Aggiornamento monografico
Il diabete insipido centrale: più luci e meno ombre
CENTRAL DIABETES INSIPIDUS: A STEP FORWARD
MOHAMAD MAGHNIE
Clinica Pediatrica dell’Università di Pavia, IRCCS Policlinico S. Matteo, Pavia
Giugno 2001 - pagg. 361 -368
Abstract
Diabetes insipidus is a multifactorial disease caused by the lack of secretion of vasopressin,
its physiologic suppression following excessive water intake, or kidney resistance to its action.
The clinical and laboratory diagnosis is confirmed by standard tests, but recent advances
in molecular biology and imaging techniques have shed a new light on the physiopathological
aspects. Magnetic resonance imaging (MRI) allowed identification of the posterior
pituitary gland in vivo and hypothalamic-pituitary abnormalities. The lack of posterior
pituitary hyperintensity at MRI is the hallmark of hypothalamic-posterior pituitary disorders
and may represent the early stage of occult local tumors. Evidence of posterior pituitary
hyperintensity does not necessarily indicate that functional integrity of the hypothalamic-
neurohypophyseal axis is preserved. Thickened pituitary stalk is a common finding of
several local inflammatory and autoimmune diseases or germinoma. A progressive increase
in the size of the anterior pituitary gland should alert physicians to the possibility that a
germinoma is present, whereas a decrease can suggest the presence of an inflammatory or
autoimmune process. Most children with acquired central diabetes insipidus have abnormal
findings on MRI, which may change over time, and at least half develope anterior pituitary
hormone deficiencies.
Parole chiave
Anterior pituitary gland
Central diabetes insipidus
Diabete insipido centrale
Ghiandola pituitaria anteriore
Iperintensità dell'ipofisi posteriore
Iperintensità della ipofisi posteriore
Magnetic resonance imaging
peduncolo ipofisario
Pituitary stalk
Posterior pituitary hyperintensity
risonanza magnetica
Classificazione MeSH
Bibliografia
1. Mootha SL, Barkovich AJ, Grumbach MM,
et al. Idiopathic hypothalamic diabetes insipidus,
pituitary stalk thickening, and the occult
intracranial germinoma in children and adolescents.
J Clin Endocrinol Metab 1997;
82:1362-7.
2. Maghnie M, Villa A, Aricò M, et al. Correlation between magnetic resonance imaging of posterior pituitary and neurohypophyseal function in children with diabetes insipidus. J Clin Endocrinol Metab 1992;74:795-800.
3. Maghnie M, Aricò M, Villa A, et al. MR of the hypothalamic-pituitary axis in Langerhans cell histiocytosis. Am J Neuroradiol 1993;13:1365-71.
4. Imura H, Nakao K, Shimatsu A, et al. Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus. N Engl J Med 1993;329:683-9.
5. Maghnie M, Genovese E, Sommaruga MG, et al. Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: Is “lymphocytic infundibulo- neurohypophysitis” in children a different entity? Eur J Endocrinol 1998;139: 635-40.
6. Verbalis JG, Robinson AG, Moses AM. Postoperative and post-traumatic diabetes insipidus. Front Horm Res 1985;13:247-65.
7. Robinson AG, Fitzsimmons MD. Diabetes insipidus. Advance Endocrinol Metab 1994; 5:261-96.
8. Robertson GL. Diabetes insipidus. Endocrinol Metab Clinics North Am 1995;24:549- 72.
9. Maghnie M. Le cause della sete intensa: recenti acquisizioni sul diabete insipido. Medico e Bambino 1996;7:428-34.
10. Leger J, Velasquez A, Garel C, Hassan M, Czernichow P. Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus. J Clin Endocrinol Metab 1999;84:1954-60.
11. Maghnie M, Cosi G, Genovese E, et al. Central diabetes insipidus in children and young aduts. N Engl J Med 2000;343:998- 1007.
12. Tien R, Kucharczyk J, Kucharczyk W. MR imaging of the brain in patients with Diabetes insipidus. Am J Neuroradiol 1991;12: 533-42.
13. Fujisawa I, Asato R, Okumura R, et al. Magnetic resonance imaging of neurohypophyseal germinomas. Cancer 1991;68: 1009-14.
14. Hansen LK, Rittig S, Robertson GL. Genetic basis of familial neurohypophyseal diabetes insipidus. Trends Endocrinol Metab 1997;8:363-72.
