Clinical, endocrinological and radiological courses in patients who was initially diagnosed as idiopathic central diabetes insipidus

초기에 특발성 중추성 요붕증으로 진단된 환자에서 임상, 내분비학 및 방사선학적 경과

  • Chung, Seung Joon (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Seong Yong (Department of Pediatrics, Seoul Metropolitan Boramae Hospital) ;
  • Shin, Choong Ho (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yang, Sei Won (Department of Pediatrics, Seoul National University College of Medicine)
  • 정승준 (서울대학교 의과대학 소아과학교실) ;
  • 이성용 (서울특별시립 보라매병원) ;
  • 신충호 (서울대학교 의과대학 소아과학교실) ;
  • 양세원 (서울대학교 의과대학 소아과학교실)
  • Received : 2007.09.14
  • Accepted : 2007.10.21
  • Published : 2007.11.15

Abstract

Purpose : Idiopathic central diabetes insipidus (CDI) is defined in CDI patients without definite etiology. Some patients initially diagnosed as idiopathic CDI progressed to organic causes. We reviewed clinical, endocrinological, and radiological courses of 20 patients who was initially diagnosed as idiopathic CDI, to assess the predicting factors for progression to brain tumors. Methods : We reviewed the medical data and followed up their clinical courses in 20 CDI patients who had no definite organic etiology, such as malformation, tumor, at the time of diagnosis. Results : Our study included 15 males and 5 females. Mean age of CDI diagnosis was $7.8{\pm}3.6$ (2.1-14.7) years. Mean follow-up duration was $8.6{\pm}5.1$ (1.5-18) years. Six (30%) patients were diagnosed as brain tumor during follow-up. Ten (50%) of 20 patients had growth hormone deficiency. Multiple pituitary hormone deficiencies were found more frequently in brain tumor patients than idiopathic patients (60% vs 7%, P=0.037). Pituitary stalk thickening (PST) and loss of posterior pituitary signal were observed in 9 patients (47%), respectively. The newly development of PST was observed in patients diagnosed as brain tumor. Conclusion : About 30% of idiopathic CDI patients progress to organic disease such as germ cell tumor or histiocytosis. If there are multiple anterior pituitary hormone deficiency or newly development of PST, more close and careful follow-up is needed.

목 적 : 특별한 원인 없이 발생하는 특발성 중추성 요붕증 중에서 일부는 후에 뇌종양이 발견된다. 이에 저자들은 요붕증 진단 시 특발성 중추성 요붕증으로 진단 받은 20명의 환자들에서 임상적, 방사선학적, 그리고 내분비학적 경과를 추적 관찰하여 기질성 원인으로의 진행 유무를 예측할 수 있는 지표가 있는지 연구하였다. 방 법 : 1984년 1월부터 2006년 12월까지 서울대학교병원에서 중추성 요붕증으로 진단 받았던 환자들 중 뇌 자기공명영상에서 뚜렷한 기질적 원인의 증거가 없었던 20명의 환자들에서 후향적으로 임상소견과 검사소견을 검토하였다. 중추성 요붕증 진단 시 뇌종양, 선천성 중추신경계 기형이 있는 경우는 제외시켰다. 결 과 : 남아 15명, 여아 5명이었고, 진단 시 평균 연령은 $7.8{\pm}3.6$(2.1-14.7)세로, 야뇨증이 11명, 두통이 4명, 구토가 2명에서 있었다. 평균 추적관찰 기간은 $8.6{\pm}5.1$(1.5-18)년 이었다. 추적관찰 도중 뇌종양으로 진단 받은 환자는 6명(30%)이었다(생식세포종 5명, 랑게르한스 조직구증 1명; 추적기간 $2.6{\pm}2.1$년). 성장호르몬결핍증은 10명(50%)에서 관찰되었다. 복합 뇌하수체전엽호르몬결핍은 뇌종양 환자군에서 비뇌종양 환자군에서보다 더 높은 빈도로 관찰되었다(60% vs. 7%, P=0.037). 진단 시 뇌하수체 줄기 비후는 9명(47%), 뇌하수체 후엽 신호 소실은 9명(47%)에서 관찰되었으며, 추적 중 새롭게 뇌하수체 줄기 비후가 생긴 3명의 환자 모두에서 뇌종양이 발생하였다. 결 론 : 특발성 중추성 요붕증 환자의 일부는 추적관찰 중 뇌종양을 발견할 수 있는데, 특히 복합 뇌하수체전엽호르몬결핍증이 동반되거나, 뇌하수체 줄기 비후가 새롭게 발생하는 경우에는 더욱 세심한 뇌종양에 대한 추적관찰이 필요하다.

