Adipsia Clinical Presentation

Updated: Dec 13, 2018
  • Author: Vikas R Dharnidharka, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Presentation

History

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  • 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

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  • 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

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  • 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

    • Holoprosencephaly

  • The following can also produce adipsia:

    • Meningoencephalitis

    • Subarachnoid hemorrhage

    • Hydrocephalus

    • Pseudotumor cerebri

    • Psychogenic abnormalities

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