Adipsia Clinical Presentation

  • Author: Vikas R Dharnidharka, MD, MPH; Chief Editor: Craig B Langman, MD   more...
 
Updated: Mar 12, 2012
 

History

  • In most situations, patients with adipsia present with obtundation caused by hypernatremic dehydration.
  • Information regarding the quantity and type of fluid intake may reveal the lack of thirst, pointing to the diagnosis. The presence of an inappropriately high urinary output is highly suggestive of concomitant central diabetes insipidus.
  • A history of brain tumors or congenital malformations suggests the possibility of a hypothalamic lesion.
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Physical

  • No physical signs are specific for adipsia. The most prominent physical signs are referable to alterations in brain water content due to hypernatremia. These alterations include the following:
    • Hyperpnea
    • Muscle weakness
    • Restlessness
    • High-pitched cry
    • Insomnia
    • Lethargy
    • Coma
    • Convulsions (uncommon, except in cases of overly rapid rehydration)
  • Loss of skin turgor and dry mucous membranes are evident but may not be commensurate with the grade of dehydration.
  • Physical signs indicative of an underlying abnormality are often evident. Examples of such physical signs include the following:
    • Cleft palate
    • Other midline facial defects
    • Hydrocephalus
    • A scar from a previous tumor surgery
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Causes

  • Most common neoplastic lesions are germinomas, histiocytomas, and gliomas.
  • Congenital lesions that are associated with adipsia include the following:
    • Microcephaly
    • Ectrodactyly-ectodermal dysplasia-cleft lip/palate (EEC) syndrome
    • Empty sella syndrome
    • Malformation of the septum pellucidum
  • The following can also produce adipsia:
    • Meningoencephalitis
    • Subarachnoid hemorrhage
    • Hydrocephalus
    • Pseudotumor cerebri
    • Psychogenic abnormalities
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Contributor Information and Disclosures
Author

Vikas R Dharnidharka, MD, MPH  Associate Professor and Chief, Division of Pediatric Nephrology, University of Florida Health Science Center-Shands Children's Hospital

Vikas R Dharnidharka, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, and International Pediatric Transplant Association

Disclosure: Bristol-Myers-Squibb Consulting fee Consulting; Genzyme Honoraria Speaking and teaching; American Society of Transplantation Honoraria Speaking and teaching; Chimerix Honoraria Other

Specialty Editor Board

Uri S Alon, MD  Director of Bone and Mineral Disorders Clinic and Renal Research Laboratory, Children's Mercy Hospital of Kansas City; Professor, Department of Pediatrics, Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine

Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Adrian Spitzer, MD  Clinical Professor Emeritus, Department of Pediatrics, Albert Einstein College of Medicine

Adrian Spitzer, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Pediatric Society, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Howard Trachtman, MD  Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine

Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD  The Isaac A Abt, MD, Professor of Kidney Diseases, Northwestern University, The Feinberg School of Medicine; Division Head of Kidney Diseases, Children's Memorial Hospital

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

References

  1. Verbalis JG, Berl T. Disorders of water balance. In: Brenner BM. The Kidney. 8. WB Saunders; 2007:8.

  2. Sinha A, Ball S, Jenkins A, Hale J, Cheetham T. Objective assessment of thirst recovery in patients with adipsic diabetes insipidus. Pituitary. Dec 2011;14(4):307-11. [Medline].

  3. Pal GK, Pal P, Raj SS, Mohan M. Modulation of feeding and drinking behaviour by catecholamines injected into nucleus caudatus in rats. Indian J Physiol Pharmacol. Apr 2001;45(2):172-80. [Medline].

  4. Kang JH, Chang D, Lee YW, Na KJ, Yang MP. Adipsic hypernatremia in a dog with antithyroid antibodies in cerebrospinal fluid and serum. J Vet Med Sci. Jul 2007;69(7):751-4. [Medline].

  5. Weiland TJ, Voudouris NJ, Kent S. CCK(2) receptor nullification attenuates lipopolysaccharide-induced sickness behavior. Am J Physiol Regul Integr Comp Physiol. Jan 2007;292(1):R112-23. [Medline].

  6. Blank MS, Farnsworth PB. Idiopathic symptomatic hypernatremia in a 9-year-old boy: a clinical and physiologic evaluation. J Pediatr. Aug 1974;85(2):215-9. [Medline].

  7. Conley SB, Brocklebank JT, Taylor IT, Robson AM. Recurrent hypernatremia; a proposed mechanism in a patient with absence of thirst and abnormal excretion of water. J Pediatr. Dec 1976;89(6):898-903. [Medline].

  8. Hayek A, Peake GT. Hypothalamic adipsia without demonstrable structural lesion. Pediatrics. Aug 1982;70(2):275-8. [Medline].

  9. Mavrakis AN, Tritos NA. Diabetes insipidus with deficient thirst: report of a patient and review of the literature. Am J Kidney Dis. May 2008;51(5):851-9. [Medline].

  10. Lopez-Capape M, Golmayo L, Lorenzo G, et al. Hypothalamic adipic hypernatraemia syndrome with normal osmoregulation of vasopressin. Eur J Pediatr. Oct 2004;163(10):580-3. [Medline].

  11. [Guideline] Mentes JC. Hydration management. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2004 Feb. [Full Text].

  12. Booth JD, Josse RG, Singer W. Pituitary and hypothalamic dysfunction in a patient with a basal encephalocele. J Endocrinol Invest. Dec 1983;6(6):473-8. [Medline].

  13. Bradley WG, Price DL. Adipsia in association with an arachnoid cyst. Neurology. Sep 1971;21(9):930-6. [Medline].

  14. Christie SB, Ross EJ. Ectopic pinealoma with adipsia and hypernatraemia. Br Med J. Jun 15 1968;2(606):669-70. [Medline].

