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증례 : 내분비-대사 ; 중추성 요붕증과 제2형 당뇨병이 동반된 고혈당성 고삼투압 증후군 1예
이정환 ( Jung Hwan Lee ),홍지택 ( Ji Taek Hong ),민상준 ( Sang Joon Min ),홍성빈 ( Seong Bin Hong ),남문석 ( Moonsuk Nam ),김용성 ( Yong Seong Kim ),김소헌 ( So Hun Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.1
본 저자들은 제2형 당뇨병이 발생하였고, 특발성 중추성 으로 추정되는 요붕증에 의해 고혈당성 고삼투압성 증후군의 임상적 형태로 나타난 환자를 경험하였다. 수액치료와 슐린 치료 및 데스모프레신에 의해 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus. (Korean J Med 2012;82:90-94)
( Yeun Seoung Choi ),( Jung Soo Lim ),( Woocheol Kwon ),( Soon Hee Jung ),( Il Hwan Park ),( Myoung Kyu Lee ),( Won Yeon Lee ),( Suk Joong Yong ),( Seok Jeong Lee ),( Ye Ryung Jung ),( Jiwon Choi ),( 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
중추성 요붕증 여성에서 병발한 국소피부경화증과 편평사마귀
우유리 ( Yu Ri Woo ),이혜민 ( Hye Min Lee ),이중선 ( Joong Sun Lee ),구대원 ( Dae Won Koo ) 대한피부과학회 2012 大韓皮膚科學會誌 Vol.50 No.10
Morphea, localized scleroderma, is a connective tissue disease characterized by localized, circumscribed sclerotic patches, or plaques of the skin. The pathogenesis of morphea is still unclear. Central diabetes insipidus is a disease characterized by excessive thirst and urination. In more than half of the cases of central diabetes insipidus, the etiology is still unknown. We experienced the case of morphea and verruca plana in a 32-year old female with a history of central diabetes insipidus. Central diabetes insipidus might have influenced disrupting the homeostasis of the endocrine or immune environment. In the state of disrupted homeostasis, there might be an increased chance for morphea and disseminated verruca plana to develop easily. Based on this, we suppose the possible mechanism about the morphea and disseminated verruca plana developed in central diabetes insipidus.
김영재,박기남,정순호,최영균,박진우,신치만,박주열 인제대학교 2001 仁濟醫學 Vol.22 No.1
Central diabetes insipidus is caused by hypothalamic, posterior pituitary lesions, resalting in impaired arginine vasopressin (AVP) production and release due to surgery, tumors, trauma, hemorrhagic infarction, inflammation, or infiltration. This report describes the perioperative management for central diabetes insipidus. She was 11 years old and underwent the operation for removal of hypothalmic tumor. But hypernatremia was diagnosed during operation. Aquous vasopressin was injected intravenously to confirm diagnosis and to differentiate central diabetes insipidus from nephrogenic diabetes insipidus. Serum Na+ decreased from 182mEg/L to 170mEg/L 1 hour later. After operation, serum Na+ was 165 mEg/L. And she was completely recovered at recovery room. We could treat acute situation such as hypernatremia due to intraoperative central diabetes insipidus with intravenous injection of aquous vasopressin. However, We must take careful management to avoid excessively rapid correction or overcorrection of hypernatremia, which increase the risk of iatrogenic cerebral edema, with possible catastrophic consequences.
