Abstract：
BACKGROUND: Salt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not consistently considered in primary care management of nocturia.
OBJECTIVE: To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management.
METHODS: Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT).
RESULTS: Twelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity <600 mOsm/l after overnight fluid avoidance.
CONCLUSIONS: Endocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia.
RESULTS: People with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.
OBJECTIVE: To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management.
METHODS: Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT).
RESULTS: Twelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity <600 mOsm/l after overnight fluid avoidance.
CONCLUSIONS: Endocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia.
RESULTS: People with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.
摘要：
背景：盐和水的体内平衡受激素调节，因此，多尿可以直接或通过继发性作用由内分泌疾病引起。这些机制在夜尿症的初级保健管理中并未得到一致考虑。
目的：进行内分泌疾病夜尿症的系统评价（SR），并达成初级保健管理专家共识。
方法：从2000年1月至2020年4月检索了四个数据库。总共筛选了4382个标题和摘要，36项研究进行了全文筛选，14项研究纳入分析.专家和公众的共识是使用名义组技术（NGT）。
结果：12项研究集中在夜尿症的机制上，虽然两种治疗方案进行了评估，但没有一项研究是在初级医疗机构进行的。NGT共识确定了关键的临床评估主题，包括口渴的存在,糖尿病或尿崩症的医学背景，甲状腺疾病,雌激素状态,药物（液体流失或口干），和包括体重指数在内的一般检查。建议的调查包括膀胱日记，肾和甲状腺功能，钙，和糖化血红蛋白.尽管有液体建议，但在多尿>2.5l/24h持续的情况下，应检查晨尿渗透压。限制液体后尿液浓度>600mOsm/l，不包括尿崩症。治疗应该包括教育，在可能的情况下，包括调整生活方式和药物治疗。任何潜在的内分泌疾病应根据当地指导进行管理。如果有甲状腺功能亢进，需要转诊到内分泌科，甲状旁腺功能亢进,或早晨尿液渗透压<600mOsm/l后过夜液体避免。
结论：内分泌疾病可通过不同的盐和水调节途径导致夜尿症。管理的目的是识别和处理致病因素，但副作用会限制夜尿症的改善。
结果：荷尔蒙功能改变的人可能会因为控制水和盐水平的问题而需要通过尿液而遭受严重的睡眠障碍。一个专家小组根据现有的少量最新发表的研究，建议了评估和治疗这些问题的最佳方法。
目的：进行内分泌疾病夜尿症的系统评价（SR），并达成初级保健管理专家共识。
方法：从2000年1月至2020年4月检索了四个数据库。总共筛选了4382个标题和摘要，36项研究进行了全文筛选，14项研究纳入分析.专家和公众的共识是使用名义组技术（NGT）。
结果：12项研究集中在夜尿症的机制上，虽然两种治疗方案进行了评估，但没有一项研究是在初级医疗机构进行的。NGT共识确定了关键的临床评估主题，包括口渴的存在,糖尿病或尿崩症的医学背景，甲状腺疾病,雌激素状态,药物（液体流失或口干），和包括体重指数在内的一般检查。建议的调查包括膀胱日记，肾和甲状腺功能，钙，和糖化血红蛋白.尽管有液体建议，但在多尿>2.5l/24h持续的情况下，应检查晨尿渗透压。限制液体后尿液浓度>600mOsm/l，不包括尿崩症。治疗应该包括教育，在可能的情况下，包括调整生活方式和药物治疗。任何潜在的内分泌疾病应根据当地指导进行管理。如果有甲状腺功能亢进，需要转诊到内分泌科，甲状旁腺功能亢进,或早晨尿液渗透压<600mOsm/l后过夜液体避免。
结论：内分泌疾病可通过不同的盐和水调节途径导致夜尿症。管理的目的是识别和处理致病因素，但副作用会限制夜尿症的改善。
结果：荷尔蒙功能改变的人可能会因为控制水和盐水平的问题而需要通过尿液而遭受严重的睡眠障碍。一个专家小组根据现有的少量最新发表的研究，建议了评估和治疗这些问题的最佳方法。
