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Adipsic Diabetes Insipidus in Pediatric Patients

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Abstract

Objective

To present symptoms, complications and proposition of management protocol in children diagnosed with adipsic diabetes insipidus (aDI).

Methods

Clinical and biochemical analysis of six pediatric patients diagnosed with aDI, four boys aged 5, 13, 16, and 17 y and two girls aged 2.5 and 10 y. The etiology of aDI was germinoma (n = 2), extensive surgery due to optic glioma (n = 1) and astrocytoma (n = 1), congenital brain malformations (n = 1) and complications secondary to bacterial meningitis (n = 1). Two patients had severely impaired vision and two had hemiparesis.

Results

In all the patients, loss of thirst reflex was observed. The serum electrolytes in all patients showed sodium concentration from 159 to 176.6 mmol/L with plasma osmolality from above 297 mOsmol/kg. Polyuria was absent in three most severely dehydrated patients on admission. In two patients in whom DDAVP (1-desamino-8-D-arginine vasopressin; Desmopressin) therapy was withdrawn based on lack of polyuria deep venous thrombosis developed.

Conclusions

Lack of polydipsia and polyuria, the key symptoms of diabetes insipidus (DI), may delay the diagnosis of aDI and may lead to severe complications of chronic hyperosmolar status. The fluid intake in patients diagnosed with aDI need to be supervised daily based on calculated constant volume of oral fluids, daily measurements of fluid balance, body weight and sodium levels, especially in patients whose vision is compromised or who are physically unable to take care of themselves.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

LH:

Luteinizing hormone

FSH:

Follicle stimulating hormone

GH:

Growth hormone

TSH:

Thyroid stimulating hormone

DDAVP:

1-desamino-8-D-arginine vasopressin; Desmopressin

AVP:

Arginine vasopressin

DI:

Diabetes insipidus

aDI:

Adipsic diabetes insipidus

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JBS will act as guarantor for this paper.

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, Jagiellonian University, Krakow, Poland

    Dominika Malgorzata Janus, Malgorzata Wojcik, Agata Zygmunt-Górska & Jerzy Bogdan Starzyk

  2. Department of Radiology, University Children Hospital, Krakow, Poland

    Lukasz Wyrobek

  3. Department of Radiology, Jagiellonian University, Krakow, Poland

    Andrzej Urbanik

Authors
  1. Dominika Malgorzata Janus
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  2. Malgorzata Wojcik
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  3. Agata Zygmunt-Górska
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Correspondence to Dominika Malgorzata Janus.

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Janus, D.M., Wojcik, M., Zygmunt-Górska, A. et al. Adipsic Diabetes Insipidus in Pediatric Patients. Indian J Pediatr 81, 1307–1314 (2014). https://doi.org/10.1007/s12098-014-1421-8

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  • DOI: https://doi.org/10.1007/s12098-014-1421-8

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