Differentiating Diabetes insipidus from other diseases: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 3: | Line 3: | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Diabetes insipidus must be differentiated from other diseases that cause polyuria which is defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children, increased frequency or nocturia and polydipsia. It is important to know that levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus. | Diabetes insipidus must be differentiated from other diseases that cause [[polyuria]] which is defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children, increased frequency or [[nocturia]] and [[polydipsia]]. It is important to know that levels of [[Hyponatremia|hypo]] or [[hypernatremia]] is not sufficient to describe the underlying cause of diabetes insipidus. | ||
==Differentiating Diabetes insipidus from other Diseases== | ==Differentiating Diabetes insipidus from other Diseases== | ||
| Line 10: | Line 10: | ||
*'''Central diabetes insipidus''' | *'''Central diabetes insipidus''' | ||
**Acquired | **Acquired | ||
***Trauma (surgery, deceleration injury) | ***[[Trauma]] ([[surgery]], deceleration injury) | ||
***Vascular (cerebral hemorrhage, infarction, anterior communicating artery aneurysm or ligation, | ***[[Vascular]] ([[cerebral hemorrhage]], [[infarction]], [[anterior communicating artery aneurysm]] or [[ligation]], intra-hypothalamic hemorrhage) | ||
***Neoplastic (craniopharyngioma, meningioma, germinoma, pituitary tumor or metastases) | ***[[Neoplastic]] ([[craniopharyngioma]], [[meningioma]], [[germinoma]], [[pituitary tumor]] or [[Metastasis|metastases]]) | ||
***Granulomatous (histiocytosis, sarcoidosis) | ***[[Granulomatous]] ([[histiocytosis]], [[sarcoidosis]]) | ||
***Infectious (meningitis, encephalitis) | ***[[Infectious]] ([[meningitis]], [[encephalitis]]) | ||
***Inflammatory/autoimmune (lymphocytic infundibuloneurohypophysitis) | ***[[Inflammatory]]/[[autoimmune]] (lymphocytic infundibuloneurohypophysitis) | ||
***Drug/toxin-induced (ethanol, diphenylhydantoin, snake venom) | ***[[Drug]]/[[toxin]]-induced ([[ethanol]], [[diphenylhydantoin]], snake venom) | ||
***Other disorders (hydrocephalus, ventricular/suprasellar cyst, trauma, degenerative diseases) | ***Other disorders ([[hydrocephalus]], ventricular/suprasellar cyst, [[trauma]], degenerative diseases) | ||
***Idiopathic | ***[[Idiopathic]] | ||
**Congenital | **[[Congenital disorder|Congenital]] | ||
***Congenital malformations | ***Congenital malformations | ||
****Autosomal dominant: AVP-neurophysin gene mutations | ****[[Autosomal dominant|Autosomal dominant:]] AVP-neurophysin gene mutations | ||
****Autosomal recessive <ref name="pmid10369876">{{cite journal| author=Willcutts MD, Felner E, White PC| title=Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin. | journal=Hum Mol Genet | year= 1999 | volume= 8 | issue= 7 | pages= 1303-7 | pmid=10369876 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10369876 }} </ref><ref name="pmid19897608">{{cite journal| author=Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC et al.| title=Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy. | journal=Eur J Endocrinol | year= 2010 | volume= 162 | issue= 2 | pages= 221-6 | pmid=19897608 | doi=10.1530/EJE-09-0772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19897608 }} </ref> | ****[[Autosomal recessive]] :<ref name="pmid10369876">{{cite journal| author=Willcutts MD, Felner E, White PC| title=Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin. | journal=Hum Mol Genet | year= 1999 | volume= 8 | issue= 7 | pages= 1303-7 | pmid=10369876 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10369876 }} </ref><ref name="pmid19897608">{{cite journal| author=Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC et al.