[Acquired disorder of thirst perception with intact osmoregulation of vasopressin].
We report a 45 y old male patient with severe hypodipsia, but intact vasopressin secretion and maximal renal response to vasopressin. The patient presented during hot summer days, 18 months after a frontal lobe hemorrhage due to a ruptured aneurysm, with severe hypernatremia (171 mmol/L) and a plasma osmolality of 348 mosm/kg. He was awake and had no interest in fluid intake. After initial correction, a thirst test for 36 hours was performed. Plasma osmolality rose from 295 to 320, urine osmolality rose from 220 to 700 mosm/kg, while plasma vasopressin levels increased more than 3-fold. Throughout the test the patient did not exhibit appreciable thirst. The intact osmoregulation of vasopressin as evidenced by the plasma levels and the elicited renal response, indicates that a selective acquired disturbance of thirst is present. Whether the thirst center is destroyed or/and thirst recognition (frontal lobe affection) is disturbed primarily, can not be decided.
Klinik B für Innere Medizin, Kantonsspital St. Gallen, Schweiz.
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Zünd
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Fretz
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Krapf
D017542:Aneurysm, Ruptured / Q000601:surgery; D001931:Brain Mapping; D002543:Cerebral Hemorrhage / Q000601:surgery; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D006955:Hypernatremia / Q000503:physiopathology*; D002532:Intracranial Aneurysm / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000503:physiopathology*; D011183:Postoperative Complications / Q000503:physiopathology; D013894:Thirst / Q000502:physiology*; D014667:Vasopressins / Q000502:physiology*; D014882:Water-Electrolyte Balance / Q000502:physiology*
D014667:Vasopressins
Erworbene Störung des Durstempfindens bei intakter Osmoregulation des Vasopressins.