15. Blotner H. Primary or idiopathic diabetes insipidus: a system disease. Metabolism 1958;3:191-200.
16. Bode HH. Disorders of posterior pituitary. In: Kaplan SA, (ed). Clinical Pediatric Endocrinology. Philadelphia: WB Saunders, 1990:63-86.
17. Pomerade R, Czernichow P, Rappaport R, et al. Le diabète pitresso-sensible de l’enfant. Arch Fr Pédiatr 1980;37:37-44.
18. Czernichow P, Pomarede R, Brauner R, Rappaport R. Neurogenic diabetes insipidus in children. Front Horm Res 1985;13:190-209.
19. Greger NG, Kirkland RT, Clayton GW, Kirkland JL. Central diabetes insipidus: 22 years experience. Am J Dis Child 1986; 140:551-4.
20. Wang LC, Cohen ME, Duffner PK. Etiologies of central diabetes insipidus in children. Pediatr Neurol 1994;11:273-7.
21. Maghnie M, Genovese E, Aricò M, et al. Evolving pituitary hormone deficiency is associated with pituitary vasculopathy: dynamic MR study in children with hypopituitarism, diabetes insipidus, and Langerhans cell histiocytostis. Radiology 1994;193:493-9.
22. Sklar CA, Grumbach MM, Kaplan SL, Conte AF. Hormonal and metabolic abnormalities associated with central nervous system germinoma in children and adolescents and the effect of therapy: report of 10 patients. J Clin Endocrinol Metab 1981;52:9-16.
23. Czernichow P, Pomarede R, Basmaciogullari A, Brauner R, Rappaport R. Diabetes insipidus in children. Anterior pituitary dysfunction in idiopathic types. J Pediatr 1985; 106:41-4.
24. Brooks BS, El Gammal T, Allison JD, Hoffmann WH. Frequency and variation of the posterior pituitary bright signal on MR images. Am J Neuroradiol 1989;153:1033-8.
25. Maghnie M, Sommaruga MG, Beluffi G, Severi F. Role of MR imaging in the evaluation of the functional status of the posterior pituitary gland: the view of a Pediatric endocrinologist. Am J Neuroradiol 1993;14:1443-5.
26. Miller WL. Molecular genetics of familial central diabetes insipidus. J Clin Endocrinol Metab,1993;77:592-5.
27. Mena W, Royal S, Pass RF, Whitley RJ, Philips III JB. Diabetes insipidus associated with symptomatic congenital cytomegalovirus infection. J Pediatr 1993;122:911-3.
28. Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S. Clinical case seminar: Lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab 1995;80:2302-11.
29. Ahmed SR, Aiello DP, Page R, Hopper K, Towfighi J, Santen RJ. Necrotizing infundibulo- hypophysitis: a unique syndrome of diabetes insipidus and hypopituitarism. J Clin Endocrinol Metab 1993;76:1499-504.
30. Halimi R, Sigal D, Doyon S, et al. Posttraumatic diabetes insipidus: MR demonstration of pituitary stalk rupture. J Comp Assist Tomogr 1988;12:135-7.
31. Maghnie M, Genovese E, Bernasconi S, Binda S, Aricò M. Persistent high MR signal of the posterior pituitary gland in central diabetes insipidus. Am J Neuroradiol 1997;18: 1749-52.
2. Maghnie M, Villa A, Aricò M, et al. Correlation between magnetic resonance imaging of posterior pituitary and neurohypophyseal function in children with diabetes insipidus. J Clin Endocrinol Metab 1992;74:795-800.
3. Maghnie M, Aricò M, Villa A, et al. MR of the hypothalamic-pituitary axis in Langerhans cell histiocytosis. Am J Neuroradiol 1993;13:1365-71.
4. Imura H, Nakao K, Shimatsu A, et al. Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus. N Engl J Med 1993;329:683-9.
5. Maghnie M, Genovese E, Sommaruga MG, et al. Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: Is “lymphocytic infundibulo- neurohypophysitis” in children a different entity? Eur J Endocrinol 1998;139: 635-40.
6. Verbalis JG, Robinson AG, Moses AM. Postoperative and post-traumatic diabetes insipidus. Front Horm Res 1985;13:247-65.
