Differentiating Diabetes insipidus from other diseases: Difference between revisions

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__NOTOC__
__NOTOC__
{{Diabetes insipidus}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diabetes_insipidus]]
{{CMG}}
{{CMG}}; {{AE}} {{DAMI}}
 
==Overview==
==Overview==
Diabetes insipidus must be differentiated from other diseases that cause polyuria which is defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children, increased frequency or nocturia and polydipsia. It is important to know that levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus.
The most important differential diagnosis for diabetes insipidus include: Central diabetes insipidus, acquired, [[Trauma]] ([[surgery]], deceleration injury), [[Vascular]] ([[cerebral hemorrhage]], [[infarction]], [[anterior communicating artery aneurysm]] or [[ligation]], intra-hypothalamic [[hemorrhage]]), [[Neoplastic]] ([[craniopharyngioma]], [[meningioma]], [[germinoma]], [[pituitary tumor]] or [[Metastasis|metastases]]), [[Granulomatous]] ([[histiocytosis]], [[sarcoidosis]]), [[Infectious]] ([[meningitis]], [[encephalitis]]), [[Inflammatory]]/[[autoimmune]] ([[lymphocytic]] infundibuloneurohypophysitis), [[Drug]]/[[toxin]]-induced ([[ethanol]], [[diphenylhydantoin]], snake venom), [[hydrocephalus]], [[Idiopathic]], [[Congenital disorder|congenital]], [[Congenital malformations]], nephrogenic diabetes insipidus: [[Acquired disorder|Acquired]], drug-induced ([[demeclocycline]], [[lithium]], [[cisplatin]], [[methoxyflurane]], etc.), [[Hypercalcemia]], [[hypokalemia]], infiltrating lesions ([[sarcoidosis]], [[amyloidosis]], [[multiple myeloma]], [[Sjögren's syndrome|Sjogren's disease]]), [[Vascular]] ([[Sickle-cell disease|sickle cell disease]]), congenital, [[X-linked recessive]], primary polydipsia,[[Psychogenic]], dipsogenic (downward resetting of thirst threshold), gestational diabetes insipidus, [[Diabetes mellitus]].


==Differentiating Diabetes insipidus from other Diseases==
== Differentiating diabetes insipidus based on the type of diabetes insipidus caused ==
The most important differential diagnosis for diabetes insipidus include:<ref name="pmid10369876">{{cite journal| author=Willcutts MD, Felner E, White PC| title=Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin. | journal=Hum Mol Genet | year= 1999 | volume= 8 | issue= 7 | pages= 1303-7 | pmid=10369876 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10369876  }} </ref><ref name="pmid19897608">{{cite journal| author=Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC et al.| title=Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy. | journal=Eur J Endocrinol | year= 2010 | volume= 162 | issue= 2 | pages= 221-6 | pmid=19897608 | doi=10.1530/EJE-09-0772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19897608  }} </ref><ref name="pmid9350817">{{cite journal| author=Barrett TG, Bundey SE| title=Wolfram (DIDMOAD) syndrome. | journal=J Med Genet | year= 1997 | volume= 34 | issue= 10 | pages= 838-41 | pmid=9350817 | doi= | pmc=1051091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9350817  }} </ref>


