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Adipsia Differential Diagnoses

  • Author: Vikas R Dharnidharka, MD, MPH; Chief Editor: Craig B Langman, MD  more...
 
Updated: Dec 30, 2014
 
 

Diagnostic Considerations

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.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Vikas R Dharnidharka, MD, MPH Associate Professor and Director, Division of Pediatric Nephrology, St Louis Children's Hospital, Washington University in St Louis School of Medicine

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

Disclosure: Received consulting fee from Bristol-Myers-Squibb for consulting; Received honoraria from Genzyme/Sanofi for advising; Received honoraria from American Society of Transplantation for speaking and teaching; Received grant/research funds from Bristol-Myers-Squibb, Novartis and Amgen for site PI on study. for: Bristol-Myers-Squibb; Genzyme-Sanofi; American Society of Transplantation; Novartis; Amgen.

Specialty Editor Board

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, 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, The Ann and Robert H Lurie Children's Hospital of Chicago

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

Disclosure: Received income in an amount equal to or greater than $250 from: Alexion Pharmaceuticals; Raptor Pharmaceuticals; Eli Lilly and Company; Dicerna<br/>Received grant/research funds from NIH for none; Received grant/research funds from Raptor Pharmaceuticals, Inc for none; Received grant/research funds from Alexion Pharmaceuticals, Inc. for none; Received consulting fee from DiCerna Pharmaceutical Inc. for none.

Additional Contributors

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.

References
  1. Verbalis JG, Berl T. Disorders of water balance. 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. 2011 Dec. 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. 2001 Apr. 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. 2007 Jul. 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. 2007 Jan. 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. 1974 Aug. 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. 1976 Dec. 89(6):898-903. [Medline].

  8. Hayek A, Peake GT. Hypothalamic adipsia without demonstrable structural lesion. Pediatrics. 1982 Aug. 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. 2008 May. 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. 2004 Oct. 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. 1983 Dec. 6(6):473-8. [Medline].

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

  14. Christie SB, Ross EJ. Ectopic pinealoma with adipsia and hypernatraemia. Br Med J. 1968 Jun 15. 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. 1974 Nov. 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. 1978 Nov 3. 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. 2003 Apr 5. 152(14):436-8. [Medline].

  18. Johnson AK, Buggy J. Periventricular preoptic-hypothalamus is vital for thirst and normal water economy. Am J Physiol. 1978 Mar. 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. 1991 Mar. 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. 2004 Oct. 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. 1999 Feb. 16:87-8. [Medline].

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

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

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

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

  26. Robertson GL. Abnormalities of thirst regulation. Kidney Int. 1984 Feb. 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. 1985 Nov-Dec. 7(6):893-7. [Medline].

  28. Schaad U, Vassella F, Zuppinger K, Oetliker O. Hypodipsia-hypernatremia syndrome. Helv Paediatr Acta. 1979 Feb. 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. 1982 Aug. 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. 1992 Jun. 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. 1981 Jan. 52(1):9-16. [Medline].

  32. Spiro SG, Jenkins JS. Adipsia and hypothermia after subarachnoid hemorrhage. Br Med J. 1971 Aug 14. 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. 1967 Jun. 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. 1985 Aug. 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. 1987 Jan. 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. 1988 Dec. 35(6):915-24. [Medline].

  37. Crowley RK, Sherlock M, Agha A, Smith D, Thompson CJ. Clinical insights into adipsic diabetes insipidus: a large case series. Clin Endocrinol (Oxf). 2007 Apr. 66(4):475-82. [Medline].

  38. Arima H, Wakabayashi T, Nagatani T, Fujii M, Hirakawa A, Murase T. Adipsia increases risk of death in patients with central diabetes insipidus. Endocr J. 2014. 61(2):143-8. [Medline].

  39. Damm J, Harden LM, Gerstberger R, Roth J, Rummel C. The putative JAK-STAT inhibitor AG490 exacerbates LPS-fever, reduces sickness behavior, and alters the expression of pro- and anti-inflammatory genes in the rat brain. Neuropharmacology. 2013 Aug. 71:98-111. [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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