Hashimoto M, Ogura T, Otsuka F, Yamauchi T, Mimura Y, Hayakawa N, Makino H, Ota Z, Seki N, Hiramatsu Y, Kudo N
Third Department of Internal Medicine, Okayama University Medical School, Japan.
Endocr J. 1996 Oct;43(5):577-83. doi: 10.1507/endocrj.43.577.
We describe a case of diabetes insipidus (DI) due to a pituitary tumor in a 33-year-old pregnant woman who developed a sudden onset of polyuria (over 8 l/day) and polydipsia at 30 weeks of gestation. Her plasma concentration of vasopressin (AVP) was low compared with high serum osmolality (298 mOsm/kg), and her urine output was well controlled by treatment with desmopressin acetate (DDAVP). Cranial magnetic resonance imaging (MRI) demonstrated a 1.8 x 1.2-cm pituitary tumor, but she did not have any disturbance in the release of anterior pituitary hormones. The serum concentration of cystine aminopeptidase (CAP) was within the normal range for a woman at 34 weeks of gestation. After an uncomplicated delivery of a healthy girl, her polyuria gradually resolved. The size of the pituitary tumor gradually decreased in parallel to a reduction in her urine output, but a silent hemorrhage was detected in her pituitary gland 4 weeks after the delivery. Although pregnancy is sometimes associated with central DI, the occurrence of DI due to pituitary tumor under pregnancy is rare. The basal AVP recovered to within the normal range, but the low response of AVP secretion to high osmolality persisted. In this case, pregnancy may affect the manifestation of subclinical DI. This case may therefore enhance our understanding of the mechanisms of DI during pregnancy.
我们描述了一例33岁孕妇因垂体瘤导致尿崩症（DI）的病例。该孕妇在妊娠30周时突然出现多尿（每天超过8升）和烦渴。与高血清渗透压（298 mOsm/kg）相比，她的血浆血管加压素（AVP）浓度较低，且她的尿量通过醋酸去氨加压素（DDAVP）治疗得到了良好控制。头颅磁共振成像（MRI）显示有一个1.8×1.2厘米的垂体瘤，但她的垂体前叶激素释放没有任何紊乱。胱氨酸氨基肽酶（CAP）的血清浓度在妊娠34周女性的正常范围内。在顺利产下一个健康女婴后，她的多尿逐渐缓解。垂体瘤的大小随着尿量的减少而逐渐减小，但产后4周在她的垂体中检测到了无症状性出血。虽然妊娠有时与中枢性尿崩症有关，但妊娠期间因垂体瘤导致尿崩症的情况很少见。基础AVP恢复到正常范围内，但AVP分泌对高渗透压的低反应仍然存在。在这个病例中，妊娠可能影响了亚临床尿崩症的表现。因此，该病例可能会增进我们对妊娠期间尿崩症机制的理解。
