Differentiating Diabetes insipidus from other diseases: Difference between revisions

	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

VisualWikitext

Revision as of 14:58, 16 October 2017

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

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 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, 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)
  - 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, Sjogren'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 mellitus

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) 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 dysfunction Diabetes insipidus Hypothyroidism Adrenal failure Diabetes insipidus (e.g., excessive fluid intake and urination) Growth failure and delayed puberty	Suprasellar calcified cyst on MRI 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 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 Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930
	Congenital	Hydrocephalus	Cognitive deterioration Headaches Neck pain Blurred vision Unsteady gait Incontinence such as polyuria	Dilated ventricles on CT and MRI Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453
	Congenital	Wolfram Syndrome (DIDMOAD)	Diabetes Insipidus Diabetes Mellitus Optic Atrophy Deafness	Negative islet cell antibodies Optic atrophy on electroretinogram Deafness on audiogram 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	Ca levels greater than 11 meq/L
		Hypokalemia	Polyuria 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	IgG or IgA spike on serum protein electrophoresis Monoclonal M spike Disordered plasma cell proliferation on bone marrow biopsy 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	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 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	Polyuria Polydipsia Nocturia	Dry mucus membrane History of psychiatric disorders
Gestational diabetes insipidus			Polyuria Polydipsia Nocturia Pregnancy	Dry mucus membranes Pregnancy
Diabetes mellitus			Polyuria Polydipsia Nocturia Weight gain	Elevated blood sugar levels >126 Elevated HbA1c > 6.5

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.

Template:WH Template:WS

[pmid10369876-1] 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.

[pmid19897608-2] 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.

[pmid9350817-3] Barrett TG, Bundey SE (1997). "Wolfram (DIDMOAD) syndrome". J Med Genet. 34 (10): 838–41. PMC 1051091. PMID 9350817.

[pmid1340034-4] 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.

[1]

[2]

[3]

[4]

@@ Line 63: / Line 63: @@
 * 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]]
@@ Line 75: / Line 76: @@
 |
 * [[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]]
@@ Line 94: / Line 96: @@
 * [[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
@@ Line 105: / Line 108: @@
 * [[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]]
 |-
 |[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
@@ Line 161: / Line 165: @@
 * [[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]]
@@ Line 175: / Line 180: @@
 * [[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]]
 |-
 | colspan="2" |Primary polydipsia