Differentiating Diabetes insipidus from other diseases: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{ | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diabetes_insipidus]] | ||
{{ | {{CMG}}; {{AE}} {{DAMI}} | ||
==Overview== | ==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 [[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 | == 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> | |||
{| class="wikitable" | {| class="wikitable" | ||
!Type of DI | !Type of DI | ||
| Line 46: | Line 16: | ||
!Lab/Imaging findings | !Lab/Imaging findings | ||
|- | |- | ||
! rowspan="5" |Central | |||
! rowspan="3" |Acquired | |||
![[Histiocytosis]] | |||
| | | | ||
* Bone lysis and fracture | * Bone lysis and [[Bone fracture|fracture]] | ||
* Purulent otitis media | * Purulent [[otitis media]] | ||
* Diabetes insipidus and delayed puberty | * [[Diabetes insipidus]] and delayed puberty | ||
* Maxillary, mandibular, and gingival disease | * [[Maxillary]], [[mandibular]], and [[gingival]] disease | ||
* Rash and maculoerythematous skin lesions | * [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions | ||
* Scaly, erythematous scalp patches | * Scaly, [[erythematous]] scalp patches | ||
* Lung involvement | * [[Lung]] involvement | ||
* GI bleeding | * [[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> | * [[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 + | * CD1a and CD45 + | ||
* Interleukin-17 (ILITA) | * 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 | * [[Headache]] | ||
* Endocrine dysfunction | * [[Endocrine disorders|Endocrine dysfunction]] | ||
** Diabetes insipidus | ** [[Diabetes insipidus]] | ||
** Hypothyroidism | ** [[Hypothyroidism]] | ||
** Adrenal failure | ** [[Adrenal failure]] | ||
** Diabetes insipidus ( | ** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination) | ||
** Growth failure and delayed puberty | ** Growth failure and [[delayed puberty]] | ||
| | | | ||
* | * [[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]] | |||
|- | |- | ||
![[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 | * [[Hypercalcemia]] | ||
* Hypercalciuria (noncaseating granulomas) | * [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]]) | ||
* Elevated alkaline phosphatase | * Elevated [[alkaline phosphatase]] | ||
* Serum amyloid A (SAA) | * [[Serum amyloid A]] (SAA) | ||
* ACE levels may be elevated | * [[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]] | |||
| | | | ||
* 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 CT and MRI | |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]] | |||
|- | |- | ||
|Wolfram Syndrome (DIDMOAD) | ![[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD) | ||
| | | | ||
* Diabetes Insipidus | * [[Diabetes insipidus|Diabetes Insipidus]] | ||
* Diabetes Mellitus | * [[Diabetes mellitus|Diabetes Mellitus]] | ||
* Optic Atrophy | * [[Optic atrophy|Optic Atrophy]] | ||
* Deafness | * [[Deafness]] | ||
| | | | ||
* Negative islet cell antibodies | * Negative [[islet cell]] antibodies | ||
* Optic atrophy on electroretinogram | * [[Optic atrophy]] on [[electroretinogram]] | ||
* Deafness on | * [[Deafness]] on [[audiogram]] | ||
* Atrophy of brain stem on MRI | * [[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 | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
| | | | ||
* Urine osmolality <100 mmol/ | * [[Urine osmolality]] <100 mmol/ | ||
* Arginine vasopressin level >4.6 pmol/ | * [[Arginine vasopressin]] level >4.6 pmol/ | ||
* | * Little or no response to administration of exogenous [[arginine vasopressin]] | ||
|- | |- | ||
![[Hypercalcemia]] | |||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Gastrointestinal disturbances | * [[Gastrointestinal]] disturbances | ||
