Differentiating Diabetes insipidus from other diseases: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 44: Line 44:
!Disease
!Disease
!Defining signs and symptoms
!Defining signs and symptoms
!Lab findings
!Lab/Imaging findings
!Treatment
|-
|-
|Central
| rowspan="3" |Central
|Acquired
| rowspan="3" |Acquired
|Histiocytosis
|Histiocytosis
|
|
Line 61: Line 60:
* 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>
* 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)
|-
|-
|
|
|Craniopharyngioma
|Craniopharyngioma
|
|
Line 75: Line 73:
** Growth failure and delayed puberty
** Growth failure and delayed puberty
|
|
|
* Supra)sellar calcified cyst on MRI
*
|-
|-
|
|
|Sarcoidosis
|Sarcoidosis
|
|
Line 92: Line 89:
* Diabetes mellitus
* Diabetes mellitus
|
|
|
* Hypercalcemia
* Hypercalciuria (noncaseating granulomas)
* Elevated alkaline phosphatase
* Serum amyloid A (SAA)
* ACE levels may be elevated
|-
|-
|
| rowspan="2" |
|
| rowspan="2" |Congenital
|Hydrocephalus
|Hydrocephalus
|
|
Line 104: Line 105:
* Unsteady gait
* Unsteady gait
* Incontinence such as polyuria
* Incontinence such as polyuria
|
|Dilated ventricles on CT and MRI
|
|-
|-
|
|Congenital
|AVP-neurophysin gene mutations
|
|
|
|-
|
|
|Wolfram Syndrome (DIDMOAD)
|Wolfram Syndrome (DIDMOAD)
|
|
Line 123: Line 114:
* Deafness
* Deafness
|
|
|
* Negative islet cell antibodies
* Optic atrophy on electroretinogram
* Deafness on audiograms
* Atrophy of brain stem on MRI
|-
|-
|Nephrogenic
| rowspan="5" |Nephrogenic
|Acquired
| rowspan="5" |Acquired
|Drug-induced (demeclocycline, lithium)
|Drug-induced (demeclocycline, lithium)
|
|
Line 133: Line 127:
* Nocturia
* Nocturia
|
|
|
* Urine osmolality <100 mmol/
* Arginine vasopressin level >4.6 pmol/
* little or no response to administration of  exogenous arginine vasopressin
|-
|-
|
|
|Hypercalcemia
|Hypercalcemia
|
|
Line 145: Line 139:
* Confusion
* Confusion
* Palpitations and cardiac arrhythmias
* Palpitations and cardiac arrhythmias
|
|
|
|-
|-
|
|
|Hypokalemia
|Hypokalemia
|
|
Line 156: Line 147:
* Palpitations and cardiac arrhythmias
* Palpitations and cardiac arrhythmias
*  
*  
|
|
|
|-
|-
|
|
|Amyloidosis
|
|
|
|-
|
|
|Multiple myeloma
|Multiple myeloma
|
|
|
* Pathologic bone fractures
* Bleeding
* Hypercalcemia leading to polyuria
* Infection
* Hyperviscosity
* Anemia
|
|
|-
|-
|
|
|Sickle cell disease
|Sickle cell disease
|
|
* 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 smears demonstrate target cells, elongated cells, and characteristic sickle erythrocytes
|Congenital
* MRI can demonstrate avascular necrosis of the femoral and humeral heads
|AVP V2 receptor gene mutations
|
|
|
|-
|
|
|AQP2 water channel gene mutations
|
|
|
|-
|-
|Primary polydipsia
|Primary polydipsia
Line 198: Line 177:
|Psychogenic
|Psychogenic
|
|
|
* Polyuria
* Polydipsia
* Nocturia
|
|
|-
|-
Line 205: Line 186:
|Gestational diabetes insipidus
|Gestational diabetes insipidus
|
|
|
* Polyuria:
* Polydipsia
* Nocturia
* Pregnancy
|
|
|-
|-
Line 212: Line 196:
|
|
|
|
* Polyuria:
* Polydipsia
* Nocturia
* Weight gain
|
|
|
* Elevated blood sugar levels >126
* Elevated HbA1c > 6.5
|-
|-
|
|
|
|
|

Revision as of 19:29, 12 July 2017

Diabetes insipidus Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diabetes insipidus from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

CT scan

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating Diabetes insipidus from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating Diabetes insipidus from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating Diabetes insipidus from other diseases

CDC on Differentiating Diabetes insipidus from other diseases

Differentiating Diabetes insipidus from other diseases in the news

Blogs on Differentiating Diabetes insipidus from other diseases

Directions to Hospitals Treating Diabetes insipidus

Risk calculators and risk factors for Differentiating Diabetes insipidus from other diseases

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 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, 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 [1][2]: Wolfram Syndrome (DIDMOAD) [3]
        • 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
Type of DI Subclass Disease Defining signs and symptoms Lab/Imaging findings
Central Acquired 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[4]
  • CD1a and CD45 +
  • Interleukin-17 (ILITA)
Craniopharyngioma
  • Headache
  • Endocrine dysfunction
    • Diabetes insipidus
    • Hypothyroidism
    • Adrenal failure
    • Diabetes insipidus (eg, excessive fluid intake and urination)
    • Growth failure and delayed puberty
  • Supra)sellar calcified cyst on MRI
Sarcoidosis
  • Systemic complaints
    • Fever
    • Anorexia
    • Arthralgias
  • Pulmonary complaints
    • Dyspnea on exertion
    • Cough
    • Chest pain,
    • Hemoptysis (rare)
  • Diabetes mellitus
  • Hypercalcemia
  • Hypercalciuria (noncaseating granulomas)
  • Elevated alkaline phosphatase
  • Serum amyloid A (SAA)
  • ACE levels may be elevated
Congenital Hydrocephalus
  • Cognitive deterioration
  • Headaches
  • Neck pain
  • Blurred vision
  • Unsteady gait
  • Incontinence such as polyuria
 Dilated ventricles on CT and MRI
Wolfram Syndrome (DIDMOAD)
  • Diabetes Insipidus
  • Diabetes Mellitus
  • Optic Atrophy
  • Deafness
  • Negative islet cell antibodies
  • Optic atrophy on electroretinogram
  • Deafness on audiograms
  • Atrophy of brain stem on MRI
Nephrogenic Acquired Drug-induced (demeclocycline, lithium)
  • Polyuria
  • Polydipsia
  • Nocturia
  • 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
  • Pathological fractures
  • Confusion
  • Palpitations and cardiac arrhythmias
Hypokalemia
  • Polyuria
  • Hyporeflexia
  • Palpitations and cardiac arrhythmias
Multiple myeloma
  • Pathologic bone fractures
  • Bleeding
  • Hypercalcemia leading to polyuria
  • Infection
  • Hyperviscosity
  • Anemia
Sickle cell disease
  • 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 smears demonstrate target cells, elongated cells, and characteristic sickle erythrocytes
  • MRI can demonstrate avascular necrosis of the femoral and humeral heads
Primary polydipsia Psychogenic
  • Polyuria
  • Polydipsia
  • Nocturia
Pregnancy Gestational diabetes insipidus
  • Polyuria:
  • Polydipsia
  • Nocturia
  • Pregnancy
Diabetes mellitus
  • Polyuria:
  • Polydipsia
  • Nocturia
  • Weight gain
  • 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.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Differentiating_Diabetes_insipidus_from_other_diseases&oldid=1325560"