Juvenile-onset gout and adipsic diabetes insipidus: A case report and literature review

Abstract

The prevalence of juvenile-onset gout has been increasing. Hereditary factors and secondary diseases should be considered in these patients. Adipsic diabetes insipidus (ADI) is characterized by arginine vasopressin (AVP) deficiency, which results in hypotonic polyuria, and dysfunction of thirst osmoreceptors, which results in failure to generate a thirst sensation in response to hypernatremia. We herein report a case of a boy with gouty arthritis, refractory hyperuricemia, prominent hypernatremia, a high creatinine concentration, and a history of surgery for a hypothalamic hamartoma. The patient was diagnosed with central diabetes insipidus after endocrine evaluation. Because he never had symptoms of thirst, the final diagnosis was corrected to ADI. This is the first report of gout due to chronic ADI in an adolescent. Volume contraction due to ADI might be one cause of hyperuricemia and renal impairment in such patients. Moreover, AVP deficiency might directly lead to low urate clearance due to the lack of vasopressin receptor 1 stimulation. Lack of polydipsia and polyuria may delay the diagnosis of ADI and lead to severe complications of a chronic hyperosmolar status. Sufficient and effective establishment of normovolemia is critical for these patients.

Diagnosis and management of diabetes insipidus for the internist: an update

“…AVP deficiency in central DI is associated with chronic low uric acid clearance and hyperuricaemia. Volaemia is an important determinant of uric acid regulation, but AVP by its action on AVPR1 has also been speculated to play a role in uric acid clearance [33,34,35]. The clinical consequence of the potentially altered uric acid metabolism in DI patients remains unclear.…”

Rheumatologists' understanding of Refractory Gout: A questionnaire survey in China

“…Besides, there is a small population of gout patients who are challenging to treat due to genetic susceptibilities or some other predispositions [30]. This population usually requires a higher dose or a combined therapy along with a protracted treatment course, which may potentially pose even more difficulties; however, this entity is not within the scope of this study.…”

Rheumatologists’ understanding of refractory gout: a questionnaire survey in China

“…23 There is a small population of patients with gout whose treatment is challenging owing to genetic susceptibilities or other predispositions. 24 This population usually requires a higher drug dose or combined therapy as well as a protracted treatment course, which may cause additional difficulties. However, a consideration of this population is beyond the scope of the present study, which was characterized by a low incidence of gout and strong focus on tertiary medical hospitals.…”