中德班尿崩症 Diabetes insipidus.ppt

water deprivation test- Case 2 male，aged 36 y Polydipsia for 6m。Urine volume7000-8000ml/d，polyuria despite of no drinking, nuctouria. water deprivation test-result time U- osms (mOsm/L P- osms (mOsm/L 6am 66 8am 94 10am 121 285 10:30* ADH 5u sq 11:30 533 12:30 551 U/P=0.42 diagnosis: complete CDI (551-121)/121=355% water deprivation test-result ADH 5u sq U/P=0.42 diagnosis: complete CDI (551-121)/121=355% water deprivation test- Case 3 male,27 y Polydipsia and polyuria for 1y。 Urine volume 6000ml/d, no headache and visiual disorders PE：normal time U-(ml) U-SG U-mOsm Bw(Kg) （reduction%） BP-mmHg 1:25 600 1.010 98 67 118/80 3:38 450 1.012 124 6.18 610 1.010 135 8.08 400 1.012 183 64.5(3.73%) 119/76 10:40 350 1.012 232 54(4.47%) 127/80 time U-(ml) U-SG U-mOsm Bw(Kg) （reduction%） BP-mmHg 12:40 350 1.010 198 14:15 300 1.010 265 63.5 (5.22%) 124/90 15:30 150 1.014 308 113/88 16.17 100 1.014 362 17:00* (ADH) 100 1.016 378 63(4.62%) 132/87 18:30 110 1.022 541 19:30 100 1.022 571 64(4.47%) 116/92 Diagnose: partiale CDI (571-378)/378=51% (ADH) Diagnose: partiale CDI (571-378)/378=51% MRI of Case 3 Pituitary MRI in T1-weighted images showed (1)loss of the hyperintense signal of the posterior pituitary (2)thenckening of the pituitary stalk Cause may be lymphocytic infundibulo-neurohypophysitis *Treatment:with DDAVP(Minirin) 100mg Bid , urine volume reduced to 2100ml/24hr. Treatment of DI Desmopressin two-amino acid of ADH are substituted potent antidiuretic activity but no vasopressor activity safe during pregnancy for both the mother and the fetus Risks: Water retention and the development of hyponatremia. Thiazide diuretics Act independent of ADH. via a hypovolemia-induced increase in sodium and water reabsorption in the proximal tubule Follow up 1. Urin volume and medication dosis 2. Sellar and pituitary MRI pro 1