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Adipsia Workup

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

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.
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Imaging Studies

See the list below:

  • 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.
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Other Tests

See the list below:

  • 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.
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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.

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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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