7. Robinson AG, Fitzsimmons MD. Diabetes insipidus. Advance Endocrinol Metab 1994; 5:261-96.
8. Robertson GL. Diabetes insipidus. Endocrinol Metab Clinics North Am 1995;24:549- 72.
9. Maghnie M. Le cause della sete intensa: recenti acquisizioni sul diabete insipido. Medico e Bambino 1996;7:428-34.
10. Leger J, Velasquez A, Garel C, Hassan M, Czernichow P. Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus. J Clin Endocrinol Metab 1999;84:1954-60.
11. Maghnie M, Cosi G, Genovese E, et al. Central diabetes insipidus in children and young aduts. N Engl J Med 2000;343:998- 1007.
12. Tien R, Kucharczyk J, Kucharczyk W. MR imaging of the brain in patients with Diabetes insipidus. Am J Neuroradiol 1991;12: 533-42.
13. Fujisawa I, Asato R, Okumura R, et al. Magnetic resonance imaging of neurohypophyseal germinomas. Cancer 1991;68: 1009-14.
14. Hansen LK, Rittig S, Robertson GL. Genetic basis of familial neurohypophyseal diabetes insipidus. Trends Endocrinol Metab 1997;8:363-72.
15. Blotner H. Primary or idiopathic diabetes insipidus: a system disease. Metabolism 1958;3:191-200.
16. Bode HH. Disorders of posterior pituitary. In: Kaplan SA, (ed). Clinical Pediatric Endocrinology. Philadelphia: WB Saunders, 1990:63-86.
17. Pomerade R, Czernichow P, Rappaport R, et al. Le diabète pitresso-sensible de l’enfant. Arch Fr Pédiatr 1980;37:37-44.
18. Czernichow P, Pomarede R, Brauner R, Rappaport R. Neurogenic diabetes insipidus in children. Front Horm Res 1985;13:190-209.
19. Greger NG, Kirkland RT, Clayton GW, Kirkland JL. Central diabetes insipidus: 22 years experience. Am J Dis Child 1986; 140:551-4.
20. Wang LC, Cohen ME, Duffner PK. Etiologies of central diabetes insipidus in children. Pediatr Neurol 1994;11:273-7.
21. Maghnie M, Genovese E, Aricò M, et al. Evolving pituitary hormone deficiency is associated with pituitary vasculopathy: dynamic MR study in children with hypopituitarism, diabetes insipidus, and Langerhans cell histiocytostis. Radiology 1994;193:493-9.
22. Sklar CA, Grumbach MM, Kaplan SL, Conte AF. Hormonal and metabolic abnormalities associated with central nervous system germinoma in children and adolescents and the effect of therapy: report of 10 patients. J Clin Endocrinol Metab 1981;52:9-16.
23. Czernichow P, Pomarede R, Basmaciogullari A, Brauner R, Rappaport R. Diabetes insipidus in children. Anterior pituitary dysfunction in idiopathic types. J Pediatr 1985; 106:41-4.
24. Brooks BS, El Gammal T, Allison JD, Hoffmann WH. Frequency and variation of the posterior pituitary bright signal on MR images. Am J Neuroradiol 1989;153:1033-8.
25. Maghnie M, Sommaruga MG, Beluffi G, Severi F. Role of MR imaging in the evaluation of the functional status of the posterior pituitary gland: the view of a Pediatric endocrinologist. Am J Neuroradiol 1993;14:1443-5.
26. Miller WL. Molecular genetics of familial central diabetes insipidus. J Clin Endocrinol Metab,1993;77:592-5.
27. Mena W, Royal S, Pass RF, Whitley RJ, Philips III JB. Diabetes insipidus associated with symptomatic congenital cytomegalovirus infection. J Pediatr 1993;122:911-3.
28. Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S. Clinical case seminar: Lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab 1995;80:2302-11.
29. Ahmed SR, Aiello DP, Page R, Hopper K, Towfighi J, Santen RJ. Necrotizing infundibulo- hypophysitis: a unique syndrome of diabetes insipidus and hypopituitarism. J Clin Endocrinol Metab 1993;76:1499-504.
30. Halimi R, Sigal D, Doyon S, et al. Posttraumatic diabetes insipidus: MR demonstration of pituitary stalk rupture. J Comp Assist Tomogr 1988;12:135-7.
31. Maghnie M, Genovese E, Bernasconi S, Binda S, Aricò M. Persistent high MR signal of the posterior pituitary gland in central diabetes insipidus. Am J Neuroradiol 1997;18: 1749-52.