Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Enuresis as a Presenting Symptom of Graves' Disease: A Case Report

  • Hwang, Inseong (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Eujin (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Hye Jin (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center)
  • Received : 2021.02.01
  • Accepted : 2021.03.19
  • Published : 2021.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Enuresis is intermittent urinary incontinence during sleep at night in children aged 5 years or older. The main pathophysiology of enuresis involves nocturnal polyuria, abnormal sleep arousal, and low functional bladder capacity. In rare cases, enuresis is an early symptom of endocrine disorders such as diabetes or thyroid disorders. Herein, we report a case of a 12-year-old girl with enuresis as a rare initial presentation of Graves' disease. She complained of nocturnal enuresis from a month before visiting our clinic. She also complained of urinary frequency, headache, and weight loss. On physical examination, she had tachycardia, intention tremors, and a diffuse goiter on her anterior neck with bruit on auscultation. Her thyroid function test results revealed hyperthyroidism, and Graves' disease was diagnosed as the thyroid stimulating hormone receptor autoantibody was positive. After treatment for Graves' disease with methimazole, symptoms of enuresis resolved within 2 weeks as she became clinically and biochemically euthyroid. In children with secondary enuresis, Graves' disease should be considered as a differential diagnosis, and signs of hyperthyroidism should be checked for carefully.

Keywords

References

  1. Neveus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol 2020;16:10-9. https://doi.org/10.1016/j.jpurol.2019.12.020
  2. Kim MU, Kim SY, Choi JY, Cho MH, Ko CW, Kim HS, et al. Clinical features of enuresis in children with diabetes mellitus. J Korean Soc Pediatr Nephrol 2010;14:210-7. https://doi.org/10.3339/jkspn.2010.14.2.210
  3. Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med 2009;360:1429-36. https://doi.org/10.1056/NEJMcp0808009
  4. Nevo A, Mano R, Livne PM, Sivan B, Ben-Meir D. Urinary retention in children. Urology 2014;84:1475-9. https://doi.org/10.1016/j.urology.2014.08.020
  5. World Health Organization. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 3rd ed. Geneva: World Health Organization; 2007.
  6. Goldyn AK, Eugster EA, Nebesio TD. Serendipitous identification of Graves' disease in identical twins with polydipsia. J Pediatr Endocrinol Metab 2010;23:1335-7. https://doi.org/10.1515/jpem.2010.208
  7. Meir J, Roessner D, Eggert P. Enuresis in hyperthyroidism: a temporary lack of central control mechanism leads to nocturnal enuresis. Acta Paediatr 2010;99:145-6.
  8. Lopez M, Alvarez CV, Nogueiras R, Dieguez C. Energy balance regulation by thyroid hormones at central level. Trends Mol Med 2013;19:418-27. https://doi.org/10.1016/j.molmed.2013.04.004
  9. Goswami R, Seth A, Goswami AK, Kochupillai N. Prevalence of enuresis and other bladder symptoms in patients with active Graves' disease. Br J Urol 1997;80:563-6. https://doi.org/10.1046/j.1464-410X.1997.00426.x
  10. Muthukrishnan J, Saurabh D. An unusual cause of polyuria. Indian J Endocrinol Metab 2012;16:1051-2. https://doi.org/10.4103/2230-8210.103042
  11. Wang W, Li C, Summer SN, Falk S, Schrier RW. Polyuria of thyrotoxicosis: downregulation of aquaporin water channels and increased solute excretion. Kidney Int 2007;72:1088-94. https://doi.org/10.1038/sj.ki.5002475