| title=Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy. | journal=Eur J Endocrinol | year= 2010 | volume= 162 | issue= 2 | pages= 221-6 | pmid=19897608 | doi=10.1530/EJE-09-0772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19897608 }} </ref> [[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD) <ref name="pmid9350817">{{cite journal| author=Barrett TG, Bundey SE| title=Wolfram (DIDMOAD) syndrome. | journal=J Med Genet | year= 1997 | volume= 34 | issue= 10 | pages= 838-41 | pmid=9350817 | doi= | pmc=1051091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9350817 }} </ref> | ||
****X-linked recessive | ****[[X-linked recessive]] | ||
***Idiopathic | ***[[Idiopathic]] | ||
*'''Nephrogenic diabetes insipidus''' | *'''Nephrogenic diabetes insipidus''' | ||
**Acquired | **[[Acquired disorder|Acquired]] | ||
***Drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.) | ***Drug-induced ([[demeclocycline]], [[lithium]], [[cisplatin]], [[methoxyflurane]], etc.) | ||
***Hypercalcemia, hypokalemia | ***[[Hypercalcemia]], [[hypokalemia]] | ||
***Infiltrating lesions (sarcoidosis, amyloidosis, multiple myeloma, | ***Infiltrating lesions ([[sarcoidosis]], [[amyloidosis]], [[multiple myeloma]], [[Sjögren's syndrome|Sjogren's disease]]) | ||
***Vascular (sickle cell disease) | ***Vascular ([[Sickle-cell disease|sickle cell disease]]) | ||
**Congenital | **Congenital | ||
***X-linked recessive (OMIM 304800): AVP V2 receptor gene mutations | ***[[X-linked recessive]] (OMIM 304800): AVP V2 receptor gene mutations | ||
***Autosomal recessive: AQP2 water channel gene mutations | ***[[Autosomal recessive]]: AQP2 water channel gene mutations | ||
*'''Primary polydipsia''' | *'''Primary polydipsia''' | ||
**Psychogenic | **[[Psychogenic]] | ||
**Dipsogenic (downward resetting of thirst threshold) | **Dipsogenic (downward resetting of thirst threshold) | ||
*'''Gestational Diabetes insipidus''' | *'''Gestational Diabetes insipidus''' | ||
| Line 48: | Line 48: | ||
| rowspan="3" |Central | | rowspan="3" |Central | ||
| rowspan="3" |Acquired | | rowspan="3" |Acquired | ||
|Histiocytosis | |[[Histiocytosis]] | ||
| | | | ||
* Bone lysis and fracture | * Bone lysis and [[Bone fracture|fracture]] | ||
* Purulent otitis media | * Purulent [[otitis media]] | ||
* Diabetes insipidus and delayed puberty | * [[Diabetes insipidus]] and delayed puberty | ||
* Maxillary, mandibular, and gingival disease | * [[Maxillary]], [[mandibular]], and [[gingival]] disease | ||
* Rash and maculoerythematous skin lesions | * [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions | ||
* Scaly, erythematous scalp patches | * Scaly, [[erythematous]] scalp patches | ||
* Lung involvement | * [[Lung]] involvement | ||
* GI bleeding | * GI bleeding | ||
* Lymph node enlargement<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034 }} </ref> | * [[Lymphadenopathy|Lymph node enlargement]]<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034 }} </ref> | ||
| | | | ||
* CD1a and CD45 + | * CD1a and CD45 + | ||
* Interleukin-17 (ILITA) | * Interleukin-17 (ILITA) | ||
|- | |- | ||
|Craniopharyngioma | |[[Craniopharyngioma]] | ||
| | | | ||
* Headache | * [[Headache]] | ||
* Endocrine dysfunction | * Endocrine dysfunction | ||
** Diabetes insipidus | ** [[Diabetes insipidus]] | ||
** Hypothyroidism | ** [[Hypothyroidism]] | ||
** Adrenal failure | ** [[Adrenal failure]] | ||
** Diabetes insipidus (eg, excessive fluid intake and urination) | ** [[Diabetes insipidus]] (eg, excessive fluid intake and urination) | ||
** Growth failure and delayed puberty | ** Growth failure and delayed puberty | ||
| | | | ||
