diabetes insipidus.The resolution of nephrogenic diabetes insipidus following the discontinuation of a high-intensity regimen is promising, and patients should not be denied temozolomide due to this complication.
替莫唑胺（TMZ）是一种用于多形性胶质母细胞瘤和间变性星形细胞瘤治疗的烷化剂，通常会引起骨髓抑制和恶心等副作用。本病例报告描述了一名45岁患有IV级星形细胞瘤的男性在接受TMZ治疗时罕见地发生了肾性尿崩症（NDI）。由于血液学毒性而停用TMZ后，患者出现了显著的多尿和高钠血症。最初怀疑是中枢性尿崩症，但使用去氨加压素后改善有限且内分泌检查正常提示肾脏受累。最终诊断为部分性NDI，并与TMZ诱导的急性肾小管间质性肾病（ATN）相关。尽管症状发作与TMZ给药同时发生，但停药后恢复延迟，提示可能存在持久的肾小管损伤。虽然确切的发病机制仍不确定，但可能涉及TMZ诱导的肾小管炎症，影响水通道蛋白-2的表达和水潴留。在本病例中，NDI的管理包括充分的静脉补液、口服液体限制，多尿逐渐缓解，无需使用利尿剂或非甾体抗炎药。本病例强调了在接受TMZ治疗的患者中对肾脏并发症，特别是NDI保持警惕的必要性，需要仔细监测电解质、肾功能和尿量，以确保及时识别和处理这种罕见但严重的副作用。
替莫唑胺在罕见情况下可导致尿崩症，更罕见的是导致肾性尿崩症。停用高强度治疗方案后肾性尿崩症的缓解是有希望的，不应因这种并发症而拒绝患者使用替莫唑胺。
