PEDIATRIC SURGERY UPDATE ©

VOLUME 51 NO 02 AUGUST 2018

Diabetes Insipidus

Diabetes insipidus (DI) is a condition that occurs when there is insufficient production of antidiuretic hormone (ADH), also known as vasopressin. ADH is a hormone that helps the kidney and body to conserve the correct amount of water by controlling the output of urine ADH is secreted by the hypothalamus to decrease the amount of urine output so that dehydration does not occur, stored in the pituitary gland and released into the blood. Diabetes insipidus can be of central and nephrogenic origin. Central DI occurs after damage to hypothalamus or pituitary due to head injury, surgery, genetic disorders or brain tumors (craniopharyngioma), while nephrogenic DI is a lack of response of the kidney to normal ADH levels due to drugs, chronic disorders, sickle cell disease or polycystic kidney disease. Most common symptoms of DI are excessive thirst (polydipsia) and urine production (polyuria), inability to concentrate the urine along with hypernatremia, seizures and dehydration. In addition children develop irritability, poor feeding, failure to thrive and fever. DI is diagnosed with history, labs (urine /blood tests), water deprivation test DDAVP trial (which should be done in the hospital) and imaging (MRI/CT Scan), Diabetes insipidus can lead to further brain damage, impaired mental function, intellectual disability, hyperactivity and restlessness. Management of diabetes insipidus depends on the cause of DI. Treatment includes adequate hydration and antidiuretic hormone medication (oral, injection or nasal spray), or medications that stimulate the production of ADH such as Non-steroidal antiinflammatory or chlorpropamide. Depending on the cause of diabetes insipidus the disease can be temporary or permanent. Children with central and nephrogenic diabetes insipidus can lead full healthy lives with proper and monitored management.  

References:
1- Hunter JD, Calikoglu AS: Etiological and clinical characteristics of central diabetes insipidus in
children: a single center experience.Int J Pediatr Endocrinol. 2016;2016:3. doi: 10.1186/s13633-016-0021-y. Epub 2016 Feb 11.
2- Liu W, Wang L, Liu M, Li G: Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus. Int J Endocrinol. 2016;2016:6365830. doi: 10.1155/2016/6365830. Epub 2016 Mar 29.
3- Dabrowski E, Kadakia R, Zimmerman D: Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):317-28. doi: 10.1016/j.beem.2016.02.006. Epub 2016 Feb 27.
4- Elder CJ, Dimitri PJ: Diabetes insipidus and the use of desmopressin in hospitalised children. Arch Dis Child Educ Pract Ed. 102(2):100-104, 2017
5- Bockenhauer D, Bichet DG: Nephrogenic diabetes insipidus. Curr Opin Pediatr. 29(2):199-205, 2017
6- Zhao C, Tella SH, Del Rivero J et al: Anti-PD-L1 Treatment Induced Central Diabetes Insipidus.  J Clin Endocrinol Metab. 103(2):365-369, 2018

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*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
P.O. Box 10426, Caparra Heights Station, San Juan, Puerto Rico 00922-0426
Tel (787)-999-9450 Fax (787)-720-6103 E-mail: TITOLUGO@COQUI.NET
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Pediatric Surgery Update ISSN 1089-7739
Last updated: September 2018