Diabetes Insípida en Pediatría: Serie Clínica y Revisión de la Literatura

Abstract

Diabetes Insipidus in Pediatrics Introduction: Diabetes insipidus (DI) is a syndrome characterized by polyuria and polydipsia secondary to a decreased secretion or action of the antidiuretic hormone (ADH). An early diagnosis is essential. Diagnosis is made by measuring plasma and urinary osmolarity and their changes under water deprivation and after DDAVP administration. Objective: To describe the clinical, radiological characteristics as well as the initial treatment of eight children with DI, 3 of them nephrogenic DI (DIN) and 5 with central DI. Methods: A Retrospective, descriptive study in DI patients under control at the Catholic University of Chile and Sotero del Rio Hospital between 1998-2008 is presented. Clinical files were evaluated collecting clinical, epidemiologic, biochemical and image data. Serum (Sosm) and urinary osmolarity (Uosm) were registered. DI was diagnosed with a Sosm > 300 and Usm < 600 mOsm/L. Central DI was defined as the inability to reach a Uosm > 600 or a 50%-increase after DDAVP treatment. Otherwise DI was classified as DIN. Results: Eight patients (5 males) were studied. Chief complaints were polydipsia/polyuria (5/8), hyperthermia (2/8), and failure to grow (1/8). MRI showed endocraneal lesion in all patients with Central DI. All of these utilized oral or inhalatory DDAVP treatment. Patients with Nephrogenic DI were trated with Hydrochlrothiazide. Conclusion: Polydipsia, polyuria, hyperthermia with hypernatremia are suggestive of DI in the first year of life. Water deprivation test is diagnostic in differentiating Central and Nephrogenic DI. MRI is an essential diagnostic tool in CDI. Manegement should be multidisciplinary, including a pediatician, nephrologist, endocrinologist and nutricionist.

Clinical profile of patients with Central Diabetes Insipidus at the Endocrinology Unit of Instituto Nacional de Salud del Niño (INSN) during 2001 -2010. Lima – Peru

“…Maghnie y cols (10) , en una investigación multicéntrica realizado en 4 diferentes hospitales pediátricos de Italia encuentran una cifra un poco más baja de tumores intracraneales (23.6%), principalmente craneofaringioma y germinoma hipotalámico. Por otro lado Catli et al (8) , observan un 38.5% de tumores intracraneales siendo el craneofaringioma el más frecuente, mientras que Luoreiro y cols (26) . En Chile describen un 40% de casos atribuidos a los tumores intracerebrales.…”

“…La poliuria estuvo presente en el 100% de pacientes seguido por la polidipsia (78.9%), cefalea (23.7%), nicturia (21.1%), talla baja (10.5%), vómitos (7.9%), fatiga (5.3%) y pérdida de peso (2.6%). Esto es coherente con lo que describe De Buyst et al (19) , siendo poliuria (74%) y polidipsia, (70%), los signos más prevalentes y lo que también observan Luoreiro y cols (26) con mayor frecuencia (62.5% para poliuria y polidipsia).…”