* | * [[Suprasellar]] calcified cyst on [[MRI]] | ||
|- | |- | ||
|Sarcoidosis | |[[Sarcoidosis]] | ||
| | | | ||
* Systemic complaints | * Systemic complaints | ||
** Fever | ** [[Fever]] | ||
** Anorexia | ** [[Anorexia]] | ||
** Arthralgias | ** [[Arthralgias]] | ||
* Pulmonary complaints | * Pulmonary complaints | ||
** Dyspnea on exertion | ** [[Dyspnea on exertion]] | ||
** Cough | ** [[Cough]] | ||
** Chest pain, | ** Chest pain, | ||
** Hemoptysis (rare) | ** [[Hemoptysis]] (rare) | ||
* Diabetes mellitus | * [[Diabetes mellitus]] | ||
| | | | ||
* Hypercalcemia | * [[Hypercalcemia]] | ||
* Hypercalciuria (noncaseating granulomas) | * [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]]) | ||
* Elevated alkaline phosphatase | * Elevated [[alkaline phosphatase]] | ||
* Serum amyloid A (SAA) | * [[Serum amyloid A]] (SAA) | ||
* ACE levels may be elevated | * [[Angiotensin-converting enzyme|ACE]] levels may be elevated | ||
|- | |- | ||
| rowspan="2" | | | rowspan="2" | | ||
| rowspan="2" |Congenital | | rowspan="2" |Congenital | ||
|Hydrocephalus | |[[Hydrocephalus]] | ||
| | | | ||
* Cognitive deterioration | * Cognitive deterioration | ||
* Headaches | * [[Headaches]] | ||
* Neck pain | * [[Neck pain]] | ||
* Blurred vision | * [[Blurred vision]] | ||
* Unsteady gait | * [[Unsteady gait]] | ||
* Incontinence such as polyuria | * [[Incontinence]] such as [[polyuria]] | ||
|Dilated ventricles on CT and MRI | |Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]] | ||
|- | |- | ||
|Wolfram Syndrome (DIDMOAD) | |[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD) | ||
| | | | ||
* Diabetes Insipidus | * [[Diabetes insipidus|Diabetes Insipidus]] | ||
* Diabetes Mellitus | * [[Diabetes mellitus|Diabetes Mellitus]] | ||
* Optic Atrophy | * [[Optic atrophy|Optic Atrophy]] | ||
* Deafness | * [[Deafness]] | ||
| | | | ||
* Negative islet cell antibodies | * Negative [[islet cell]] antibodies | ||
* Optic atrophy on electroretinogram | * [[Optic atrophy]] on [[electroretinogram]] | ||
* Deafness on | * [[Deafness]] on [[audiogram]] | ||
* Atrophy of brain stem on MRI | * [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]] | ||
|- | |- | ||
| rowspan="5" |Nephrogenic | | rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]] | ||
| rowspan="5" |Acquired | | rowspan="5" |[[Acquired disorder|Acquired]] | ||
|Drug-induced (demeclocycline, lithium) | |Drug-induced ([[demeclocycline]], [[lithium]]) | ||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
| | | | ||
* Urine osmolality <100 mmol/ | * [[Urine osmolality]] <100 mmol/ | ||
* Arginine vasopressin level >4.6 pmol/ | * [[Arginine vasopressin]] level >4.6 pmol/ | ||
* little or no response to administration of exogenous arginine vasopressin | * little or no response to administration of exogenous [[arginine vasopressin]] | ||
|- | |- | ||
|Hypercalcemia | |[[Hypercalcemia]] | ||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Gastrointestinal disturbances | * [[Gastrointestinal]] disturbances | ||
* Pathological fractures | * [[Bone fracture|Pathological fractures]] | ||
* Confusion | * [[Confusion]] | ||
* Palpitations and cardiac arrhythmias | * [[Palpitations]] and [[cardiac arrhythmias]] | ||
| | | | ||
* Ca levels greater than 11 meq/L | * Ca levels greater than 11 meq/L | ||
|- | |- | ||
|Hypokalemia | |[[Hypokalemia]] | ||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Hyporeflexia | * [[Hyporeflexia]] | ||
* Palpitations and cardiac arrhythmias | * [[Palpitations]] and [[cardiac arrhythmias]] | ||
| | | | ||
* K levels less than 3meq/L on CBC | * K levels less than 3meq/L on CBC | ||
| Line 151: | Line 151: | ||
|Multiple myeloma | |Multiple myeloma | ||
| | | | ||
* Pathologic bone fractures | * Pathologic [[bone fractures]] | ||
