A careful family history is important, not only to identify members of rare kindreds with inherited DI, but also to identify autoimmune endocrine disease, which could suggest autoimmune CDI. It should be further noted that the diagnostic criteria recommended for interpretation of the WDT are based on only 36 patients.With the introduction of the first sensitive and specific radioimmunoassay for AVP in 1973,If the WDT does not produce a firm diagnosis, measurement of the AVP responses during the intravenous infusion of hypertonic (3%‐5%) sodium chloride solution can help to distinguish between CDI and NDI or primary polydipsia.As the technical issues of plasma AVP measurements are substantial, the measurement of plasma copeptin has been proposed as a surrogate for measurement of plasma AVP.
Patients with diabetes insipidus have high amounts of urine that is diluted (clear) because of this inability to control the amount of water in the urine.
In adipsic DI, the demonstration of absent osmoregulated thirst during WDT or hypertonic saline infusion is the gold standard for diagnosis of the condition.Once a diagnosis of CDI is made, MRI imaging of the hypothalamo‐pituitary region is required to establish whether there is a structural lesion which is responsible for AVP deficiency. The differential diagnosis is usually straight forward, but the recommended gold standard test, the water deprivation test, is not without interpretative pitfalls. We report the case of a pituitary stalk germinoma initially misdiagnosed and treated as infundibuloneurohypophysitis (INH). Once the diagnosis of CDI is biochemically certain, investigations to determine the cause of AVP deficiency are needed. © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)
In an adult patient, if the daily urine volume is <2.5 L, no further investigations of osmoregulatory function are required, though urological referral may be indicated.In contrast, an abrupt recent onset of polyuria and polydipsia is characteristic of idiopathic or autoimmune CDI.The clinic plasma sodium concentration can give useful clues to the differential diagnosis. Treatments, triggers & symptoms, from the experiences of 156 diagnosed members.
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Last full review/revision Jul 2019 | Content last modified Aug 2019
In addition, the measurement of thirst ratings can help the differentiation between CDI and primary polydipsia. The assay should be manageable in most reputable laboratories so that it is likely to replace measurement of plasma AVP in routine diagnostic practice.Measurement of thirst, using a simple 10 cm long, unmarked visual analogue scale, has shown in physiological studies that thirst onset occurs at the same osmotic threshold as for AVP secretion.Measurement of thirst is of diagnostic value in two scenarios. A possible INH diagnosis was considered, after excluding other … In addition, if the patient is suspected to have adipsia, an urgent plasma osmolality measurement should be requested prior to water deprivation, to ensure that the test does not commence when the patient is already dehydrated. In clinical practice, it needs to be distinguished from renal resistance to the antidiuretic effects of AVP (nephrogenic DI), and abnormalities of thirst appreciation (primary polydipsia).
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