Central Diabetes Insipidus: Clinical Characteristics and Long-Term Course in a Large Cohort of Adults

Masri-Iraqi, Hiba; Hirsch, Dania; Herzberg, Dana; Lifshitz, A; Tsvetov, Gloria; Benbassat, Carlos; Shimon, Ilan

doi:10.4158/ep161555.or

Cited by 14 publications

(10 citation statements)

References 17 publications

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“…It should be kept in mind that water intoxication may also occur in adults and may be quite common as was shown in a retrospective study on 70 adult patients with central diabetes insipidus in which 32 of the patients developed hyponatremia with 10 of them having severe hyponatremia (sodium < 125 mEq/L) and this was more common in females. This study also showed that 84% of the patients who developed hyponatremia were found to be on the nasal spray or nasal drops with only 16% taking oral desmopressin ( 9 ). Our patient was on intra-nasal desmopressin at the time she developed the hyponatremia and in the past, she had been on oral desmopressin.…”

Section: Discussionmentioning

confidence: 71%

Management of a patient with Sheehan’s syndrome and diabetes insipidus complicated by recurrent hyponatremia

Al-Sharafi

Faiza

Qais

2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 38-year-old female was initially seen in the intensive care unit after severe postpartum hemorrhage. She was initially diagnosed to have Sheehan’s syndrome and after discharge, she was diagnosed to have a vesicovaginal fistula which initially caused a delay in diagnosing diabetes insipidus in the patient because she was having urinary incontinence. The patient had the vesicovaginal fistula repaired and was on replacement with levothyroxine, prednisone, and desmopressin. Years after her diagnosis, the patient experienced recurrent episodes of hyponatremia in the setting of desmopressin therapy. This case highlights the challenges of diagnosing diabetes insipidus in a patient with Sheehan’s syndrome and a vesicovaginal fistula, as well as the long-term management of central diabetes insipidus in a resource-limited setting. Learning points Sheehan’s syndrome is rarely associated with diabetes insipidus, and in our patient, it was initially missed due to a vesicovaginal fistula which caused urinary incontinence. Water intoxication is more common in young children and older adults but can occur years after initiating treatment with desmopressin in adults and should be kept in mind when treating patients with hyponatremia who have hypopituitarism associated with diabetes insipidus. Water intoxication is much more common in patients with diabetes insipidus being treated with intranasal desmopressin than in those using the oral preparations.

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Section: Discussionmentioning

confidence: 71%

Management of a patient with Sheehan’s syndrome and diabetes insipidus complicated by recurrent hyponatremia

Al-Sharafi

Faiza

Qais

2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Given desmopressin's mode of action, ongoing patient monitoring during treatment dose optimisation is important. This is because of the risk of developing hyponatremia if too little water is excreted or too much fluid ingested [13], or hypernatremia [8,12,16,17] if too much water is lost or too little fluid ingested. It is important to allow water offload in this process, to prevent hyponatraemia.…”

Section: Treating Cdi: Treatment Initiation and Optimisationmentioning

confidence: 99%

“…Patients and/or caregivers have an important role to play in the ongoing management of CDI and in engaging with healthcare professionals about optimising treatment [17]. For example, patients may have preferences for specific formulations [workshop insights] in light of their absorption, the types of complications experienced or how straightforward the formulation is to administer.…”

Section: Influences Related To Patient Engagement With Care Related D...mentioning

confidence: 99%

“…For example, patients may have preferences for specific formulations [workshop insights] in light of their absorption, the types of complications experienced or how straightforward the formulation is to administer. Patient engagement is also essential in the context of monitoring treatment effectiveness and reporting any changes in effectiveness to healthcare professionals [6,17], as well as in the context of ensuring dose adherence and compliance with treatment [8,20]. For some formulations, patient skills in administering the treatment, such as dexterity in administering intranasal formulations, play a role in treatment effectiveness [16].…”

