Hypodipsic hypernatremia with intact AVP response to non-osmotic stimuli induced by hypothalamic tumor: A case report.
10.3346/jkms.2001.16.5.677
- Author:
Mi Ja KANG
1
;
Kun Ho YOON
;
Seong Su LEE
;
Jung Min LEE
;
You Bae AHN
;
Sang Ah CHANG
;
Moo Il KANG
;
Bong Yun CHA
;
Kwang Woo LEE
;
Ho Young SON
;
Sung Koo KANG
;
Yong Kil HONG
Author Information
1. Departments of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Hypodipsic;
Hypernatremia;
Argipressin;
Hypothalamic Neoplasms
- MeSH:
Adult;
Argipressin/*secretion;
Case Report;
Human;
Hypernatremia/*etiology;
Hypothalamic Neoplasms/*metabolism;
Male;
Osmolar Concentration;
*Thirst
- From:Journal of Korean Medical Science
2001;16(5):677-682
- CountryRepublic of Korea
- Language:English
-
Abstract:
Anatomical lesions of hypothalamic area associated with hypodipsic hypernatremia have been reported only rarely. We report here a case of hypodipsic hypernatremia induced by a hypothalamic lesion. A 25-yr-old man, who had been treated with radiation for hypothalamic tumor 5-yr before, was admitted for evaluation of hypernatremia and hypokalemia. He never felt thirst despite the elevated plasma osmolality and usually refused to drink intentionally. Plasma arginine vasopressin (AVP) level was normal despite the severe hypernatremic hyperosmolar state and urine was not properly concentrated, while AVP secretion was rapidly induced by water deprivation and urine osmolality also progressively increased to the near maximum concentration range. All of these findings were consistent with an isolated defect in osmoregulation of thirst, which was considered as the cause of chronic hypernatremia in the patient without an absolute deficiency in AVP secretion. Hypokalemia could be induced by activation of the renin-angiotensin-aldosterone system as a result of volume depletion. However, inappropriately low values of plasma aldosterone levels despite high plasma renin activity could not induce symptomatic hypokalemia and metabolic alkalosis. The relatively low serum aldosterone levels compared with high plasma renin activity might result from hypernatremia. Hypernatremia and hypokalemia were gradually corrected by intentional water intake only.
