儿童颅咽管瘤水钠失衡与下丘脑垂体功能异常的关系

The relationship of water and sodium imbalance to hypothalamic pituitary dysfunction in children with craniopharyngiomas

目的探讨儿童颅咽管瘤患者水钠失衡的特点及其与下丘脑-垂体-靶腺轴功能异常的关系。方法回顾性分析2015年1月至2019年1月首都医科大学附属北京天坛医院内分泌科收治的102例肿瘤切除术后儿童颅咽管瘤患者的临床资料。评估手术前、后的下丘脑-垂体-靶腺轴功能变化和水钠异常情况,分析水钠失衡与下丘脑垂体功能异常的关系。结果102例患儿中,术前存在中枢性尿崩症(CDI)38例(37.3%)、垂体-甲状腺轴受损(IPTA)41例(40.2%)、垂体-肾上腺轴受损(IPAA)35例(34.3%)、高钠血症35例(34.3%)、低钠血症6例(5.9%);术后CDI 76例(74.5%)、IPTA 88例(86.3%)、IPAA 82例(80.4%)、高钠血症60例(58.8%)、低钠血症16例(15.7%),与术前相比,差异均有统计学意义(均P<0.05)。术后血清皮质醇、游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素水平均较术前下降(均P≤0.01)。无论术前、术后,合并CDI、IPTA、IPAA的患者其高钠血症、低钠血症、正常血钠所占比率的差异均有统计学意义(均P<0.05),且血钠异常均以高钠血症所占比例最高。结论儿童颅咽管瘤患者术前即存在水钠失衡,术后水钠失衡的发生比率较术前明显增加。合并CDI、IPTA、IPAA患儿的血钠异常以高钠血症为主。

Objective To explore the characteristics of water and sodium imbalance in children with craniopharyngiomas and its relationship with the dysfunction of hypothalamus and hypophysis.Methods From January 2015 to January 2019,the clinical data of 102 children with craniopharyngioma admitted to Department of Endocrinology,Beijing Tiantan Hospital,Capital Medical University were retrospectively analyzed.All the children underwent surgery prior to their admission.The conditions of pituitary target gland axis function and water and sodium abnormalities were evaluated before and after surgery,and the relationship between the imbalance of sodium and water and the abnormal function of hypothalamus and pituitary was analyzed.Results Among 102 children,38(37.3%)cases had central diabetes insipidus(CDI),41(40.2%)cases had impaired pituitary-thyroid axis(IPTA),35(34.3%)cases had impaired pituitary-adrenal axis(IPAA),35(34.3%)cases had hypernatremia,and 6(5.9%)cases had hyponatremia before operation.There were 76(74.5%)cases of CDI,88(86.3%)cases of IPTA,82(80.4%)cases of IPAA,60(58.8%)cases of hypernatremia,and 16(15.7%)cases of hyponatremia post operation.The differences between the ratios before and after operation were statistically significant(all P<0.05).The levels of serum cortisol,free triiodothyronine,free thyroxine and thyroid stimulating hormone decreased after operation compared to those before operation(all P≤0.01).The ratios of hypernatremia,hyponatremia and normal blood sodium in patients with CDI,IPTA and IPAA were different either prior to operation or post operation(all P<0.05),and hypernatremia accounted for the highest proportion of the blood sodium abnormality.Conclusions In children with craniopharyngiomas,the imbalance of water and sodium exists before operation,and the incidence after operation seems significantly higher than that before operation.Hypernatremia is the main abnormal blood sodium in patients with CDI,IPTA and IPAA.