Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- history of pituitary/hypothalamic disease
- family history/genetic mutations
- history of lithium therapy (or certain other drugs)
- history of autoimmune disorders
- polyuria
- increased thirst/polydipsia
Outros fatores diagnósticos
- nocturia
- signs of volume depletion
- nonspecific central nervous system symptoms of hypernatremia
- visual field defects
- endocrine signs
- focal motor deficits
- sensorineural deafness and visual failure
- skin lesions
Fatores de risco
- pituitary surgery
- craniopharyngioma
- pituitary stalk lesions
- traumatic brain injury
- congenital pituitary abnormalities
- use of certain drugs
- hypophysitis
- autoimmune disease
- family history/genetic mutations
- pregnancy
- subarachnoid hemorrhage
- renal sarcoidosis
- renal amyloidosis
- hypercalcemia or hypokalemia
- release of obstructive uropathy
- previous central nervous system infections
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- urine osmolality
- serum osmolality
- serum glucose
- serum sodium
- serum potassium
- serum BUN
- serum calcium
- urine dipstick
- 24-hour urine collection for volume
- water deprivation test
- AVP (desmopressin) stimulation test
- hypertonic saline-stimulated test with measurement of copeptin
Investigações a serem consideradas
- pituitary MRI (contrast-enhanced)
- genetic testing
- antithyroid peroxidase autoantibodies
- serum and cerebrospinal fluid alpha-fetoprotein and beta-human chorionic gonadotropin
- serum growth hormone (GH)
- serum insulin-like growth factor 1 (IGF-1)
- provocative growth hormone (GH) tests
- serum LH
- serum follicle-stimulating hormone
- morning serum testosterone
- serum thyroid-stimulating hormone and triiodothyronine/thyroxine (T3/T4)
- morning serum cortisol and adrenocorticotropic hormone (ACTH)
- cosyntropin stimulation test
- serum prolactin
Algoritmo de tratamento
hypernatremia at any stage
acute arginine vasopressin deficiency (AVP-D)
chronic arginine vasopressin deficiency (AVP-D)
arginine vasopressin resistance (AVP-R)
Colaboradores
Autores
Miles Levy, MBBS, MD, FRCP
Consultant Endocrinologist
University Hospitals of Leicester
Hon. Associate Professor at Leicester University
Leicester
UK
Declarações
Mark Sherlock MB, MRCPI, MD, PhD,
Consultant Endocrinologist
Beaumont Hospital
Professor of Medicine
Royal College of Surgeons in Ireland
Dublin
Ireland
Declarações
MS has received consultancy fees for Ferring (manufacturers of desmopressin).
Agradecimentos
Professor Miles Levy and Professor Mark Sherlock wish to gratefully acknowledge Professor Stephen Ball, a previous contributor to this topic.
Declarações
SB declares that he has no competing interests.
Revisores
Janet Amico, MD
Professor of Medicine
Division of Endocrinology and Metabolism
University of Pittsburgh School of Medicine
Pittsburgh
PA
Declarações
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Christ-Crain M, Bichet DG, Fenske WK, et al. Diabetes insipidus. Nat Rev Dis Primers. 2019 Aug 8;5(1):54. Resumo
Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf). 2019 Jan;90(1):23-30.Texto completo Resumo
Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatr Clin North Am. 2019 Feb;66(1):227-34. Resumo
Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol. 2015 Oct;11(10):576-88. Resumo
Knepper MA, Kwon TH, Nielsen S. Molecular physiology of water balance. N Engl J Med. 2015 Apr 2;372(14):1349-58. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Psychogenic polydipsia
- Diabetes mellitus
- Diuretic use
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