Section: Influences Related To Patient Engagement With Care Related D...mentioning

confidence: 99%

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Challenges and improvement needs in the care of patients with central diabetes insipidus

Teare

Argente

Dattani

et al. 2022

Orphanet J Rare Dis

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Central diabetes insipidus (CDI) is a rare condition, with significant impact on patient health and well-being. It is a chronic condition which usually requires meticulous long-term care. It can affect both children and adults. There is limited literature considering the needs and challenges inherent in providing high quality care to patients with CDI, across the care pathway. This paper seeks to address this gap by providing a unique and well-rounded understanding of clinical and healthcare systems-related challenges. It draws on insights from the literature, from direct clinical experience contributed by five clinicians as co-authors (providing insights from France, Ireland, Italy, Spain and the United Kingdom), and from patient perspectives provided through interviews with patient representatives from three patient organisations. We identify clinical challenges related to the diagnosis of CDI, including differentiating between other similar conditions and determining the underlying aetiology. Treatment is challenging, given the need to tailor medication to each patient’s needs and ongoing management is required to ensure that patients continue to respond adequately to treatment. Ongoing support is required when patients switch between formulations. We also identify healthcare systems challenges related to limited awareness of CDI amongst primary care physicians and general paediatricians, and the need for highly skilled specialist care and appropriate workforce capacity. There is also a significant need for raising awareness and for the education of both healthcare professionals and patients about different aspects of CDI, with the aim of supporting improved care and effective patient engagement with healthcare professionals. We reflect on this information and highlight improvement opportunities. These relate to developing guidance to support patients, carers, primary care physicians and general paediatricians to identify clinical features earlier, and to consider CDI as a possible diagnosis when a patient presents with suggestive symptoms.

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“…Enxiang Zhang, 1-3 * Yang Zhao, 4,5 * and Hongbo Hu 2 Sodium glucose cotransporter 2 (SGLT2), a type of membrane protein highly expressed in the kidney, can regulate plasma glucose through the glomerular filtration process by reabsorption from the kidney. SGLT2 inhibitors, which are newly developed oral antidiabetic drugs, can play a role in liver diseases by inhibiting SGLT2-mediated renal glucose reabsorption and inducing glycosuria.…”

Section: Impact Of Sodium Glucose Cotransporter 2 Inhibitors On Nonalcoholic Fatty Liver Disease Complicated By Diabetes Mellitusmentioning

confidence: 99%

Impact of Sodium Glucose Cotransporter 2 Inhibitors on Nonalcoholic Fatty Liver Disease Complicated by Diabetes Mellitus

Zhang

Zhao

2021

Hepatology Communications

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Sodium glucose cotransporter 2 (SGLT2), a type of membrane protein highly expressed in the kidney, can regulate plasma glucose through the glomerular filtration process by reabsorption from the kidney. SGLT2 inhibitors, which are newly developed oral antidiabetic drugs, can play a role in liver diseases by inhibiting SGLT2-mediated renal glucose reabsorption and inducing glycosuria. Nonalcoholic fatty liver disease (NAFLD) is the most common type of liver disease, resulting in severe liver dysfunction. During the progression of NAFLD, there are some hallmark complications, including lipid metabolism disorders, inflammation induction, and hepatocyte death. Herein, we review several SGLT2 inhibitors that are capable of protecting individuals with NAFLD from severe complications by inhibiting de novo lipogenesis, oxidative responses, inflammation induction, and hepatocyte death.

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Central Diabetes Insipidus: Clinical Characteristics and Long-Term Course in a Large Cohort of Adults

Cited by 14 publications

References 17 publications

Management of a patient with Sheehan’s syndrome and diabetes insipidus complicated by recurrent hyponatremia

Management of a patient with Sheehan’s syndrome and diabetes insipidus complicated by recurrent hyponatremia

Challenges and improvement needs in the care of patients with central diabetes insipidus

Impact of Sodium Glucose Cotransporter 2 Inhibitors on Nonalcoholic Fatty Liver Disease Complicated by Diabetes Mellitus

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