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Adipsic diabetes insipidus in pediatric patients
Dominika Malgorzata Janus1, Malgorzata Wojcik, Agata Zygmunt-Górska
1Department of Pediatric Endocrinology, Jagiellonian University, Krakow, Poland, d.janus@wp.pl.
Indian Journal of Pediatrics
|May 3, 2014
Summary
Adipsic diabetes insipidus (aDI) in children often lacks typical thirst and urine symptoms, delaying diagnosis. Close monitoring of fluid intake and electrolytes is crucial to prevent severe complications like deep venous thrombosis.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Neurology
Background:
- Adipsic diabetes insipidus (aDI) is a rare condition characterized by impaired thirst regulation.
- Diagnosis can be delayed due to the absence of classic diabetes insipidus symptoms like polydipsia and polyuria.
- Children with aDI are at risk for severe hypernatremia and dehydration.
Purpose of the Study:
- To describe the clinical presentation, complications, and propose a management protocol for pediatric aDI.
- To highlight the diagnostic challenges and potential severe outcomes in children with aDI.
Main Methods:
- Clinical and biochemical analysis of six pediatric patients (4 boys, 2 girls) with aDI.
- Etiologies included germinoma, optic glioma, astrocytoma, congenital brain malformations, and bacterial meningitis.
- Assessment included serum electrolytes, plasma osmolality, and monitoring for complications.
Main Results:
- All patients exhibited a loss of thirst reflex.
- Markedly elevated serum sodium (159–176.6 mmol/L) and plasma osmolality (>297 mOsmol/kg) were observed.
- Polyuria was absent in severely dehydrated patients; withdrawal of DDAVP led to deep venous thrombosis in two cases.
Conclusions:
- The lack of polydipsia and polyuria in aDI can significantly delay diagnosis, leading to chronic hyperosmolar complications.
- Daily supervision of fluid intake, fluid balance, body weight, and sodium levels is essential for managing pediatric aDI.
- Particular vigilance is required for patients with compromised vision or physical limitations.
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