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2016, Number 5

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Rev Mex Pediatr 2016; 83 (5)

Central diabetes insipidus. Case analysis and diagnostic guide

Táquez-Castro CL, Mirón-García J, Olalde-Carmona R

Language: Spanish
References: 25
Page: 163-168
PDF size: 292.18 Kb.


ABSTRACT

Central diabetes insipidus is characterized by a deficiency of antidiuretic hormone, which mainly regulates the ability to concentrate urine, among other functions. Its deficit generates polyuria and hypotonic urine. We present the case of a teenager who debuts with polyuria, polydipsia, progressive symptoms of neurological impairment, in whom tumor of the pineal region is detected. Then he was scheduled for surgery, so the water intake was restricted, but polyuria increased and later he developed hypernatremia, low urine osmolality and increased serum osmolarity. Using our institutional diagnosis algorithm it led to the diagnosis of central diabetes insipidus, so, we increased water intake and intranasal vasopressin (10 µg) was administered. Clinical aspects and laboratory studies subsequently improved. Pathological diagnosis corresponds to a germ cell tumor in the pineal region, this tumor compromises the hypothalamic-pituitary system. The presentation of the institutional algorithm intends to use clinical criteria and few laboratory studies for the diagnosis and treatment of a condition, whose onset, exacerbation and management determine the quality of life of pediatric patients.


REFERENCES

  1. Di Iorgi N, Napoli F, Allegri AE, Olivieri I, Bertelli E, Gallizia A et al. Diabetes insipidus-diagnosis and management. Horm Res Paediatr. 2012; 77(2): 69-84.

  2. Loureiro C, Martínez A, Fernández R, Lizama M, Cattani A, García H. Diabetes insípida en pediatría. Serie clínica y revisión de la literatura. Rev Chil Pediatr. 2009; 80(3): 245-255.

  3. Saifan C, Nasr R, Mehta S, Sharma-Acharya P, Perrera I, Faddoul G et al. Diabetes insipidus: a challenging diagnosis with new drug therapies. ISRN Nephrol. 2013; 2013: 797620.

  4. Bellastella A, Bizzarro A, Colella C, Bellastella G, Sinisi AA, De Bellis A. Subclinical diabetes insipidus. Best Pract Res Clin Endocrinol Metab. 2012; 26(4): 471-483.

  5. Velásquez JC, Campuzano G, Alfaro JM. Diabetes Insípida: generalidades y diagnóstico en pacientes pediátricos. Medicina & Laboratorio. 2013; 19(7-8): 353-379.

  6. Maghnie M. Diabetes insipidus. Horm Res. 2003; 59 Suppl 1: 42-54.

  7. Qureshi S, Galiveeti S, Bichet DG, Roth J. Diabetes insipidus: celebrating a century of vasopressin therapy. Endocrinology. 2014; 155(12): 4605-4621.

  8. Kumar S, Berl T. Sodium. Lancet. 1998; 352(9123): 220-228.

  9. Ball P. Water and life: seeking the solution. Nature. 2005; 436(7054): 1084-1085.

  10. Dantzler WH, Layton AT, Layton HE, Pannabecker TL. Urine-concentrating mechanism in the inner medulla: function of the thin limbs of the loops of Henle. Clin J Am Soc Nephrol. 2014; 9(10): 1781-1789.

  11. Eknoyan G. A history of diabetes insipidus: paving the road to internal water balance. Am J Kidney Dis. 2010; 56(6): 1175-1183.

  12. Kwon TH, Frøkiær J, Nielsen S. Regulation of aquaporin-2 in the kidney: a molecular mechanism of body-water homeostasis. Kidney Res Clin Pract. 2013; 32(3): 96-102.

  13. Day RE, Kitchen P, Owen DS, Bland C, Marshall L, Conner AC et al. Human aquaporins: regulators of transcellular water flow. Biochim Biophys Acta. 2014; 1840(5): 1492-1506.

  14. Sharman A, Low J. Vasopressin and its role in critical care. Contin Educ Anaesth Crit Care Pain. 2008; 8(4): 134-137.

  15. Ikeda M, Matsuzaki T. Regulation of aquaporins by vasopressin in the kidney. Vitam Horm. 2015; 98: 307-37.

  16. Sands JM, Layton HE. Advances in understanding the urine-concentrating mechanism. Annu Rev Physiol. 2014; 76: 387-409.

  17. Wilson JL, Miranda CA, Knepper MA. Vasopressin and the regulation of aquaporin-2. Clin Exp Nephrol. 2013; 17(6): 751-764.

  18. Knepper MA, Kwon TH, Nielsen S. Molecular physiology of water balance. N Engl J Med. 2015; 372(14): 1349-1358.

  19. Ishibashi K, Kondo S, Hara S, Morishita Y. The evolutionary aspects of aquaporin family. Am J Physiol Regul Integr Comp Physiol. 2011; 300(3): R566-R576.

  20. Sands JM, Blount MA, Klein JD. Regulation of renal urea transport by vasopressin. Trans Am Clin Climatol Assoc. 2011; 122: 82-92.

  21. Bothra M, Jain V. Diabetes insipidus in pediatric patients. Indian J Pediatr. 2014; 81(12): 1285-1286.

  22. García EJ. Diabetes insípida. Protoc Diagn Ter Pediatr. 2011; 1(1): 44-53.

  23. Lumbreras J, Amil B. Poliuria y polidipsia. Protoc Diagn Ter Pediatr. 2014; 1: 81-89.

  24. Wong LM, Man SS. Water deprivation test in children with polyuria. J Pediatr Endocrinol Metab. 2012; 25(9-10): 869-874.

  25. Di Iorgi N, Morana G, Napoli F, Allegri AE, Rossi A, Maghnie M. Management of diabetes insipidus and adipsia in the child. Best Pract Res Clin Endocrinol Metab. 2015; 29(3): 415-436.




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