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}}; {{AE}} {{DAMI}}
{{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 urine frequency, or [[nocturia]]; and [[polydipsia]]. It is important to know that levels of [[Hyponatremia|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]], 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)
***Other disorders ([[hydrocephalus]], ventricular/[[suprasellar]] cyst, [[trauma]], [[degenerative diseases]])
***[[Idiopathic]]
**[[Congenital disorder|Congenital]]
***[[Congenital malformations]]
****[[Autosomal dominant|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|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 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]] (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 mellitus]]'''
{| class="wikitable"
{| class="wikitable"
!Type of DI
!Type of DI
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!Lab/Imaging findings
!Lab/Imaging findings
|-
|-
| rowspan="5" |Central
! rowspan="5" |Central
| rowspan="3" |Acquired
! rowspan="3" |Acquired
|[[Histiocytosis]]
![[Histiocytosis]]
|
|
* Bone lysis and [[Bone fracture|fracture]]
* Bone lysis and [[Bone fracture|fracture]]
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[[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]]
[[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]]
![[Craniopharyngioma]]
|
|
* [[Headache]]
* [[Headache]]
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[[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]]
[[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]]
![[Sarcoidosis]]
|
|
* Systemic complaints
* Systemic complaints
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[[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]]
[[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
! rowspan="2" |Congenital
|[[Hydrocephalus]]
![[Hydrocephalus]]
|
|
* Cognitive deterioration
* Cognitive deterioration
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[[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
[[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|Wolfram Syndrome]] (DIDMOAD)
![[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
|
|
* [[Diabetes insipidus|Diabetes Insipidus]]
* [[Diabetes insipidus|Diabetes Insipidus]]
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* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
|-
|-
| rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
! rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
| rowspan="5" |[[Acquired disorder|Acquired]]
! rowspan="5" |[[Acquired disorder|Acquired]]
|Drug-induced ([[demeclocycline]], [[lithium]])
!Drug-induced ([[demeclocycline]], [[lithium]])
|
|
* [[Polyuria]]
* [[Polyuria]]
Line 134: Line 103:
* Little or no response to administration of  exogenous [[arginine vasopressin]]
* Little or no response to administration of  exogenous [[arginine vasopressin]]
|-
|-
|[[Hypercalcemia]]
![[Hypercalcemia]]
|
|
* [[Polyuria]]
* [[Polyuria]]
Line 145: Line 114:
* Ca levels greater than 11 meq/L
* Ca levels greater than 11 meq/L
|-
|-
|[[Hypokalemia]]
![[Hypokalemia]]
|
|
* [[Polyuria]]
* [[Polyuria]]
Line 153: Line 122:
* K levels less than 3meq/L on CBC
* K levels less than 3meq/L on CBC
|-
|-
|[[Multiple myeloma]]
![[Multiple myeloma]]
|
|
* Pathologic [[bone fractures]]
* Pathologic [[bone fractures]]
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[[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]]
[[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|Sickle cell disease]]
|
|
* [[Chronic pain]]
* [[Chronic pain]]
Line 182: Line 151:
[[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]]
[[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]]
|-
|-
| colspan="2" |Primary polydipsia
! colspan="2" |Primary polydipsia
|[[Psychogenic]]
![[Psychogenic]]
|
|
* [[Polyuria]]
* [[Polyuria]]
Line 192: Line 161:
* History of [[psychiatric disorders]]
* History of [[psychiatric disorders]]
|-
|-
| colspan="3" |Gestational diabetes insipidus
! colspan="3" |Gestational diabetes insipidus
|
|
* [[Polyuria]]  
* [[Polyuria]]  
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* [[Pregnancy]]
* [[Pregnancy]]
|-
|-
| colspan="3" |[[Diabetes mellitus]]
! colspan="3" |[[Diabetes mellitus]]
|
|
* [[Polyuria]]  
* [[Polyuria]]  

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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