Description

Central Diabetes Insipidus (CDI) is a rare condition, affecting approximately 1 in 25,000 people. It has a significant impact on the patient’s health and well-being and usually requires long-term care. Evidence regarding the care of patients with this condition is fragmented. You need to increase your knowledge of various patient care challenges and identify opportunities for improvement. CDI is characterized by hypotonic polyuria and polydipsia resulting from decreased levels of arginine vasopressin, also known as antidiuretic hormone. Other symptoms include fatigue, dizziness, hypotension, and tachycardia associated with dehydration and hypernatremia that are a direct result of CDI. Severe dehydration is especially difficult for young children who may not yet be able to regulate their thirst on their own. , failure to thrive, and may experience developmental disorders due to repeated episodes of dehydration and hypernatremia.

The disease is caused by damage to her AVP-producing magnocellular neurons in the hypothalamus. The degree of AVP deficiency is a major factor in determining the severity of CDI symptoms. Damage to this brain region can result from either traumatic or non-traumatic injury, for example, in response to tumors, infiltration, infection or inflammation, or in rare cases in response to genetic mutations. The genotype of CDI appears early in life, whereas the acquired form can appear at any age. CDI shows similar prevalence in men and women. The patient’s quality of life is often compromised by the disease, for example by sleep disturbances caused by nocturia. In the most severe cases, there is also a risk of death due to chronic or severe dehydration, hypernatremia, fever, and cardiovascular disease due to impaired blood pressure regulation. Adypsia may increase the risk of death. An intact thirst mechanism is important in CDI patients to protect against hypernatremia and dehydration.

CDI is one of the conditions associated with polyuria and polydipsia, along with nephrogenic diabetes insipidus, primary polydipsia, and gestational diabetes insipidus. Once diagnosed, treatment of CDI is generally effective, with desmopressin being used as the main treatment to help regulate fluid levels in the body. However, identifying and correctly diagnosing patients and persuading them to receive appropriate treatment can be difficult. Optimizing dosage and treatment regimens to ensure personalized care is also challenging. Additionally, including when treating her CDI with other comorbidities, particularly corticotropic hormone deficiency, it can be difficult to ensure that a patient’s treatment remains stable over time. In addition, the lifelong treatment that CDI patients often require places great demands on the healthcare system for on-going management and monitoring. In children and adults, a battery of tests is used to diagnose her CDI, confirm polyuria and polydipsia, and try to understand the underlying cause. Investigation usually follows a logical sequence of history and examination, followed by biochemical and endocrine evaluation, followed by radiology.

The approach to diagnosis is similar across the various medical facilities covered in this article. In countries where primary care is generally the first point of entry into health care, patients with CDI are usually the first to see a primary care physician presenting with symptoms such as dehydration, thirst and frequent urination. Magnetic resonance imaging (MRI) is essential to identify possible causes of CDI. For example, it can indicate thickening of the pituitary stalk.

Acknowledgement

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Conflict of Interest

The author has nothing to disclose and also state no conflict of interest in the submission of this manuscript.