Adipsia increases risk of death in patients with central diabetes insipidus

Arima, Hiroshi; Wakabayashi, Toshihiko; Nagatani, Tetsuya; Fujii, Masazumi; Hirakawa, Akihiro; Murase, Takashi; Yambe, Yuko; Yamada, Tsutomu; Yamakawa, Fumiko; Yamamori, Ikuo; Yamauchi, Masashi; Oiso, Yutaka

doi:10.1507/endocrj.ej13-0368

Cited by 44 publications

(40 citation statements)

References 13 publications

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“…First, since most patients with hyponatremia were asymptomatic, the number of hyponatremia cases could increase if we had measured the serum sodium levels more frequently. However, the incidence of hyponatremia (<130 mmol/L) with intranasal desmopressin shown in this study (4.2%) was similar to what we reported in a previous study in which hyponatremia occurred in 154 out of 3,527 measurements (4.3%) in 126 CDI patients without adipsia treated with intranasal desmopressin [25]. Thus, the number of measurements (intranasal desmopressin: 264; desmopressin ODT: 238) in this study seems sufficient to represent the frequency of hyponatremia in each formulation.…”

Section: Discussionsupporting

confidence: 92%

Comparison of incidence of hyponatremia between intranasal and oral desmopressin in patients with central diabetes insipidus

et al. 2015

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ARGININE VASOPRESSIN (AVP) is the antidiuretic hormone which is synthesized in the magnocellular neurons in the supraoptic and paraventricular nuclei [1,2]. AVP is axonally transported to the posterior pituitary, released into the systemic circulation, and acts through V2 receptor in the kidney in order to promote reabsorption of free water [1,2]. The osmoregulation of AVP release is so precise that increases in plasma osmolality of only 1-2% lead to increases in plasma AVP [1,3,4]. As a result, plasma osmolality in most cases is controlled at levels of around 280 mOsm/kg, which is the threshold of AVP release [1,3,4].The deficiency of AVP causes a disorder called cen- Abstract. Central diabetes insipidus (CDI), which is characterized by polyuria and polydipsia, is caused by a deficiency of the antidiuretic hormone arginine vasopressin (AVP). While CDI is treated with desmopressin, an analogue of AVP, the intranasal formulation is inconvenient and CDI patients reportedly prefer the oral formulation to the intranasal one. In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when the desmopressin orally disintegrating tablet (ODT) was approved for treatment. In this study we analyzed 26 patients with CDI in whom intranasal desmopressin was switched to desmopressin ODT. The mean daily dose of intranasal desmopressin was 10 ± 8 μg/day, and that of desmopressin ODT was 142 ± 59 μg/day. The mean serum sodium levels were 140 ± 5 mmol/L and 140 ± 3 mmol/L with intranasal desmopressin and desmopressin ODT, respectively, and there were no significant differences between these values. The frequency of hyponatremia (<135 mmol/L) with intranasal desmopressin was 11.7% and that with desmopressin ODT was 7.6%, while the frequency of hyponatremia (<130 mmol/L) with intranasal desmopressin was 4.2% and that with desmopressin ODT was 1.3%. Statistical analyses revealed that incidence of hyponatremia was significantly decreased after the switch to desmopressin ODT. Thus, it is suggested that water balance is better controlled with desmopressin ODT than with intranasal desmopressin in patients with CDI.Key words: Desmopressin, Central diabetes insipidus, Hyponatremia, Vasopressin tral diabetes insipidus (CDI), which is characterized by polyuria accompanied by thirst and polydipsia [5,6]. Patients with CDI are treated with desmopressin, an analogue of AVP, which is usually given twice or three times per day [7]. The concentration of desmopressin in blood reaches a peak soon after administration, and the antidiuretic action remains maximal for several hours [8][9][10][11]. Due to the pharmacokinetics/pharmacodynamics of desmopressin, its most frequent side effect in the treatment of CDI is hyponatremia [12,13].In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when desmopressin orally disintegrating tablet (ODT) was approved for treatment. Because the efficiency and safety of desmopressin ODT have been demonstrated [13,14], and oral form...

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Section: Discussionsupporting

confidence: 92%

Comparison of incidence of hyponatremia between intranasal and oral desmopressin in patients with central diabetes insipidus

et al. 2015

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“…Adipsia rarely accompanies DI (ADI) due to osmoreceptor destruction. These patients become easily dehydrated and are at a high risk of fluid and electrolyte disorders (2). ADI is often associated with significant hypothalamic dysfunction and complications, such as obesity, sleep apnea, thermoregulatory disorders, seizure, venous thromboembolism, and muscle dysfunction (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Adipsic Diabetes Insipidus: A Single-Center Case Series

et al. 2017

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Adipsic diabetes insipidus (ADI) is a rare and challenging complication secondary to several neurosurgical procedures. It can lead to severe hyperosmolarity and is associated with high rates of morbidity and mortality. Considering the variable time of thirst sensation recovery, long-term treatment is accompanied with the risk of extreme extracellular osmolality fluctuations. Herein, we report 3 cases of this rare presentation of hypothalamic injury.

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“…Moreover behavioral therapy is also required because the thirst mechanism fails to perform its function in patients of ADI. 80 …”

Section: Adipsic Diabetes Insipidusmentioning

confidence: 99%