Desmopressin responding female nephrogenic diabetes insipidus: a case report
Juyeon Lee,Hae Il Cheong,Jung Won Lee,Ki Soo Pai 대한소아신장학회 2022 Childhood kidney diseases Vol.26 No.2
Nephrogenic diabetes insipidus, decreased ability to concentrate urine, with production of large amounts of urine, is caused by the refractory response of renal tubules to the action of antidiuretic hormone. This rare disorder, known as X-linked nephrogenic diabetes insipidus, is caused by a mutation in the AVPR2 gene. Because it is hereditary, most patients are male. This report highlights a case of nephrogenic diabetes insipidus in a 3-year 5-month-old female; upon presentation to the hospital, her symptoms included frequent urination and consumption of a significant amount of water, which had begun 2 years ago. The results of blood tests showed increased levels of serum antidiuretic hormone, and sellar magnetic resonance imaging showed no abnormality. The results of the water restriction test and the desmopressin administration test confirmed the diagnosis of nephrogenic di-abetes insipidus showing a partial response to desmopressin. The results of genetic testing indicated the presence of an AVPR2 mutation, a heterozygous missense mutation (p.Val88Met), suggesting inheritance of X-linked nephrogenic diabetes insipidus. This report describes a significant case of symptomatic X-linked nephrogenic diabetes insipidus in a female patient who showed a partial response to desmopressin.
Choi, Yeun Seoung,Lim, Jung Soo,Kwon, Woocheol,Jung, Soon-Hee,Park, Il Hwan,Lee, Myoung Kyu,Lee, Won Yeon,Yong, Suk Joong,Lee, Seok Jeong,Jung, Ye-Ryung,Choi, Jiwon,Choi, Ji Sun,Jeong, Joon Taek,Yoo, The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
최은성,김상하,임정수,권우철,정순희,박일환,이명규,리원연,용석중,이석정,정예령,최지원,최지선,정순택,유진세 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
소아에서 배아종 절제를 위한 개두술 마취 중 발생한 요붕증 처치경험 -증례 보고-
전준표 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.4
Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.
폐 선양낭성암에 동반된 중추성 요붕증으로 발현한 뇌하수체 종양 1예
이강완,함종렬,정정화,강미연,이기동,김현진,정순일 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.3
저자들은 다음, 다뇨의 증상을 호소한 52세 여자환자에서 폐에 원발성으로 발생한 선양낭성암의 전이로 추정되는 뇌하수체 종양에 의한 중추성 요봉증을 경험하였기에 문헌 고찰과 함께 증례 보고하는 바이다. The metastatic tumor occurs in about 6% to 20% of all cases with central diabetes insipidus. Many kinds of cancers such as breast, lung, colon, prostate, leukemia, and lymphoma can metastasize to the pituitary and its stalk. Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease. It is histologically and ultrastructurally identical to salivary gland adenoid cystic tumor and is regarded as a slowly growing, low graded-malignancy. This is a case report of a 52-year-old woman with diabetes insipidus caused by a pituitary tumor that might have been associated with adenoid cystic carcinoma arising in the bronchus. The patient was diagnosed by water deprivation test, chest CT scan, bronchoscopic biopsy, and brain MRI scan. The water deprivation test showed the patient had central diabetes insipidus, while chest CT scan revealed a lung mass lesion with distal right intermediate bronchial obstruction. The primary malignancy was confirmed by bronchoscopic biopsy. Finally, we confirmed that the patient had a 7mm-sized in the posterior pituitary gland and a thickened stalk by brain MRI scan (J Kor Soc Endocrinol 18:311~317, 2003).
다장기에 침범한 쯔쯔가무시 병의 치료 중에 발생한 중추성 요붕증 1례
조은주,박지영,장태원 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1
Tsutsugamushi disease (Scrub typhus) is an acute febrile illness caused by infection with Orientia tsutsugamushi and characterized by focal or disseminated vasculitis, which may involve the lungs, heart, liver and central nervous system. Tsutsugamushi meningitis are reported worldwide, but central diabetes insipidus associated with CNS involvement have not been reported. A 53-year-old female diagnosed with tsutsugamushi disease showed polyuria during therapy with doxycycline. After injection of vasopressin, urine output was decreased and urine osmolarity was increased. So, we diagnosed as central diabetic insipidus. We report a case of central diabetes insipidus occurring during therapy for tsutsugamushi disease.