=== Differentiating diabetes insipidus based on the type of diabetes insipidus caused ===
*'''Central diabetes insipidus'''
**Acquired
***Trauma (surgery, deceleration injury)
***Vascular (cerebral hemorrhage, infarction, anterior communicating artery aneurysm or ligation, intrahypothalamic hemorrhage)
***Neoplastic (craniopharyngioma, meningioma, germinoma, pituitary tumor or metastases)
***Granulomatous (histiocytosis, sarcoidosis)
***Infectious (meningitis, encephalitis)
***Inflammatory/autoimmune (lymphocytic infundibuloneurohypophysitis)
***Drug/toxin-induced (ethanol, diphenylhydantoin, snake venom)
***Other disorders (hydrocephalus, ventricular/suprasellar cyst, trauma, degenerative diseases)
***Idiopathic
**Congenital
***Congenital malformations
****Autosomal dominant: AVP-neurophysin gene mutations
****Autosomal recessive <ref name="pmid10369876">{{cite journal| author=Willcutts MD, Felner E, White PC| title=Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin. | journal=Hum Mol Genet | year= 1999 | volume= 8 | issue= 7 | pages= 1303-7 | pmid=10369876 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10369876  }} </ref><ref name="pmid19897608">{{cite journal| author=Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC et al.| title=Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy. | journal=Eur J Endocrinol | year= 2010 | volume= 162 | issue= 2 | pages= 221-6 | pmid=19897608 | doi=10.1530/EJE-09-0772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19897608  }} </ref>: Wolfram Syndrome (DIDMOAD) <ref name="pmid9350817">{{cite journal| author=Barrett TG, Bundey SE| title=Wolfram (DIDMOAD) syndrome. | journal=J Med Genet | year= 1997 | volume= 34 | issue= 10 | pages= 838-41 | pmid=9350817 | doi= | pmc=1051091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9350817  }} </ref>
****X-linked recessive
***Idiopathic
*'''Nephrogenic diabetes insipidus'''
**Acquired
***Drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.)
***Hypercalcemia, hypokalemia
***Infiltrating lesions (sarcoidosis, amyloidosis, multiple myeloma, Sjoergen's disease)
***Vascular (sickle cell disease)
**Congenital
***X-linked recessive (OMIM 304800): AVP V2 receptor gene mutations
***Autosomal recessive: AQP2 water channel gene mutations
*'''Primary polydipsia'''
**Psychogenic
**Dipsogenic (downward resetting of thirst threshold)
*'''Gestational Diabetes insipidus'''
*'''Diabetes meliitus'''
{| class="wikitable"
{| class="wikitable"
!Type of DI
!Type of DI
Line 44: Line 14:
!Disease
!Disease
!Defining signs and symptoms
!Defining signs and symptoms
!Lab findings
!Lab/Imaging findings
!Treatment
|-
|-
|Central
! rowspan="5" |Central
|Acquired
! rowspan="3" |Acquired
|Histiocytosis
![[Histiocytosis]]
|
* Bone lysis and fracture
* Purulent otitis media
* Diabetes insipidus and delayed puberty
* Maxillary, mandibular, and gingival disease
* Rash and maculoerythematous skin lesions
* Scaly, erythematous scalp patches
* Lung involvement
* GI bleeding
* Lymph node enlargement<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034  }} </ref>
|
|
* Bone lysis and [[Bone fracture|fracture]]
* Purulent [[otitis media]]
* [[Diabetes insipidus]] and delayed puberty
* [[Maxillary]], [[mandibular]], and [[gingival]] disease
* [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions
* Scaly, [[erythematous]] scalp patches
* [[Lung]] involvement
* [[GI bleeding]]
* [[Lymphadenopathy|Lymph node enlargement]]<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034  }} </ref>
|
|
* CD1a and CD45 +
* Interleukin-17 (ILITA)
[[Image:Langerhans Skull X ray.jpg|center|300px|thumb|Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459]]
|-
|-
![[Craniopharyngioma]]
|
|
* [[Headache]]
* [[Endocrine disorders|Endocrine dysfunction]]
** [[Diabetes insipidus]]
** [[Hypothyroidism]]
** [[Adrenal failure]]
** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination)
** Growth failure and [[delayed puberty]]
|
|
|Craniopharyngioma
* [[Suprasellar]] calcified cyst on [[MRI]]
|
[[Image:Craniopharyngioma-papillary-1.jpg|center|300px|thumb|Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812]]
* Headache
* Endocrine dysfunction
** Diabetes insipidus
** Hypothyroidism
** Adrenal failure
** Diabetes insipidus (eg, excessive fluid intake and urination)
** Growth failure and delayed puberty
|
|
|-
|-
|
![[Sarcoidosis]]
|
|Sarcoidosis
|
|
* Systemic complaints
* Systemic complaints
