Anterior pituitary dysfunction common among adults with central diabetes insipidus
Nearly three quarters of adults with central diabetes insipidus had anterior pituitary dysfunction, with a fairly low incidence of serious complications, according to researchers in Israel.
“[Central diabetes insipidus] can be accompanied by anterior pituitary hormone deficiency as a result of surgery, trauma, systemic disease, or infiltration of the stalk and/or pituitary gland,” Hiba Masri-Iraqi, MD, of the Endocrine Institute at Rabin Medical Center–Beilinson Hospital, Petach Tikva, Israel, and colleagues wrote. “Rates of at least one anterior pituitary hormone deficit ranged from 53% to 80% in different studies. Most patients with [central diabetes insipidus] are treated with vasopressin analogue. … However, there are no official guidelines addressing the specific method of treatment or dosing, and data on treatment safety, particularly in terms of hypernatremia and hyponatremia, are sparse.”
Masri-Iraqi and colleagues gathered data on presentation, demographics, imaging findings, treatment, affected pituitary axes and complications from records of 70 adults with central diabetes insipidus. Forty patients were women, and mean age at the time of study was 46.8 years (29.3 years at time of diagnosis). Twenty-eight patients were diagnosed before age 20 years, while 40 (57%) acquired the condition after surgery.
Researchers reported that common sellar pathologies included craniopharyngioma (n = 17; 11 diagnosed in childhood), Langerhans histiocytosis (n = 10; 5 diagnosed in childhood), growth-hormone-secreting adenoma (n = 7; all diagnosed as adults) and idiopathic central diabetes insipidus (n = 12; 6 diagnosed in childhood).
Researchers reported that 73% had at least one affected anterior pituitary axis: 44% had ACTH-cortisol deficiency, 55% had central hypothyroidism, 56% had hypogonadism and 59% had GH deficiency. