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Diagnosis and Treatment of Diabetes Insipidus in Childhood.

Journal of the Korean Pediatric Society 1987;30(7):749-758.
Published online July 31, 1987.
Diagnosis and Treatment of Diabetes Insipidus in Childhood.
Yong Hoom Park, Jin Sang Son, Jeong Ok Hah
Department of Pediatrics, College of Medicine, Yeung Nam University, Taegu, Korea
소아 뇨붕증의 진단 및 치료
박용훈, 손진상, 하정옥
영남대학교 의과대학 소아과학교실
Abstract
In eight cases of diabetes insipidus who were diagnosed at the pediatric department of Yeungnam University Hospital from July 1985 till May 1986, the levels of plaana AVP were measured by radioimmunoassay and the effects of various treatment were studied. In central diabetes insipidus patients basal plasma AVP level was 2.92 ±2.55 pg/ml which was significantly lower than the level of control group, 8.25 ±3.03 (p<0.01) and it was 1.60 ±0.36 pg/ml, not increased, after water deprivation. But in germinoma patient plasma AVP level was 7.88 pg/ml and it was considered to be due to partial deficiency of ADH of increased intracranial pressure. In nephrogenic diabetes insipidus patients basal plasma AVP level was 37.24 pg/ml and it increased significantly to 39.94 pg/ml after water deprivation. The levels of plasma AVP according to the changes of serum osmolality correlated significantly in control groups (p< 0.005) but they remained low regardless the changes of serum osmolality in central diabetes insipidus and they were high in nephrogenic diabetes insipidus. The ratios of plasma AVP to serum sodium and osmolality respectively were significantly low in central diabetes insipidus patients comparing to control group (p<0.01) but they were high in nephrogenic diabetes insipidus. Thus measurement of plasma AVP level not only helped in making the diagnosis of diabetes insipidus but also helped in differentiating between central diabetes insipidus and nephrogenic diabetes insipidus. Especially it was useful in accurate diagnosis of diabetes insipidus with partially deficient ADH which was difficult to diagnose by water deprivation and pitressin test alone. Among 7 patients with central diabetes insipidus, 3 patients of meningoencephalitis, hypoxic encephalopathy and germinoma respectively had markedly reduced amount of urine after pitressin injection but other 4 patients had remarkable effect with the use of DDAVP. Nephrogenic diabetes insipidus patient had some benefit from the theraphy with hydrochlorthiazide and tolmetin sodium.
Key Words: Diabetes insipidus, Plasma arginine vasopressin.


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