| Diagnosis and Treatment of Diabetes Insipidus in Childhood. |
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Yong Hoom Park, Jin Sang Son, Jeong Ok Hah |
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Department of Pediatrics, College of Medicine, Yeung Nam University, Taegu, Korea |
| 소아 뇨붕증의 진단 및 치료 |
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박용훈, 손진상, 하정옥 |
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영남대학교 의과대학 소아과학교실 |
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| Abstract |
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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.
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| Key Words:
Diabetes insipidus, Plasma arginine vasopressin. |
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