The Causes And Follow-up Of Central Diabetes Insipidus In Children

Background Central Diabetes insipidus(CDI) is caused by a variety of disease or trauma,tumor involvement of the neuroendocrine hypothalmo-neurohypophysial system(pituitary hypothalamus,pituitary stalk and neurohypophysis).Central diabetes insipidus could have the main clinical manifestations such as polydipsia,polyuria,polydipsia,low specific gravity and hypotonic of urine due to deficiency in synthesis and/or secretion of antidiuretic hormone(ADH).Central diabetes insipidus patients can also associate with single growth hormone deficiency disease or multiple pituitary hormone deficiency which caused by anterior pituitary function deficiency.And then,it could have influence on children^ growth and development.Therefore,it is useful to find the causes early and to have some new insight into the pathogenesis and therapy of central diabetes insipidus,especially when associate with anterior pituitary hormone deficiency.With the development of laboratory examination and imaging examination,diagnosis and etiology for central diabetes insipidus has become mature,especially MRI examination of the hypothalamic pituitary region can visually display the abnormal area and adjacent structures and lesions of the hypothalamo neurohypophysial system,which plays an irreplaceable role in the etiological diagnosis.As we know,it is difficult to display the posterior pituitary and pituitary stalk clearly in the conventional MRI examination.However,the application of fast high resolution T1 weighted three-dimensional magnetization prepared rapid gradient echo sequence will likely meet the clinical requirements.So,we used this sequence to study its diagnostic value for central diabetes insipidus,and explored the relationship between clinical and imaging in order to provide help for clinical treatment and evaluation.Objective The aim was to evaluate the qualitative and semi-quantitative diagnostic value of MRI on central diabetes insipidus in children And,the correlation between central diabetes insipidus and hypopituitarism and MRI changing of the hypothalamic-pituitary region.It have showed helpful and useful for the diagnosis and treatmeant.Methods79 patients with central diabetes insipidusbe hospitalized from July 2012 to March 2017 and 43 healthy children were studied.All cases underwent MR examination including T1-weighted three-dimensional magnetization-prepared rapid gradient-echo imaging(T1lWI-3D-MPRAGE)sequences.We collected the information about the volume of pituitary,the signal intensity of posterior pituitary,the morphology of pituitary stalk after measurement and analysed the difference between the two groups.The patient history,urine analysis,the image evaluation of hypothalamic-pituitary region and hormones detection also were recorded.We analysed the changing of hypothalamic-pituitary region on MR imaging of the patients with central diabetes insipidus associated with hypopituitarism.Results?The age and gender of the central diabetes insipidus group were similar to the control group,while the height and BMI of people in the central diabetes insipidus group were lower than the control group,and the urine volume in 24 hours were higher in the central diabetes insipidus group.The signal intensity of posterior pituitary were bright in the control group,while the volume of pituitary were smaller in central diabetes insipidus group.There were 44 cases with morphological change of pituitary stalk among the79 cases central diabetes insipidus,including 33 cases with pituitary stalk interruption and 11 cases with pituitary stalk thickening.?The main clinical signs and symptoms was polydipsia and duresis(79 cases),short stature,vomiting,et al.7 cases followed by progressive loss of vision,onset of headache.There were 25 cases of craniopharyngioma,17 cases of intracranial germ cell tumor(icGCT),2 cases of Langerhans Cell Histiocytosis.33 cases of pituitary stalk interruption syndrome(PSIS) with the bright of posterior pituitary disappeared,2 cases of idiopathic central diabetes insipidus among the 79 central diabetes insipidus patients.All patients were confirmed by water-deprivation vasopressin test.?There were 44 cases associated with hypopituitarism among the central diabetes insipidus patients,including 33 cases of PSIS with multiple pituitary hormone deficiencies(MPHD).We found 11 cases were isolated growth hormone deficiency(IGHD).33 cases were hypothyroidism,20 cases were hypogonadotrophic hypogonadism,30 cases were adrenal insufficiency and 11 cases with prolactin reduction.The volume of pituitary were smaller in MPHD resulted from PSIS patients than the IGHD patients.2 patients with mental retardation were MPHD.Conclusions?The high signal intensity of the posterior lobe and the pituitary stalk clearly displayed on T1WI-3D MP RAGE images.?The signal intensity ratio of the posterior lobe,the measurement of pituitary volume and the morphology assessment of pituitary stalk on T1WI-3D MP RAGE images provided help to the diagnosis of patients with central diabetes insipidus.?The thiched pituitary stalk in the The patients with central diabetes insipidus need follow-up and biomarker of tumor such as beta-HCG are helpful for etiological differencial diagnosis.?The central diabetes insipidus patients associated with MPHD show pituitary stalk interrupted comepletely or the pituitary stalk thickened middle and seriously on MR images and result from intracranial tumor.