Central Diabetes Insipidus: An Unusual Initial Presentation of Lung Cancer

肺癌最初以中樞性尿崩症為表現的實為罕見。這些患者通常合併有其它中樞神經系統的症狀。我們在此報告一個病例：一位五十四歲的男性，主訴多尿已三個月，住院接受理學及神經學檢查皆正常。經限水試驗(water deprivation test)證實是中樞性尿崩症(central diabetes insipidus)。腦部核磁共振影像發現多處轉移性病灶，包括一位於腦垂腺後葉的病變。胸部X光片看到一左上肺葉結節。電腦斷層導引細針切片術證實它是肺腺癌。之後患者接受desmopressin鼻噴劑，數碼導航刀暨全腦部放射線治療及化學治療。多尿的症狀明顯地改善而且無相關的併發症。我們藉由這樣的病例報告，對於最初表現僅是中樞性尿崩症的患者，即使無中樞神經系統的症狀，臨床醫師亦須考慮腦部轉移的癌症，尤其是肺癌的可能性。

關鍵字

尿崩症；肺癌；腦垂腺轉移

並列摘要

Central diabetes insipidus (DI) rarely occurs as the initial presentation of lung cancer. Lung cancer patients with the presentation of central DI often exhibit other central nervous system (CNS) symptoms. We reported a 54-year-old man with polyuria for 3 months. His physical and neurological examination results were unremarkable. Water deprivation test confirmed the diagnosis of central DI. A magnetic resonance image of the brain revealed multiple lesions consistent with metastases, including a lesion in the posterior lobe of the pituitary gland. A chest radiograph showed a nodule in the left upper lobe of the lung. Computed tomography-guided needle biopsy of the nodule confirmed the diagnosis of lung adenocarcinoma. The patient was treated with a nasal spray of desmopressin, cyber-knife radiosurgery followed by whole brain radiotherapy, and chemotherapy. His polyuria improved markedly and he was well without significant complications. In conclusion, if a patient initially presents with central DI without other CNS symptoms, physicians should consider the possibility of metastatic disease, especially that resulting from lung cancer.

並列關鍵字

diabetes insipidus ； lung cancer ； pituitary metastasis

國際替代計量

Central Diabetes Insipidus: An Unusual Initial Presentation of Lung Cancer

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