Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • history of pituitary/hypothalamic disease
  • family history/genetic mutations
  • history of lithium therapy
  • history of autoimmune disorders
  • polyuria
  • increased thirst/polydipsia

Other diagnostic factors

  • nocturia
  • nonspecific CNS symptoms of hypernatremia
  • signs of volume depletion
  • muscle twitching
  • hyperthermia
  • visual field defects
  • focal motor deficits
  • sensorineural deafness
  • skin rash

Risk factors

  • pituitary surgery
  • craniopharyngioma
  • pituitary stalk lesions
  • traumatic brain injury
  • congenital pituitary abnormalities
  • medication
  • autoimmune disease
  • Wolfram syndrome
  • family history/genetic mutations
  • pregnancy
  • cerebrovascular accident
  • sickle cell anemia
  • renal sarcoidosis
  • renal amyloidosis
  • poorly controlled diabetes mellitus
  • chronic hypercalcemia or hypokalemia
  • protein malnutrition
  • previous release of ureteric obstruction
  • previous CNS infections

Diagnostic investigations

1st investigations to order

  • urine osmolality
  • serum osmolality
  • serum sodium
  • serum calcium
  • serum potassium
  • urine dipstick
  • 24-hour urine collection for volume
  • serum BUN
  • serum glucose
Full details

Investigations to consider

  • water deprivation test
  • AVP (desmopressin) stimulation test
  • 3% hypertonic saline infusion test
  • MRI (contrast enhanced)
  • serum TSH and free T4
  • antithyroid peroxidase autoantibodies
  • genetic studies
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Endocrinologist

Adelaide and Meath Hospitals Dublin

Department of Endocrinology

Trinity College Dublin

Dublin

Ireland

Disclosures

MS declares that he has no competing interests.

Professor of Medicine

University of Leeds

Leeds

UK

Disclosures

PMS declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Division of Endocrinology and Metabolism

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

At the time of peer review, JA received research grants from the National Institutes of Health, the Department of Veterans' Affairs, and the Department of Defense. We were made aware that Professor Amico is now deceased.

Professor of Endocrinology

Department of Endocrinology

Beaumont Hospital

Dublin

Ireland

Disclosures

CT declares that he has no competing interests.

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