Diagnosis and management of central diabetes insipidus in adults

Abstract

Central diabetes insipidus (CDI) is characterized by hypotonic polyuria due to impairment of AVP secretion from the posterior pituitary. In clinical practice, it needs to be distinguished from renal resistance to the antidiuretic effects of AVP (nephrogenic DI), and abnormalities of thirst appreciation (primary polydipsia). As nephrogenic diabetes insipidus is rare in adults, unless they are treated with lithium salts, the practical challenge is how to differentiate between CDI and clinical disorders of excess thirst. The differential diagnosis is usually straight forward, but the recommended gold standard test, the water deprivation test, is not without interpretative pitfalls. The addition of the measurement of plasma AVP concentrations improves diagnostic accuracy, but the radioimmunoassay for AVP is technically difficult, and is only available in a few specialized centres. More recently, the measurement of plasma copeptin concentrations has been claimed to provide a reliable alternative to measurement of plasma AVP, without the sampling handling challenges. In addition, the measurement of thirst ratings can help the differentiation between CDI and primary polydipsia. Once the diagnosis of CDI is biochemically certain, investigations to determine the cause of AVP deficiency are needed. In this review, we will outline the diagnostic approach to polyuria, revisit the caveats of the water deprivation test and review recent data on value of adding AVP/copeptin measurement. We will also discuss treatment strategies for CDI, with analysis of potential complications of treatment.

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report

“…The difference between these two could represent a fluctuating course or laboratory variation around an arbitrary diagnostic cutoff for urine osmolality of 300 mOsm/kg. Although the sodium levels were within the normal range at these timepoints (140 and 142), this is often the case in compensated DI (Garrahy et al, 2018).…”

“…She remained fully T A B L E 1 Hospitalization data Thompson, 2018). Calories started at 1,000 kcal/day, advancing by 200 kcal/day up to 3,400 kcal/day, which ultimately provided the desired rate of weight gain.…”

“…She was again hyponatremic upon admission (Table 1, Hospitalization #2), presumed secondary to excess water intake, which was quickly corrected. Nourishment during the first 4 days of Hospitalization #2 was provided by Thompson, 2018). The difference between these two could represent a fluctuating course or laboratory variation around an arbitrary diagnostic cutoff for urine osmolality of 300 mOsm/kg.…”

Granulomatosis Polyangiitis Presented with Diabetes Insipidus

“…Anahtar kelimeler: Diabetes insipidus; pituiter yetmezlik; granülomatöz polianjiitis; vaskülit vasopressinergic neurons in the supraoptic and paraventricular nuclei of the posterior pituitary get damaged (2). Pituitary dysfunction is one of the rare findings of GPA.…”

Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

“…According to the literature, post-surgical CDI was diagnosed in the presence of new onset hypotonic polyuria (diuresis > 40 mL/ kg/day in absence of glycosuria), u-Osm inappropriately low for p-Osm (u-Osm/p-Osm ratio < 2 in the presence of p-Osm > 295 mOsm/kg), with or without hypernatremia (s-Na > 145 mmol/L) [3,4,17,18]. In these cases, a substitutive treatment with 1-deamino-8-D-AVP (dDAVP) was started.…”