Abstract
Adipsic diabetes insipidus (ADI) is characterised by impaired thirst and defective AVP secretion. We have assessed the thirst response to graded osmotic stimulation using a visual analog scale (VAS) in patients with a history of ADI following surgery for a craniopharyngioma. The patients were thought to be regaining their thirst response but we wanted to confirm that this was the case objectively before relaxing their strict fluid balance regimen. Three patients with adipisa in the presence of hypernatremia following surgery for a craniopharyngioma are described. Their median age at surgery was 13 years (range 11–15 years). All patients had previously demonstrated no desire to drink despite a serum osmolality in excess of 300 mOsmol/kg. Fluid balance was maintained postoperatively with a regimen involving a fixed daily fluid intake and DDAVP dose together with daily weights and regular assessment of capillary sodium concentrations. Patients were thought to be regaining thirst sensation and so were assessed by hypertonic saline infusion (HSI) with thirst measured using a VAS. Patients underwent a HSI test 4, 6 and 9 months post surgery. All had abnormally low AVP production at raised plasma osmolalities but the visual analogue scale confirmed partial or complete thirst recovery. The intensive regimen used to maintain stable serum sodium concentrations was relaxed without the patients subsequently developing a significant hyperosmolar state. We have shown objective recovery of thirst perception in patients with adipsia within 9 months of surgery, despite persistence of cranial diabetes insipidus. These observations indicate that both osmoreceptors regulating thirst and their efferent pathways demonstrate more plasticity than those regulating AVP production. The HSI and thirst VAS are an objective way of assessing patients known to have ADI who are thought to be recovering thirst perception.
Similar content being viewed by others
References
Crowley RK, Sherlock M, Agha A, Smith D, Thompson CJ (2007) Clinical insights into adipsic diabetes insipidus: a large case series. Clin Endocrinol (Oxf) 66(4):475–482
DeVile CJ, Grant DB, Hayward RD, Stanhope R (1996) Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child 75(2):108–114
Ball SG, Vaidja B, Baylis PH (1997) Hypothalamic adipsic syndrome: diagnosis and management. Clin Endocrinol (Oxf) 47(4):405–409
Mohn A, Acerini CL, Cheetham TD, Lightman SL, Dunger DB (1998) Hypertonic saline test for the investigation of posterior pituitary function. Arch Dis Child 79(5):431–434
Rooke P, Baylis PH (1982) A new sensitive radioimmunoassay for plasma arginine vasopressin. J Immunoassay 3(2):115–131
Thompson CJ, Bland J, Burd J, Baylis PH (1986) The osmotic thresholds for thirst and vasopressin release are similar in healthy man. Clin Sci (Lond) 71(6):651–656
Thompson CJ, Edwards CR, Baylis PH (1991) Osmotic and non-osmotic regulation of thirst and vasopressin secretion in patients with compulsive water drinking. Clin Endocrinol (Oxf) 35(3):221–228
Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S, Tinelli C, Gallucci M, Bernasconi S, Boscherini B, Severi F, Arico M (2000) Central diabetes insipidus in children and young adults. N Engl J Med 343(14):998–1007. doi:10.1056/NEJM200010053431403
Smith D, Finucane F, Phillips J, Baylis PH, Finucane J, Tormey W, Thompson CJ (2004) Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma. Clin Endocrinol (Oxf) 61(2):273–279
Smith D, McKenna K, Moore K, Tormey W, Finucane J, Phillips J, Baylis P, Thompson CJ (2002) Baroregulation of vasopressin release in adipsic diabetes insipidus. J Clin Endocrinol Metab 87(10):4564–4568
Baylis PH, Thompson CJ (1988) Osmoregulation of vasopressin secretion and thirst in health and disease. Clin Endocrinol (Oxf) 29(5):549–576
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sinha, A., Ball, S., Jenkins, A. et al. Objective assessment of thirst recovery in patients with adipsic diabetes insipidus. Pituitary 14, 307–311 (2011). https://doi.org/10.1007/s11102-011-0294-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-011-0294-3