* Pathological fractures | * [[Bone fracture|Pathological fractures]] | ||
* Confusion | * [[Confusion]] | ||
* Palpitations and cardiac arrhythmias | * [[Palpitations]] and [[cardiac arrhythmias]] | ||
| | | | ||
* Ca levels greater than 11 meq/L | |||
|- | |- | ||
![[Hypokalemia]] | |||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Hyporeflexia | * [[Hyporeflexia]] | ||
* Palpitations and cardiac arrhythmias | * [[Palpitations]] and [[cardiac arrhythmias]] | ||
| | | | ||
* K levels less than 3meq/L on CBC | |||
|- | |- | ||
![[Multiple myeloma]] | |||
| | | | ||
* Pathologic bone fractures | * Pathologic [[bone fractures]] | ||
* Bleeding | * [[Bleeding]] | ||
* Hypercalcemia leading to polyuria | * [[Hypercalcemia]] leading to [[polyuria]] | ||
* Infection | * [[Infection]] | ||
* Hyperviscosity | * [[Hyperviscosity]] | ||
* Anemia | * [[Anemia]] | ||
| | | | ||
* [[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]] | |||
|- | |- | ||
|Sickle cell disease | ![[Sickle-cell disease|Sickle cell disease]] | ||
| | | | ||
* Chronic pain | * [[Chronic pain]] | ||
* Anemia | * [[Anemia]] | ||
* Aplastic crisis | * [[Aplastic crisis]] | ||
* Splenic sequestration | * Splenic sequestration | ||
* Infection | * [[Infection]] | ||
* Isosthenuria presenting with polyuria | * [[Isosthenuria]] presenting with [[polyuria]] | ||
| | | | ||
* Hemoglobin level is 5-9 g/dL | * [[Hemoglobin]] level is 5-9 g/dL | ||
* Hematocrit is decreased to 17-29% | * [[Hematocrit]] is decreased to 17-29% | ||
* Peripheral blood smears demonstrate target cells, elongated cells, and characteristic sickle erythrocytes | * [[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 | * 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]] | |||
|- | |- | ||
|Primary polydipsia | ! colspan="2" |Primary polydipsia | ||
![[Psychogenic]] | |||
| | | | ||
* [[Polyuria]] | |||
* [[Polydipsia]] | |||
* Polyuria | * [[Nocturia]] | ||
* Polydipsia | |||
* Nocturia | |||
| | | | ||
* Dry mucus membrane | |||
* History of [[psychiatric disorders]] | |||
|- | |- | ||
! colspan="3" |Gestational diabetes insipidus | |||
|Gestational diabetes insipidus | |||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
* Pregnancy | * [[Pregnancy]] | ||
| | | | ||
* Dry mucus membranes | |||
* [[Pregnancy]] | |||
|- | |- | ||
|Diabetes mellitus | ! colspan="3" |[[Diabetes mellitus]] | ||
| | | | ||
* [[Polyuria]] | |||
* Polyuria | * [[Polydipsia]] | ||
* Polydipsia | * [[Nocturia]] | ||
* Nocturia | * [[Weight gain (patient information)|Weight gain]] | ||
* Weight gain | |||
| | | | ||
* Elevated blood sugar levels >126 | * Elevated blood sugar levels >126 | ||
* Elevated HbA1c > 6.5 | * Elevated [[HbA1c]] > 6.5 | ||
|} | |} | ||
| Line 215: | Line 186: | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[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 |
|
 |
| Craniopharyngioma |
|
 | ||
| Sarcoidosis |
|
 | ||
| Congenital | Hydrocephalus |
|
Dilated ventricles on CT and MRI
 | |
| Wolfram Syndrome (DIDMOAD) |
| |||
| Nephrogenic | Acquired | Drug-induced (demeclocycline, lithium) |
| |
| Hypercalcemia |
| |||
| Hypokalemia |
| |||
| Multiple myeloma |
|
 | ||
| Sickle cell disease |
|
 | ||
| Primary polydipsia | Psychogenic |
| ||
| Gestational diabetes insipidus |
| |||
| Diabetes mellitus |
| |||
References
- ↑ 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.
- ↑ 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.
- ↑ Barrett TG, Bundey SE (1997). "Wolfram (DIDMOAD) syndrome". J Med Genet. 34 (10): 838–41. PMC 1051091. PMID 9350817.
- ↑ 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.