** Fever
** [[Fever]]
** Anorexia
** [[Anorexia]]
** Arthralgias
** [[Arthralgias]]
* Pulmonary complaints
* Pulmonary complaints
** Dyspnea on exertion
** [[Dyspnea on exertion]]
** Cough
** [[Cough]]
** Chest pain,  
** Chest pain,  
** Hemoptysis (rare)
** [[Hemoptysis]] (rare)
* Diabetes mellitus
* [[Diabetes mellitus]]
|
|
|
* [[Hypercalcemia]]
* [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]])
* Elevated [[alkaline phosphatase]]
* [[Serum amyloid A]] (SAA)
* [[Angiotensin-converting enzyme|ACE]] levels may be elevated
[[Image:Neurosarcoidosis.jpg|center|300px|thumb|Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930]]
|-
|-
|
! rowspan="2" |Congenital
|
![[Hydrocephalus]]
|Hydrocephalus
|
|
* Cognitive deterioration
* Cognitive deterioration
* Headaches
* [[Headaches]]
* Neck pain
* [[Neck pain]]
* Blurred vision
* [[Blurred vision]]
* Unsteady gait
* [[Unsteady gait]]
* Incontinence such as polyuria
* [[Incontinence]] such as [[polyuria]]
|
|Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]]
|
[[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
|-
|
|Congenital
|AVP-neurophysin gene mutations
|
|
|
|-
|
|
|Wolfram Syndrome (DIDMOAD)
|
* Diabetes Insipidus
* Diabetes Mellitus
* Optic Atrophy
* Deafness
|
|
|-
|Nephrogenic
|Acquired
|Drug-induced (demeclocycline, lithium)
|
* Polyuria
* Polydipsia
* Nocturia
|
|
|-
|
|
|Hypercalcemia
|
|
|
|-
|
|
|Hypokalemia
|
|
|
|-
|-
![[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
|
|
* [[Diabetes insipidus|Diabetes Insipidus]]
* [[Diabetes mellitus|Diabetes Mellitus]]
* [[Optic atrophy|Optic Atrophy]]
* [[Deafness]]
|
|
|Amyloidosis
* Negative [[islet cell]] antibodies
|
* [[Optic atrophy]] on [[electroretinogram]]
|
* [[Deafness]] on [[audiogram]]
|
* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
|-
|-
! rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
! rowspan="5" |[[Acquired disorder|Acquired]]
!Drug-induced ([[demeclocycline]], [[lithium]])
|
|
* [[Polyuria]]
* [[Polydipsia]]
* [[Nocturia]]
|
|
|Multiple myeloma
* [[Urine osmolality]] <100 mmol/
|
* [[Arginine vasopressin]] level >4.6 pmol/
|
* Little or no response to administration of  exogenous [[arginine vasopressin]]
|
|-
|-
![[Hypercalcemia]]
|
|
* [[Polyuria]]
* [[Polydipsia]]
* [[Gastrointestinal]] disturbances
* [[Bone fracture|Pathological fractures]]
* [[Confusion]]
* [[Palpitations]] and [[cardiac arrhythmias]]
|
|
|Sickle cell disease
* Ca levels greater than 11 meq/L
|
|
|
|-
|-
![[Hypokalemia]]
|
|
|Congenital
* [[Polyuria]]
|AVP V2 receptor gene mutations
* [[Hyporeflexia]]
|
* [[Palpitations]] and [[cardiac arrhythmias]]
|
|
|
* K levels less than 3meq/L on CBC
|-
|-
![[Multiple myeloma]]
|
|
* Pathologic [[bone fractures]]
* [[Bleeding]]
* [[Hypercalcemia]] leading to [[polyuria]]
* [[Infection]]
* [[Hyperviscosity]]
* [[Anemia]]
|
|
|AQP2 water channel gene mutations
* [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]]
|
* [[Monoclonal antibody|Monoclonal M spike]]
|
* Disordered [[plasma cell]] proliferation on [[bone marrow biopsy]]
|
[[Image:Multiple-myeloma-skeletal-survey.jpg|center|300px|thumb|Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682]]
|-
|-
|Primary polydipsia
![[Sickle-cell disease|Sickle cell disease]]
|
|Psychogenic
|
|
|
* [[Chronic pain]]
* [[Anemia]]
* [[Aplastic crisis]]
* Splenic sequestration
* [[Infection]]
* [[Isosthenuria]] presenting with [[polyuria]]
|
|
* [[Hemoglobin]] level is 5-9 g/dL
* [[Hematocrit]] is decreased to 17-29%
* [[Peripheral blood smear|Peripheral blood smears]] demonstrate [[Target cell|target cells]], elongated cells, and characteristic sickle erythrocytes
* MRI can demonstrate [[avascular necrosis]] of the [[femoral]] and [[humeral]] heads
[[Image:Sickle cells.jpg|center|300px|thumb|Blood film showing the sickle cells - By Dr Graham Beards - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18421017]]
|-
|-
|Pregnancy
! colspan="2" |Primary polydipsia
|
![[Psychogenic]]
|Gestational diabetes insipidus
|
|
|
* [[Polyuria]]
* [[Polydipsia]]
* [[Nocturia]]
|
|
* Dry mucus membrane
* History of [[psychiatric disorders]]
|-
|-
|Diabetes mellitus
! colspan="3" |Gestational diabetes insipidus
|
|
|
|
|
* [[Polyuria]]
* [[Polydipsia]]
* [[Nocturia]]
* [[Pregnancy]]
|
|
* Dry mucus membranes
* [[Pregnancy]]
|-
|-
! colspan="3" |[[Diabetes mellitus]]
|
|
* [[Polyuria]]
* [[Polydipsia]]
* [[Nocturia]]
* [[Weight gain (patient information)|Weight gain]]
|
|
|
* Elevated blood sugar levels >126
|
* Elevated [[HbA1c]] > 6.5
|
|
|}
|}


