Central diabetes insipidus and adipsia due to astrocytoma: diagnosis and management

Modawi, Imad; Barger, Geoffrey; Rossi, Noreen F.

doi:10.1007/s13730-012-0030-5

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…In the medical the literature, there were 100 cases reporting Adipsia combining diabetes insipidus. To the best of our knowledge, there were only three case reports documenting adipsic diabetes insipidus with astrocytoma tumor [6][7][8] and our case is the fourth one. Table 3 summarized similarities and differences between the cases.…”

Section: Case Presentationmentioning

confidence: 74%

Adipsic Diabetes Insipidus After Second Resection of A Hypothamic Astrocytoma

Elamin

Alanazi

Saeed

et al. 2020

AACE Clinical Case Reports

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Objective We are reporting a case of adipsic diabetes insipidus (ADI) post astrocytoma resection. Method Clinical and laboratory data are presented Results 16-year-old female with a history of incompletely resected hypothalamic astrocytoma admitted with headache. Head MRI showed interval increase in suprasellar lesion with extension to the third ventricle. Following second stage resection, she developed increased urine output with diluted urine resulting in negative fluid balance, however, she was unable to sense thirst. Blood tests showed serum sodium of 155 mEq/dl (136–145), serum osmolality at 321 mOs/kg ( 285–295 ) and urine osmolality of 128 mOsm/kg (300–1600 ). Serum creatinine and potassium were normal. Pituitary hormone profile were normal : Growth Hormone 0.171 ng/ml (0.123–8.05), LH 3.44 miu/ml (7.59–89.08), FSH 5.60 miu/ml (2.55–16.69) TSH 2.9 miu/ml (0.35–4.94), Free Thyroxine 0.92 ng/dl (0.7–1.48), ACTH 19.56 pg/ml (7.2–63.3) and Prolactin 7.25 ng/ml (5.18–26.53). The patient was treated with Desmopressin Acetate 120 mcg tablets twice daily with a fixed fluid intake of 1.5 to 2.0 liters/day with closed monitoring of fluid intake, output and body weight. Response was good with gradual reduction of serum sodium level of around 7–9 mEq/L/Day. Conclusions Adipsic diabetes insipidus is a rare entity of central diabetes insipidus, where the absence of polydipsia can be challenging in diagnosing and managing the condition. Cases of ADI are likely under reported and clinicians need to be aware of this condition

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Section: Case Presentationmentioning

confidence: 74%

Adipsic Diabetes Insipidus After Second Resection of A Hypothamic Astrocytoma

Elamin

Alanazi

Saeed

et al. 2020

AACE Clinical Case Reports

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“…We performed a literature search and found reports of patients for whom the above protocol had limitations. Modawi et al [7] described a patient whose central DI was caused by astrocytoma. Because of persistent tumor, the risk of hyponatremia with resultant cerebral edema was deemed unacceptably high; thus, he was not treated with DDAVP.…”

Section: Discussionmentioning

confidence: 99%

Daily Sodium Monitoring and Fluid Intake Protocol: Preventing Recurrent Hospitalization in Adipsic Diabetes Insipidus

Pabich

Flynn

Pelley

2019

Journal of the Endocrine Society

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Management of diabetes insipidus (DI) is usually facilitated by an intact thirst mechanism prompting water ingestion in times of rising osmolality. Maintenance of eunatremia can be quite difficult in patients with DI and adipsia because of the absence of this homeostatic mechanism. Few published protocols for management of these complex cases exist. We report a case of a 16-year-old girl who had a diagnosis of craniopharyngioma with preoperative hypopituitarism and central DI. She underwent transsphenoidal resection in 2013 and additionally developed postoperative cognitive impairment and hypothalamic dysfunction, including adipsia. She subsequently experienced widely dysregulated sodium levels, necessitating inpatient care ∼30% of days in 2014 and 2015. We created a protocol for this patient that uses a fixed daily dose of subcutaneous DDAVP combined with daily modulation of fluid intake based on daily serum sodium measurement. The protocol provides guidance for the day’s fluid intake based on both the current sodium result and the rate of change from the previous day. Since the adoption of the protocol in June 2016, the patient has had a dramatic reduction in hospitalizations. Use of a protocol for providing recommendations for fluid intake based on the sodium level and rate of change may help to maintain normal sodium levels in such patients, decreasing hospitalization and improving quality of life.

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“…14 – 17 Similarly, reports in human medicine describe cases of hypodipsia with DI owing to structural brain diseases such as holoprosencephaly, cranial trauma, trauma secondary to intracranial surgery, pituitary adenoma, astrocytoma, hypothalamic hamartoma, craniopharyngioma and neurosarcoidosis. 18 – 23 …”

Section: Introductionmentioning

confidence: 99%

Congenital pituitary cyst resulting in adipsic central diabetes insipidus and secondary hypernatremia in a cat

Evenhuis

Epstein

Della-Maggiore

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 9-month-old intact female domestic mediumhair cat presented with a 5-month history of obtundation, lethargy, hypernatremia (181 mmol/l; reference interval [RI] 151–158 mmol/l), hyperchloremia (142 mmol/l; RI 117–126 mmol/l), azotemia (blood urea nitrogen 51 mg/dl; RI 18–33 mg/dl), creatinine 3.0 mg/dl (RI 1.1–2.2 mg/dl), hyperphosphatemia (8.3 mg/dl; RI 3.2–6.3 mg/dl) and total hypercalcemia (11.4 mg/dl; RI 9–10.9 mg/dl), with concurrent polyuria with adipsia. Neurologic evaluation revealed proprioceptive deficits, and this finding paired with a history of focal seizure-like activity despite improving sodium concentrations suggested a cerebrothalamic lesion. For this reason, and historical and biochemical findings consistent with adipsic diabetes insipidus (DI), MRI of the brain was performed, which revealed a lesion of the hypophyseal fossa consistent with a pituitary cyst. Given the patient’s age and the timeline of clinical signs, a congenital pituitary cyst was strongly suspected. The patient was managed initially with intravenous fluids to correct the hypernatremia, then managed for more than 4 years with topical ocular desmopressin acetate administration and free water administered through a feeding tube. This cat’s clinical diagnosis included a congenital pituitary cyst with subsequent central DI and primary adipsia. Relevance and novel information The clinical presentations of primary adipsia or central DI are both rare in cats. This is the first report to describe these conditions occurring in a cat owing to a congenital pituitary cyst and describes successful long-term management of this condition.

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Central diabetes insipidus and adipsia due to astrocytoma: diagnosis and management

Cited by 5 publications

References 29 publications

Adipsic Diabetes Insipidus After Second Resection of A Hypothamic Astrocytoma

Adipsic Diabetes Insipidus After Second Resection of A Hypothamic Astrocytoma

Daily Sodium Monitoring and Fluid Intake Protocol: Preventing Recurrent Hospitalization in Adipsic Diabetes Insipidus

Congenital pituitary cyst resulting in adipsic central diabetes insipidus and secondary hypernatremia in a cat

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