Abstract
Purpose
Adipsic diabetes insipidus (ADI) is a rare, high-risk syndrome, particularly difficult to recognize and manage in children and adolescents. This investigation examined the clinical features and management of ADI in children and adolescents with sellar germ cell tumors (GCTs).
Methods
A retrospective survey was performed on 260 patients with sellar GCTs, categorized into ADI and non-ADI groups based on thirst presence. General characteristics, hypothalamic syndrome, pituitary function, metabolic indicators, and complications were compared. Biochemical indicator changes in the ADI group were analyzed after systematic management, and receiver operating characteristic (ROC) curve analysis established the optimum serum sodium cut-off for predicting the ADI.
Results
25 patients (9.6%) developed ADI. The ADI group had larger tumors with hypothalamic involvement and more surgical resections. They also demonstrated more hypothalamic syndrome, central adrenal insufficiency, central hypogonadism, and insulin-like growth factor-1 levels below norms. Furthermore, ADI patients exhibited significantly higher rates of hypernatremia (100% vs 20.9%, p < 0.001), hyperuricemia (60.0% vs 23.4%, p < 0.001), renal impairment (32.0% vs 1.7%, p < 0.001), and venous thrombosis (4.0% vs 0%, p = 0.002). Following systematic management, ADI patients experienced significant reductions in serum sodium, uric acid, and creatinine levels, although these remained higher than in the non-ADI group. ROC analysis indicated that a serum sodium level above 149.5 mmol/L predicted ADI.
Conclusion
Patients with ADI had more tumor involvement in the hypothalamic region, surgical resections, hypothalamic syndrome, hypopituitarism, and complications. Serum sodium levels above 149.5 mmol/L necessitated heightened vigilance for ADI. Early identification and systematic management reduced complications, though clinical management remained challenging.