Analysis Of One Case Of Central Diabetes Insipidus Secondary To Intracranial Germinoma And Review Of The Associated Literature

Objective : To summarized the clinical symptoms,pathogenesis,laboratory inspection and the imageological examination characteristics of central diabetes insipidus(CDI) secondary to intracranial germinoma(IG),strengthened the understanding and awareness of this disease and improved the thetreatment level,which can avoid delay treatment.Methods: Review a case of patient who was hospitalized for three times during 2006 to 2014 due to his CDI secondary to IG,analyze his clinical features, laboratory test result, neuroimaging characteristics, etc, combine the literature review and draw a conclusion to the diagnosis,treatment and prognosis materials of the disease.Results: A man of 27 years old was hospitalized 8 years ago with original symptoms of thirst, polydipsia and polyuria. According to the inspection after admission, it was found that the urine volume was about 10000ml/d, the repeatedly measured urine specific gravity fluctuated btween 1.00~1.002 and the urine osmotic pressure(UOP) was up to 262 m Osm/kg·H2O. After the water deprivation-vasopressin test, the urine volume did not reduce, the urine specific gravity was still low and the UOP was 297 m Osm/kg·H2O. After the treatment of pituitary vasopressin 5u subcutaneous for 2h, the urine volume significantly reduced, the UOP was 419 m Osm/kg·H2O increasing by 56.39%(>50%) compared with that before drug treatment, so the patient was diagnosed with CDI. Besides, the cranial CT did not showed any abnormalities,so it is considered as idiopathic CDI. Therefore, he was asked to have desmopressin acetate 0.1mg tablets twice a day to supplement antidiuretic hormone and leave the hospital after the symptoms alleviated.The above symptom aggravated two years ago, the saddle area MRI in the hospital showed pituitary stalk thickened and there were irregular nodules above pituitary with size of about 1.47x1.7cm;β-HCG 6.95μIU/ml↑, so the patient was diagnosed with CDI secondary to IG,after the radiotherapy in other hospitals, polydipsia and polyuria symptoms once reduced, but beard, pubic hair fell off.Two months ago, polydipsia and polyuria symptom recurred,daily urine volume was about 5000~6000ml, being accompanied by the whole body fatigue, so the patients received treatment in the hospital once again.the complaint included occasional dizziness,nausea,ACTH 3.95pg/ml↓,Cor 1.59nmol/L↓,it was conforming the pituitaryadrenal insuf;TSH 5.23 m IU/ml↑,FT3 2.27pmol/L↓,FT4 4.57pmol/L↓,accorded with adenohypophysis-thyroid axis insuf;testosterone<0.025ng/ml↓,LH<0.100 m IU/ml↓, FSH 0.32 m IU/ml↓, accorded with pituitary-testicular hypofunction. Above all, the patient was diagnosed with hypothalamus-pituitary hypofunction and it was considered the disease cause was radiotherapy. The urine specific gravity 1.002, the review of saddle area MRI showed no obvious abnormity,so it was considered as the recurrence of CDI by combining with the medical history,The cause of disease is radiation therapy.Oral DDAVP was given to supplement vasopressin;oral prednisone acetate tablets were given to supplement glucocorticoid oral levothyroxine tablets were given to supplement thyroxine;intramuscular injection of HCG was conduced to promote Testosterone secretion the patients discharged from the hospital after symptoms improved.Follow-up after discharging from hospital for 5 months,polydipsia and polyuria symptoms were basically controlled,fatigue symptoms significantly alleviated.The reviewed blood testosterone 4.91ng/ml;TSH 0.03μIU/ml and FT4 16.47pmol/L,basically became normal,the patient demanded fertility, but it still remained to be seen.Conclusions:1. For young children or unknown etiology in patients with CDI, people should be alert whether it is caused by IG,regular β–HCG and saddle area MRI or CT should be tested by routine,regularly review head MRI or CT when necessary to make clear the cause,and take reasonable treatment measures, avoid missed diagnosis and misdiagnosis.2.IG is sensitive to radiation therapy, but treatment itself may cause damage to the pateerents pituitary, so after the treatment, function of the pituitary gland and its gland should be monitored so as not to reciprocal.