Central Diabetes Insipidus: A Previously Unreported Side Effect of Temozolomide
Central Diabetes Insipidus: A Previously Unreported Side Effect of Temozolomide
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DOI：
10.1210/jc.2013-2435
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发表时间：
2013-10-01
影响因子：
5.8
通讯作者：
Makimura, Hideo
中科院分区：
文献类型：
--
作者：
Faje, Alexander T.;Nachtigall, Lisa;Makimura, Hideo
背景：替莫唑胺(TMZ)是一种烷化剂，主要用于治疗中枢神经系统肿瘤。我们描述了2例明显的TMZ诱发的中枢性尿崩症患者。使用我们机构的研究患者数据库注册表，我们在接受TMZ治疗的1545名患者中发现了另外3例潜在的TMZ诱发尿崩症。病例介绍：1名53岁的男性少星形细胞瘤和1名38岁的男性少突胶质瘤患者在接受TMZ治疗约2个月后分别出现多饮和多尿的症状。实验室分析显示高钠血症和尿液浓缩缺陷，与尿崩症的存在一致，患者成功地接受了醋酸去氨加压素的治疗。停用TMZ后停用醋酸去氨加压素，尿崩症未复发。两例患者的脑垂体和下丘脑的磁共振成像均未发现明显的异常，但均未发现脑下垂体后叶亮点。两例患者的垂体前叶功能检查均正常。使用研究患者数据库注册表数据库，我们确定了2个指示性尿崩症病例和3个额外的潜在尿崩症病例，估计患病率为0.3%(每1545名服用TMZ的患者中有5例尿崩症)。结论：中枢性尿崩症是TMZ治疗的一种罕见但可逆的副作用。
Context: Temozolomide ( TMZ) is an alkylating agent primarily used to treat tumors of the central nervous system. We describe 2 patients with apparent TMZ-induced central diabetes insipidus. Using our institution's Research Patient Database Registry, we identified 3 additional potential cases of TMZ-induced diabetes insipidus among a group of 1545 patients treated with TMZ.Case Presentations: A 53-year-old male with an oligoastrocytoma and a 38-year-old male with an oligodendroglioma each developed symptoms of polydipsia and polyuria approximately 2 months after the initiation of TMZ. Laboratory analyses demonstrated hypernatremia and urinary concentrating defects, consistent with the presence of diabetes insipidus, and the patients were successfully treated with desmopressin acetate. Desmopressin acetate was withdrawn after the discontinuation of TMZ, and diabetes insipidus did not recur. Magnetic resonance imaging of the pituitary and hypothalamus was unremarkable apart from the absence of a posterior pituitary bright spot in both of the cases. Anterior pituitary function tests were normal in both cases. Using the Research Patient Database Registry database, we identified the 2 index cases and 3 additional potential cases of diabetes insipidus for an estimated prevalence of 0.3% ( 5 cases of diabetes insipidus per 1545 patients prescribed TMZ).Conclusions: Central diabetes insipidus is a rare but reversible side effect of treatment with TMZ.