Zünd S, Fretz C, Krapf R
Klinik B für Innere Medizin, Kantonsspital St. Gallen, Schweiz.
Wien Klin Wochenschr. 1998 Aug 21;110(15):538-41.
We report a 45 y old male patient with severe hypodipsia, but intact vasopressin secretion and maximal renal response to vasopressin. The patient presented during hot summer days, 18 months after a frontal lobe hemorrhage due to a ruptured aneurysm, with severe hypernatremia (171 mmol/L) and a plasma osmolality of 348 mosm/kg. He was awake and had no interest in fluid intake. After initial correction, a thirst test for 36 hours was performed. Plasma osmolality rose from 295 to 320, urine osmolality rose from 220 to 700 mosm/kg, while plasma vasopressin levels increased more than 3-fold. Throughout the test the patient did not exhibit appreciable thirst. The intact osmoregulation of vasopressin as evidenced by the plasma levels and the elicited renal response, indicates that a selective acquired disturbance of thirst is present. Whether the thirst center is destroyed or/and thirst recognition (frontal lobe affection) is disturbed primarily, can not be decided.
我们报告了一名45岁男性患者，其患有严重的渴感减退，但血管加压素分泌正常且肾脏对血管加压素的最大反应正常。该患者在因动脉瘤破裂导致额叶出血18个月后的炎热夏日就诊，伴有严重高钠血症（171 mmol/L），血浆渗透压为348 mosm/kg。他神志清醒，对液体摄入毫无兴趣。初始纠正后，进行了为期36小时的渴觉试验。血浆渗透压从295升至320，尿渗透压从220升至700 mosm/kg，而血浆血管加压素水平增加了3倍多。在整个试验过程中，患者未表现出明显的口渴。血浆水平和引发的肾脏反应证明血管加压素的渗透调节功能正常，这表明存在选择性获得性渴感障碍。口渴中枢是否被破坏和/或口渴识别（额叶病变）是否主要受到干扰，尚无法确定。