  15. DeRubertis FR, Michelis MF, Davis BB. "Essential" hypernatremia. Report of three cases and review of the literature. Arch Intern Med. Nov 1974;134(5):889-95. [Medline].

  16. Grossman SP, Dacey D, Halaris AE, et al. Aphagia and adipsia after preferential destruction of nerve cell bodies in hypothalamus. Science. Nov 3 1978;202(4367):537-9. [Medline].

  17. Jeffery ND, Watson PJ, Abramson C, Notenboom A. Brain malformations associated with primary adipsia identified usingmagnetic resonance imaging. Vet Rec. Apr 5 2003;152(14):436-8. [Medline].

  18. Johnson AK, Buggy J. Periventricular preoptic-hypothalamus is vital for thirst and normal water economy. Am J Physiol. Mar 1978;234(3):R122-9. [Medline].

  19. Johnston S, Burgess J, McMillan T, Greenwood R. Management of adipsia by a behavioural modification technique. J Neurol Neurosurg Psychiatry. Mar 1991;54(3):272-4. [Medline].

  20. Lopez-Capape M, Golmayo L, Lorenzo G, Gallego N, Barrio R. Hypothalamic adipic hypernatraemia syndrome with normal osmoregulation of vasopressin. Eur J Pediatr. Oct 2004;163(10):580-3. [Medline].

  21. Macias Batista A, Martinez Martin FJ, de Pablos Velasco PL. [Diabetes insipidus and adipsic hypernatremia in a patient with a craniopharyngioma]. An Med Interna. Feb 1999;16:87-8. [Medline].

  22. Mackay BM, Curtis N. Adipsia and hypernatraemia in a dog with focal hypothalamic granulomatous meningoencephalitis. Aust Vet J. Jan 1999;77(1):14-7. [Medline].

  23. Papadimitriou A, Kipourou K, Manta C, et al. Adipsic hypernatremia syndrome in infancy. J Pediatr Endocrinol Metab. Sep-Oct 1997;10(5):547-50. [Medline].

  24. Phillips MG, Gabow PA. Psychogenic adipsia in a patient with psychotic depression. Am J Kidney Dis. Jun 1990;15(6):592-4. [Medline].

  25. Poll-The BT, Aicardi J. Pseudomonoventricle due to a malformation of the septum pellucidum. Neuropediatrics. Feb 1985;16(1):39-42. [Medline].

  26. Robertson GL. Abnormalities of thirst regulation. Kidney Int. Feb 1984;25(2):460-9. [Medline].

  27. Ronconi GF, Ronconi M, Stella M, et al. [Neurogenic hypernatremia with adipsia and cerebral malformations in a child with ectrodactyly-ectodermal dysplasia-cleft lip-palate syndrome]. Pediatr Med Chir. Nov-Dec 1985;7(6):893-7. [Medline].

  28. Schaad U, Vassella F, Zuppinger K, Oetliker O. Hypodipsia-hypernatremia syndrome. Helv Paediatr Acta. Feb 1979;34(1):63-76. [Medline].

  29. Schallert T. Adipsia produced by lateral hypothalamic lesions: facilitation of recovery by preoperative restriction of water intake. J Comp Physiol Psychol. Aug 1982;96(4):604-14. [Medline].

  30. Silver BV, Stelly-Seitz C. Behavioral treatment of adipsia in a child with hypothalamic injury. Dev Med Child Neurol. Jun 1992;34(6):539-42. [Medline].

  31. Sklar CA, Grumbach MM, Kaplan SL, Conte FA. Hormonal and metabolic abnormalities associated with central nervous system germinoma in children and adolescents and the effect of therapy: report of 10 patients. J Clin Endocrinol Metab. Jan 1981;52(1):9-16. [Medline].

  32. Spiro SG, Jenkins JS. Adipsia and hypothermia after subarachnoid hemorrhage. Br Med J. Aug 14 1971;3(771):411-2. [Medline].

  33. Travis LB, Dodge WF, Waggener JD, Kashemsant C. Defective thirst mechanism secondary to a hypothalamic lesion: studies in a child with adipsia, polyphagia, obesity, and persistent hyperosmolality. J Pediatr. Jun 1967;70(6):915-26. [Medline].

  34. Verdin E, Smitz S, Thibaut A, et al. Adipsic hypernatremia in a patient with pseudotumor cerebri and the primary empty sella syndrome. J Endocrinol Invest. Aug 1985;8(4):369-72. [Medline].

  35. Villadsen AB, Pedersen EB. Recumbent cranial diabetes insipidus. Studies in a patient with adipsia, hypernatremia, poikilothermia and polyphagia. Acta Paediatr Scand. Jan 1987;76(1):179-83. [Medline].

  36. Yamamoto T, Shimizu M, Fukuyama J, Yamaji T. Pathogenesis of extracellular fluid abnormalities of hypothalamic hypodipsia-hypernatremia syndrome. Endocrinol Jpn. Dec 1988;35(6):915-24. [Medline].

 
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Anatomic relationships between pituitary and hypothalamic areas of interest with respect to regulation of antidiuretic hormone (ADH) secretion and thirst sensation. AN = Anterior (hypothalamic) nucleus; AP = Anterior pituitary; OC = optic chiasm; OVLT = Organum vasculosum of lamina terminalis; PA = Preoptic (hypothalamic) area; PP = Posterior pituitary; PVN = Paraventricular (hypothalamic) nucleus; SON = Supraoptic (hypothalamic) nucleus.
 
 
 
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