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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Needs overview]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Nephrology]]
[[Category:Nephrology]]

Latest revision as of 18:20, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

The most important differential diagnosis for diabetes insipidus include: Central diabetes insipidus, acquired, Trauma (surgery, deceleration injury), Vascular (cerebral hemorrhage, infarction, anterior communicating artery aneurysm or ligation, intra-hypothalamic hemorrhage), Neoplastic (craniopharyngioma, meningioma, germinoma, pituitary tumor or metastases), Granulomatous (histiocytosis, sarcoidosis), Infectious (meningitis, encephalitis), Inflammatory/autoimmune (lymphocytic infundibuloneurohypophysitis), Drug/toxin-induced (ethanol, diphenylhydantoin, snake venom), hydrocephalus, Idiopathic, congenital, Congenital malformations, nephrogenic diabetes insipidus: Acquired, drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.), Hypercalcemia, hypokalemia, infiltrating lesions (sarcoidosis, amyloidosis, multiple myeloma, Sjogren's disease), Vascular (sickle cell disease), congenital, X-linked recessive, primary polydipsia,Psychogenic, dipsogenic (downward resetting of thirst threshold), gestational diabetes insipidus, Diabetes mellitus.

Differentiating diabetes insipidus based on the type of diabetes insipidus caused

The most important differential diagnosis for diabetes insipidus include:[1][2][3]

Type of DI Subclass Disease Defining signs and symptoms Lab/Imaging findings
Central Acquired Histiocytosis
  • CD1a and CD45 +
  • Interleukin-17 (ILITA)
Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459
Craniopharyngioma
Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812
Sarcoidosis
Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930
Congenital Hydrocephalus Dilated ventricles on CT and MRI
Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453
Wolfram Syndrome (DIDMOAD)
Nephrogenic Acquired Drug-induced (demeclocycline, lithium)
Hypercalcemia
  • Ca levels greater than 11 meq/L
Hypokalemia
  • K levels less than 3meq/L on CBC
Multiple myeloma
Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682
Sickle cell disease
Blood film showing the sickle cells - By Dr Graham Beards - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18421017
Primary polydipsia Psychogenic
Gestational diabetes insipidus
Diabetes mellitus
  • Elevated blood sugar levels >126
  • Elevated HbA1c > 6.5

References

  1. ↑ Willcutts MD, Felner E, White PC (1999). "Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin". Hum Mol Genet. 8 (7): 1303–7. PMID 10369876.
  2. ↑ Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC; et al. (2010). "Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy". Eur J Endocrinol. 162 (2): 221–6. doi:10.1530/EJE-09-0772. PMID 19897608.
  3. ↑ Barrett TG, Bundey SE (1997). "Wolfram (DIDMOAD) syndrome". J Med Genet. 34 (10): 838–41. PMC 1051091. PMID 9350817.
  4. ↑ Ghosh KN, Bhattacharya A (1992). "Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory". Rev Inst Med Trop Sao Paulo. 34 (2): 181–2. PMID 1340034.

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