Ino Y, Tsurumi H, Yamada T, Murakami N, Moriwaki H, Muto Y
First Department of Internal Medicine, Gifu University School of Medicine.
Rinsho Ketsueki. 1995 Dec;36(12):1359-64.
We report a case of AML with diabetes insipidus (DI). A 68-year-old female was admitted to our hospital because of fever and leukocytosis. The WBC was 197,000/microliter with 98% blasts positive for myeloperoxidase, CD33, CD34 and HLA-DR. While, on admission, urine volume was more than 6 liters daily. Blood vasopressin level was 0.3 microgram/ml. The patient was diagnosed as having AML with DI. By chemotherapy consisting of BHAC, DNR, 6-MP and PSL and intrathecal administration of AraC, MTX and PSL, and nasal drip of DDAVP, complete remission was attained and the urine volume was reduced to normal. Finally DDAVP became unnecessary. Although the exact cause of DI cannot be ascertained, rapid increase of leukemic blasts and leukostasis in small vessels might be associated with hypothalamus-pituitary system damage. Reportedly, DI is a rare complication of leukemia and administration of DDAVP could be halted in only two patients with leukemia and DI.
我们报告一例伴有尿崩症(DI)的急性髓系白血病(AML)病例。一名68岁女性因发热和白细胞增多症入院。白细胞计数为197,000/微升,98%的原始细胞髓过氧化物酶、CD33、CD34和HLA - DR呈阳性。入院时,尿量每天超过6升。血血管加压素水平为0.3微克/毫升。该患者被诊断为患有伴有尿崩症的急性髓系白血病。通过由BHAC、柔红霉素(DNR)、6 - 巯基嘌呤(6 - MP)和泼尼松龙(PSL)组成的化疗方案,以及鞘内注射阿糖胞苷(AraC)、甲氨蝶呤(MTX)和泼尼松龙(PSL),并滴鼻给予去氨加压素(DDAVP),患者达到完全缓解,尿量恢复正常。最终不再需要去氨加压素。尽管尿崩症的确切病因尚不能确定,但白血病原始细胞的快速增加和小血管内的白细胞淤滞可能与下丘脑 - 垂体系统损伤有关。据报道,尿崩症是白血病的一种罕见并发症,仅有两名白血病合并尿崩症的患者停用了去氨加压素。