eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Adipsia: Differential Diagnoses & Workup

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

Updated: Nov 9, 2009

Differential Diagnoses

Diabetes Insipidus
Hypernatremia

Other Problems to Be Considered

An important variant of primary hypodipsia is the syndrome of essential hypernatremia. An impaired osmotic regulation of aqueous vasopressin (AVP) and thirst characterizes essential hypernatremia; however, AVP synthesis and secretion is intact in response to hemodynamic stimuli. Patients may present with mild stable elevations of serum sodium concentration, consistent with the upward regulation of the osmostats, or with severe fluctuations in serum sodium concentration, consistent with complete loss of osmoregulatory function.

Workup

Laboratory Studies

The following studies are indicated in patients with adipsia:

  • Serum electrolytes, BUN, and serum creatinine levels
    • Suspicion of adipsia frequently results from serum electrolyte abnormalities.
    • Hypernatremia is a hallmark of clinically significant water deficit that may be due to adipsia.
    • Volume depletion that is associated with adipsia also causes elevations in BUN and creatinine levels and an increase in the BUN/creatinine ratio.
  • Serum osmolality: The water deficit results in a markedly elevated serum osmolality.
  • Urine electrolyte levels and osmolality
    • Simultaneous measurements of urine electrolytes and osmolality are critical in determining the central, rather than renal, nature of the defect in water homeostasis.
    • In adipsia, the fractional excretion of sodium is less than 1%, unless a coexisting defect in aqueous vasopressin (AVP) secretion is present.
    • Urine osmolality is very high, unless a coexisting defect in AVP secretion is present.
    • In diabetes insipidus, the concentration of urine is submaximal, even in the face of high serum osmolality. In salt intoxication, the urine sodium concentrations are very high and fractional excretion of sodium is greater than 1%.
    • Difficulties in diagnosis may arise when adipsia and diabetes insipidus coexist. In these patients, initial test results may be suggestive of diabetes insipidus; however, administration of AVP increases urine osmolality and diminishes the tendency for hypernatremia. The patient's history of absence of thirst points toward the coexistence of adipsia.
  • Blood hormone levels
  • AVP levels: In isolated adipsia, circulating AVP levels must be high, reflecting an appropriate response of the pituitary to hyperosmolality. In patients who have defects in thirst regulation and AVP secretion, serum AVP levels are low or absent.
  • Plasma renin and aldosterone levels: These are elevated secondary to hypovolemia.

Imaging Studies

  • Brain imaging studies, such as CT scans and MRI studies, are indicated if the underlying cause for adipsia needs to be determined (eg, empty sella syndrome, tumor). They may also help to rule out complications of hypernatremia, such as intracranial hemorrhage.

Other Tests

  • Therapeutic challenge with intravenous AVP or nasal desmopressin acetate (DDAVP) is often required to confirm or rule out the diagnosis of diabetes insipidus. Perform these tests in consultation with experts in water metabolism.

More on Adipsia

Overview: Adipsia
Differential Diagnoses & Workup: Adipsia
Treatment & Medication: Adipsia
Follow-up: Adipsia
Multimedia: Adipsia
References
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References

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Further Reading

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Keywords

adipsia, adipsy, absence of thirst, hypernatremic dehydration, hypertonic dehydration, hypertonicity, hypodipsia, hypothalamic lesion, water depletion, thirst mechanism, thirst perception, abolition of thirst

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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 Association of Immunologists, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, and Florida Medical Association
Disclosure: Bristol-Myers-Squibb Consulting fee Consulting; Genzyme Honoraria Speaking and teaching; American Society of Transplantation Honoraria Speaking and teaching

Medical Editor

Uri S Alon, MD, Director of Research and Education, Department of Pediatrics, Division of Pediatric Nephrology, Children's Mercy Hospital of Kansas City; Professor, University of Missouri at Kansas City
Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Adrian Spitzer, MD, Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director of NIH Training Program, Children's Hospital at Montefiore Medical Center
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.

CME Editor

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, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
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: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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