Adipsic Diabetes Insipidus—The Challenging Combination of Polyuria and Adipsia: A Case Report and Review of Literature

Dalan, Rinkoo; Chin, H X; Hoe, Jeremy; Chen, Abel; Tan, Huiling; Boehm, Bernhard O.; Chua, Karen Sui Geok

doi:10.3389/fendo.2019.00630

Cited by 16 publications

(8 citation statements)

References 51 publications

(60 reference statements)

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“…Notably, the incidence of CDI (81.4%) in our study was higher than that reported in children undergoing HD ( 3 ). We found that one-third of our patients with CDI presented with adipsia, which may indicate damage to osmoregulatory and thirst perception pathways comprising the hypothalamic nuclei, namely the median preoptic nucleus (MnPO) and organum-vasculosum lamina terminalis (OVLT) ( 26 , 27 ). Comprehensive and coherent management approaches are required for ADI, including desmopressin, compensatory fluid intake, daily weighing, and frequent serum sodium monitoring ( 15 , 26 ).…”

Section: Discussionmentioning

confidence: 93%

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Yuan

et al. 2022

Front. Endocrinol.

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ObjectiveHypothalamic dysfunction (HD) results in various endocrine disorders and is associated with an increased risk of metabolic comorbidities. This study aimed to analyze the clinical characteristics and metabolic abnormalities of adults with HD of various causes.MethodsThis study retrospectively reviewed adults with HD treated at our center between August 1989 and October 2020. Metabolic characteristics of patients were compared to those of age-, sex-matched lean, and body mass index (BMI)-matched controls.ResultsTemperature dysregulation (61.0%) was the most common hypothalamic physiological dysfunction. At least one anterior pituitary hormone deficiency was observed in 50 patients (84.7%), with hypogonadotropic hypogonadism being the most frequently observed. Metabolic syndrome was confirmed in 31 patients (52.5%) and was significantly more prevalent in those with panhypopituitarism or overweight/obesity. Metabolic syndrome (MetS) was significantly more common in patients with HD than in both lean and BMI-matched controls (P < 0.001 and P = 0.030, respectively). Considering the components of MetS, elevated fasting glucose levels were significantly more common in patients with HD than in BMI-matched controls (P = 0.029). Overweight/obesity and panhypopituitarism were significant risk factors for MetS in the multivariate analysis on patients with HD. Moreover, in the multivariate analysis on patients and BMI-matched control, HD was a significant risk factor of MetS (P=0.035, OR 2.919) after adjusted for age, sex and BMI.ConclusionsTemperature dysregulation and hypogonadotropic hypogonadism are the most common physiological and endocrine dysfunctions, respectively. MetS and unfavorable metabolic profiles were prevalent in adults with HD. HD was a significant risk factor of MetS after adjusted for BMI.

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Section: Discussionmentioning

confidence: 93%

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Yuan

et al. 2022

Front. Endocrinol.

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“…The diagnosis can be confirmed by the normalization of these abnormalities by desmopressin administration, as in the present patient. 11,13 CDI is commonly caused by neoplastic or infiltrative hypothalamic lesions, traumatic brain injury, neurosurgery, or autoimmune destruction of the posterior lobe of the pituitary. 2,[14][15][16] Pituitary MRI is used for the diagnosis and to determine the etiology of CDI.…”

Section: Discussionmentioning

confidence: 99%

Persistent hypernatremia secondary to adipsic central diabetes insipidus in a patient with herpes-induced meningoencephalitis and COVID-19 infection: a case report

Cherchir,

Oueslati,

Salhi

et al. 2024

J Int Med Res

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Central diabetes insipidus (CDI) typically manifests as a polyuria–polydipsia syndrome, in which normonatremia is generally maintained through the polydipsia. A 53-year-old woman presented with diabetic ketosis and hyperosmolar hyperglycemic syndrome. Her medical history included herpes meningoencephalitis, which was associated with confusion and amnesia. On physical examination, she was apyretic, confused, and had signs of extracellular dehydration. Her capillary glucose concentration was high and her urine was positive for ketones. Laboratory investigations revealed severe hyperglycemia, hypernatremia (plasma hyperosmolarity of 393.6 mOsm/L), and mild acute renal failure. In addition, she had a paucisymptomatic COVID-19 infection. Intravenous rehydration with isotonic saline solution and insulin therapy were effective at controlling the ketosis and ameliorating the hyperglycemia, but failed to normalize the hypernatremia and hyperosmolarity. She was not thirsty and had a urine output of 1 L/day, with urinary hypotonicity. Desmopressin administration reduced the hypernatremia and hyperosmolarity to within their normal ranges, and the patient’s urinary osmolarity increased to 743 mOsm/L. Therefore, adipsic CDI was diagnosed. Endocrine investigations revealed isolated central hypothyroidism. The results of pituitary magnetic resonance imaging were normal. Thus, patients with impaired thirst may have an atypical presentation of CDI. In addition, the diagnosis of adipsic CDI is particularly challenging.

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“…Euvolemic hypernatremia is a feature of central diabetes insipidus (low ADH secretion) occurring in primary or metastatic tumors of the pituitary gland or hypothalamus, after ablative surgery of these tumors or secondary to whole brain radiation in patients with central nervous system lymphomas or brain tumors [22,23]. In some of these patients, lesions involving hypothalamic osmoreceptors may lead to reduced thirst and decreased water intake with severe dehydration, a dangerous and rare syndrome called adipsic diabetes insipidus [24,25]. Some chemotherapeutics may interfere with the renal action of ADH by inducing nephrogenic diabetes insipidus; the most commonly involved are amphotericin B, ifosfamide, platinum derivatives [26].…”

Section: Causes Of Hypernatremia In Cancermentioning

confidence: 99%

Causes of Dysnatremia in Cancer Patients: A Review

Rădulescu

Văcăroiu²,

Turcu³

et al. 2022

JPRI

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Dysnatremias occur with high incidence in cancer patients and have negative impact on quality of life, survival, hospitalization length. Both cancer and its therapy are responsible; coexisting comorbidities may also be involved. Hyponatremia is the most common electrolyte disorder and is usually multifactorial. Hypernatremia, although more rare, is associated with poorer outcome. Diagnosis of true dysnatremias may be a challenge in patients with active cancer, as they must be often differentiated from spurious dysnatremias. Assessing the extracellular volume is the first step for establishing the cause of a dysnatremia; as such hypovolemic, euvolemic and hypervolemic dysnatremias have distinct etiology. The present article briefly reviews cancer-specific and treatment-specific causes of dysnatremias.

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Adipsic Diabetes Insipidus—The Challenging Combination of Polyuria and Adipsia: A Case Report and Review of Literature

Cited by 16 publications

References 51 publications

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Persistent hypernatremia secondary to adipsic central diabetes insipidus in a patient with herpes-induced meningoencephalitis and COVID-19 infection: a case report

Causes of Dysnatremia in Cancer Patients: A Review

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