Differentiating Diabetes insipidus from other diseases: Difference between revisions
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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 diabetes insipidus can be differentaited in several ways, 2 of which are described below. Levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus. | 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 diabetes insipidus can be differentaited in several ways, 2 of which are described below. Levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus. | ||
==Differentiating Diabetes insipidus from other Diseases== | ==Differentiating Diabetes insipidus from other Diseases== | ||
Differentiating diabetes insipidus based on the type of diabetes insipidus caused | |||
*Central diabetes insipidus | === Differentiating diabetes insipidus based on the type of diabetes insipidus caused === | ||
*'''Central diabetes insipidus''' | |||
**Acquired | **Acquired | ||
***Trauma (surgery, deceleration injury) | ***Trauma (surgery, deceleration injury) | ||
| Line 24: | Line 25: | ||
****X-linked recessive | ****X-linked recessive | ||
***Idiopathic | ***Idiopathic | ||
*Nephrogenic diabetes insipidus | *'''Nephrogenic diabetes insipidus''' | ||
**Acquired | **Acquired | ||
***Drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.) | ***Drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.) | ||
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***X-linked recessive (OMIM 304800): AVP V2 receptor gene mutations | ***X-linked recessive (OMIM 304800): AVP V2 receptor gene mutations | ||
***Autosomal recessive: AQP2 water channel gene mutations | ***Autosomal recessive: AQP2 water channel gene mutations | ||
*Primary polydipsia | *'''Primary polydipsia''' | ||
**Psychogenic | **Psychogenic | ||
**Dipsogenic (downward resetting of thirst threshold) | **Dipsogenic (downward resetting of thirst threshold) | ||
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**Pregnancy | **Pregnancy | ||
Differentiating Diabetes insipidus based on the levels of ADH and the response of the body to the level of hyponatremia | === Differentiating Diabetes insipidus based on the levels of ADH and the response of the body to the level of hyponatremia === | ||
*'''Disorders in which ADH levels are elevated'''<ref name="pmid25078421">{{cite journal| author=Danziger J, Zeidel ML| title=Osmotic homeostasis. | journal=Clin J Am Soc Nephrol | year= 2015 | volume= 10 | issue= 5 | pages= 852-62 | pmid=25078421 | doi=10.2215/CJN.10741013 | pmc=4422250 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25078421 }} </ref> | *'''Disorders in which ADH levels are elevated'''<ref name="pmid25078421">{{cite journal| author=Danziger J, Zeidel ML| title=Osmotic homeostasis. | journal=Clin J Am Soc Nephrol | year= 2015 | volume= 10 | issue= 5 | pages= 852-62 | pmid=25078421 | doi=10.2215/CJN.10741013 | pmc=4422250 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25078421 }} </ref> | ||
**Reduced effective arterial blood volume | **Reduced effective arterial blood volume | ||
Revision as of 18:35, 11 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 diabetes insipidus can be differentaited in several ways, 2 of which are described below. Levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus.
Differentiating Diabetes insipidus from other Diseases
Differentiating diabetes insipidus based on the type of diabetes insipidus caused
- Central diabetes insipidus
- Acquired
- Trauma (surgery, deceleration injury)
- Vascular (cerebral hemorrhage, infarctionanterior 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
- Acquired
- 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
- Acquired
- Primary polydipsia
- Psychogenic
- Dipsogenic (downward resetting of thirst threshold)
- Increased AVP metabolism
- Pregnancy
Differentiating Diabetes insipidus based on the levels of ADH and the response of the body to the level of hyponatremia
- Disorders in which ADH levels are elevated[4]
- Reduced effective arterial blood volume
- True volume depletion
- Heart failure
- Cirrhosis
- Syndrome of inappropriate ADH secretion, including reset osmostat pattern
- Hormonal changes
- Adrenal insufficiency
- Hypothyroidism
- Pregnancy
- Reduced effective arterial blood volume
- Disorders in which ADH levels may be appropriately suppressed[5]
- Advanced renal failure
- Primary polydipsia
- Beer drinker's potomania
- Hyponatremia with normal or elevated plasma osmolality[6]
- High plasma osmolality (effective osmols)
- Hyperglycemia
- Mannitol
- High plasma osmolality (ineffective osmols)
- Renal failure
- Alcohol intoxication with an elevated serum alcohol concentration
- Normal plasma osmolality
- Pseudohyponatremia (laboratory artifact)
- High triglycerides
- Cholestatic and obstructive jaundice (lipoprotein-X)
- Multiple myeloma
- Absorption of irrigant solutions
- Glycine
- Sorbitol
- Mannitol
- Pseudohyponatremia (laboratory artifact)
- High plasma osmolality (effective osmols)
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.
- ↑ Danziger J, Zeidel ML (2015). "Osmotic homeostasis". Clin J Am Soc Nephrol. 10 (5): 852–62. doi:10.2215/CJN.10741013. PMC 4422250. PMID 25078421.
- ↑ Sterns RH (2015). "Disorders of plasma sodium--causes, consequences, and correction". N Engl J Med. 372 (1): 55–65. doi:10.1056/NEJMra1404489. PMID 25551526.
- ↑ Fenske WK, Christ-Crain M, Hörning A, Simet J, Szinnai G, Fassnacht M; et al. (2014). "A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis". J Am Soc Nephrol. 25 (10): 2376–83. doi:10.1681/ASN.2013080895. PMC 4178436. PMID 24722436.