* Bleeding | * [[Bleeding]] | ||
* Hypercalcemia leading to polyuria | * [[Hypercalcemia]] leading to [[polyuria]] | ||
* Infection | * [[Infection]] | ||
* Hyperviscosity | * [[Hyperviscosity]] | ||
* Anemia | * [[Anemia]] | ||
| | | | ||
* IgG or IgA spike on serum protein electrophoresis | * [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]] | ||
* Monoclonal M spike | * [[Monoclonal antibody|Monoclonal M spike]] | ||
* Disordered plasma cell proliferation on bone marrow biopsy | * Disordered [[plasma cell]] proliferation on [[bone marrow biopsy]] | ||
|- | |- | ||
|Sickle cell disease | |[[Sickle-cell disease|Sickle cell disease]] | ||
| | | | ||
* Chronic pain | * [[Chronic pain]] | ||
* Anemia | * [[Anemia]] | ||
* Aplastic crisis | * [[Aplastic crisis]] | ||
* Splenic sequestration | * Splenic sequestration | ||
* Infection | * [[Infection]] | ||
* Isosthenuria presenting with polyuria | * [[Isosthenuria]] presenting with [[polyuria]] | ||
| | | | ||
* Hemoglobin level is 5-9 g/dL | * [[Hemoglobin]] level is 5-9 g/dL | ||
* Hematocrit is decreased to 17-29% | * [[Hematocrit]] is decreased to 17-29% | ||
* Peripheral blood smears demonstrate target cells, elongated cells, and characteristic sickle erythrocytes | * [[Peripheral blood smear|Peripheral blood smears]] demonstrate [[Target cell|target cells]], elongated cells, and characteristic sickle erythrocytes | ||
* MRI can demonstrate avascular necrosis of the femoral and humeral heads | * MRI can demonstrate [[avascular necrosis]] of the [[femoral]] and [[humeral]] heads | ||
|- | |- | ||
|Primary polydipsia | |Primary polydipsia | ||
| | | | ||
|Psychogenic | |[[Psychogenic]] | ||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
| | | | ||
* Dry mucus membrane | * Dry mucus membrane | ||
* History of psychiatric disorders | * History of [[psychiatric disorders]] | ||
|- | |- | ||
|Pregnancy | |Pregnancy | ||
| Line 191: | Line 191: | ||
|Gestational diabetes insipidus | |Gestational diabetes insipidus | ||
| | | | ||
* Polyuria: | * [[Polyuria]]: | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
* Pregnancy | * [[Pregnancy]] | ||
| | | | ||
* Dry mucus membranes | * Dry mucus membranes | ||
* Pregnancy | * [[Pregnancy]] | ||
|- | |- | ||
|Diabetes mellitus | |[[Diabetes mellitus]] | ||
| | | | ||
| | | | ||
| | | | ||
* Polyuria: | * [[Polyuria]]: | ||
* Polydipsia | * [[Polydipsia]] | ||
* Nocturia | * [[Nocturia]] | ||
* Weight gain | * [[Weight gain (patient information)|Weight gain]] | ||
| | | | ||
* Elevated blood sugar levels >126 | * Elevated blood sugar levels >126 | ||
* Elevated HbA1c > 6.5 | * Elevated [[HbA1c]] > 6.5 | ||
|- | |- | ||
| | | | ||
Revision as of 13:36, 17 July 2017
|
Diabetes insipidus Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Differentiating Diabetes insipidus from other diseases On the Web |
|
American Roentgen Ray Society Images of Differentiating Diabetes insipidus from other diseases |
|
FDA on Differentiating Diabetes insipidus from other diseases |
|
CDC on Differentiating Diabetes insipidus from other diseases |
|
Differentiating Diabetes insipidus from other diseases in the news |
|
Blogs on Differentiating Diabetes insipidus from other diseases |
|
Risk calculators and risk factors for Differentiating Diabetes insipidus from other diseases |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diabetes insipidus must be differentiated from other diseases that cause polyuria which is defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children, increased frequency or nocturia and polydipsia. It is important to know that levels of hypo or hypernatremia is not sufficient to describe the underlying cause of diabetes insipidus.