Keywords

References

  1. Maghnie M. Diabetes insipidus. Horm Res 2003;59 Suppl 1:42-54
  2. Ghirardello S, Garre ML, Rossi A, Maghnie M. The diagnosis of children with central diabetes insipidus. J Pediatr Endocrinol Metab 2007;20:359-75
  3. Saborio P, Tipton GA, Chan JC. Diabetes insipidus. Pediatr Rev 2000;21:122-9 https://doi.org/10.1542/pir.21-4-122
  4. Wang LC, Cohen ME, Duffner PK. Etiologies of central diabetes insipidus in children. Pediatr Neurol 1994;11:273-7 https://doi.org/10.1016/0887-8994(94)90001-9
  5. Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S, et al. Central diabetes insipidus in children and young adults. N Engl J Med 2000;343:998-1007 https://doi.org/10.1056/NEJM200010053431403
  6. De Buyst J, Massa G, Christophe C, Tenoutasse S, Heinrichs C. Clinical, hormonal and imaging findings in 27 children with central diabetes insipidus. Eur J Pediatr 2007;166:43-9 https://doi.org/10.1007/s00431-006-0206-0
  7. Al-Agha AE, Thomsett MJ, Ratcliffe JF, Cotterill AM, Batch JA. Acquired central diabetes insipidus in children: a 12-year Brisbane experience. J Paediatr Child Health 2001; 37:172-5 https://doi.org/10.1046/j.1440-1754.2001.00640.x
  8. Charmandari E, Brook CG. 20 years of experience in idiopathic central diabetes insipidus. Lancet 1999;353:2212-3 https://doi.org/10.1016/S0140-6736(99)00317-7
  9. Mootha SL, Barkovich AJ, Grumbach MM, Edwards MS, Gitelman SE, Kaplan SL, et al. Idiopathic hypothalamic diabetes insipidus, pituitary stalk thickening, and the occult intracranial germinoma in children and adolescents. J Clin Endocrinol Metab 1997;82:1362-7 https://doi.org/10.1210/jc.82.5.1362
  10. Czernichow P, Garel C, Leger J. Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus. Horm Res 2000;53 Suppl 3:61-4 https://doi.org/10.1159/000023536
  11. Yoo JH, Ahn SY, Shin CH, Yang SW. Factors affecting the increments of body mass index in adult survivors of childhood brain tumors. Korean J Pediatr 2004:47:970-7
  12. Lee JB, Kim DH. Clinical study of diabetes insipidus. J Korean Pediatr Soc 1987;30:882-90
  13. Garel C, Leger J. Contribution of magnetic resonance imaging in non-tumoral hypopituitarism in children. Horm Res 2007;67:194-202 https://doi.org/10.1159/000097755
  14. Maghnie M, Villa A, Arico M, Larizza D, Pezzotta S, Beluffi G, et al. Correlation between magnetic resonance imaging of posterior pituitary and neurohypophyseal function in children with diabetes insipidus. J Clin Endocrinol Metab 1992;74:795-800 https://doi.org/10.1210/jc.74.4.795
  15. Maghnie M, Genovese E, Bernasconi S, Binda S, Arico M. Persistent high MR signal of the posterior pituitary gland in central diabetes insipidus. Am J Neuroradiol 1997;18: 1749-52
  16. Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, et al. Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus. N Engl J Med 1993;329:683-9 https://doi.org/10.1056/NEJM199309023291002
  17. Maghnie M, Ghirardello S, De Bellis A, di Iorgi N, Ambrosini L, Secco A, et al. Idiopathic central diabetes insipidus in children and young adults is commonly associated with vasopressin-cell antibodies and markers of autoimmunity. Clin Endocrinol (Oxf) 2006;65:470-8.+ https://doi.org/10.1111/j.1365-2265.2006.02616.x