Diabetes Insipidus – Diagnosis and Management

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Presentation transcript:

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 1. Schematic representation of AVP biosynthesis. CO = Copeptin; NP = neurophysin. © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 2. Normal MRI findings. a Sagittal T1-weighted image shows normal anterior pituitary (thick arrow), typical posterior pituitary hyperintensity known as ‘bright spot’ (arrowhead), and normal PS (thin arrow). Postcontrast sagittal (b) and coronal (c) T1-weighted images show normal enhancement of the PS (thin arrows) whose thickness does not exceed 3 mm on both planes. The anterior pituitary also enhances (thick arrow, b). © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 3. CDI. a Sagittal T1-weighted image shows absent posterior pituitary hyperintensity, normal anterior pituitary and normal PS size (arrow). Postcontrast sagittal (b) and coronal (c) T1-weighted images show normal thickness of the enhancing PS (arrows). The pituitary gland is also enhancing. © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 4. CDI with thickened stalk. a Sagittal T1-weighted image shows absent posterior pituitary hyperintensity and normal anterior pituitary. b Postcontrast sagittal T1-weighted image shows thickened, enhancing PS (arrow). Coronal T2-weighted (c) and T1-weighted (d) images confirm thickening of the PS (arrows). © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 5. CDI: evolution of findings. a Postcontrast sagittal T1-weighted image shows thickened PS (arrow). Postcontrast sagittal T1-weighted images obtained after 6 (b) and 12 (c) months show progressive reduction in size (arrows). © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 6. LCH with CNS involvement. a Sagittal T1-weighted image shows small anterior pituitary, absent posterior pituitary and thickened PS (arrow). b Postcontrast sagittal T1-weighted image shows enhancement of the thickened PS (thin arrow). Notice normal pineal gland (thick arrow). c Postcontrast sagittal T1-weighted image obtained after 1 year shows normalized size of the PS (thin arrow). The pineal gland has increased in size (thick arrow). d Axial FLAIR image shows ill-defined hyperintensities involving the brainstem and deep cerebellar white matter (arrowheads). © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 7. Germinoma. Sagittal T1-weighted (a) and T2-weighted (b) images show thickened stalk and pituitary gland (arrows). The posterior bright spot is not visible. The optic chiasm is compressed and displaced superiorly (arrowheads, b). c Postcontrast sagittal T1-weighted image shows the pathological tissue extends to the posterior pituitary lobe (arrowheads). The anterior lobe is displaced anteriorly in the pituitary fossa and is visible as an area of more marked enhancement (thick arrow). d Postcontrast coronal T1-weighted image confirms pathological tissue (arrow) causing thickening of the stalk and invading the pituitary fossa. © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 8. Diagnostic flowchart for polyuria-polydipsia (normal ratio: Uosm/Posm >1.5). BW = Body weight; Posm = plasma osmolality; Uosm = urine osmolality. a Laboratory; b confirmatory mainly in partial diabetes insipidus; c primary polydipsia has a different pattern of Na and Posm which did not reach the reported cutoff. © 2012 S. Karger AG, Basel

Diabetes Insipidus – Diagnosis and Management Horm Res Paediatr 2012;77:69–84 - DOI:10.1159/000336333 Fig. 9. Diagnostic flowchart for CDI. PLAP = Placental alkaline phosphatase; PPHS = posterior pituitary hyperintense signal. © 2012 S. Karger AG, Basel