Differentiating Diabetes insipidus from other Diseases
Differentiating diabetes insipidus based on the type of diabetes insipidus caused
- Central diabetes insipidus
- Acquired
- Trauma (surgery, deceleration injury)
- Vascular (cerebral hemorrhage, infarction, anterior communicating artery aneurysm or ligation, intra-hypothalamic hemorrhage)
- Neoplastic (craniopharyngioma, meningioma, germinoma, pituitary tumor or metastases)
- Granulomatous (histiocytosis, sarcoidosis)
- Infectious (meningitis, encephalitis)
- Inflammatory/autoimmune (lymphocytic infundibuloneurohypophysitis)
- Drug/toxin-induced (ethanol, diphenylhydantoin, snake venom)
- Other disorders (hydrocephalus, ventricular/suprasellar cyst, trauma, degenerative diseases)
- Idiopathic
- Congenital
- Congenital malformations
- Autosomal dominant: AVP-neurophysin gene mutations
- Autosomal recessive :[1][2] Wolfram Syndrome (DIDMOAD) [3]
- X-linked recessive
- Idiopathic
- Congenital malformations
- Acquired
- Nephrogenic diabetes insipidus
- Acquired
- Drug-induced (demeclocycline, lithium, cisplatin, methoxyflurane, etc.)
- Hypercalcemia, hypokalemia
- Infiltrating lesions (sarcoidosis, amyloidosis, multiple myeloma, Sjogren's disease)
- Vascular (sickle cell disease)
- Congenital
- X-linked recessive (OMIM 304800): AVP V2 receptor gene mutations
- Autosomal recessive: AQP2 water channel gene mutations
- Acquired
- Primary polydipsia
- Psychogenic
- Dipsogenic (downward resetting of thirst threshold)
- Gestational Diabetes insipidus
- Diabetes meliitus
| Type of DI | Subclass | Disease | Defining signs and symptoms | Lab/Imaging findings |
|---|---|---|---|---|
| Central | Acquired | Histiocytosis |
|
|
| Craniopharyngioma |
|
| ||
| Sarcoidosis |
|
| ||
| Congenital | Hydrocephalus |
|
Dilated ventricles on CT and MRI | |
| Wolfram Syndrome (DIDMOAD) |
| |||
| Nephrogenic | Acquired | Drug-induced (demeclocycline, lithium) |
| |
| Hypercalcemia |
| |||
| Hypokalemia |
| |||
| Multiple myeloma |
|
| ||
| Sickle cell disease |
|
| ||
| Primary polydipsia | Psychogenic |
| ||
| Pregnancy | Gestational diabetes insipidus |
| ||
| Diabetes mellitus |
| |||
References
- ↑ Willcutts MD, Felner E, White PC (1999). "Autosomal recessive familial neurohypophyseal diabetes insipidus with continued secretion of mutant weakly active vasopressin". Hum Mol Genet. 8 (7): 1303–7. PMID 10369876.
- ↑ Abu Libdeh A, Levy-Khademi F, Abdulhadi-Atwan M, Bosin E, Korner M, White PC; et al. (2010). "Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy". Eur J Endocrinol. 162 (2): 221–6. doi:10.1530/EJE-09-0772. PMID 19897608.
- ↑ Barrett TG, Bundey SE (1997). "Wolfram (DIDMOAD) syndrome". J Med Genet. 34 (10): 838–41. PMC 1051091. PMID 9350817.
- ↑ Ghosh KN, Bhattacharya A (1992). "Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory". Rev Inst Med Trop Sao Paulo. 34 (2): 181–2. PMID 1340034.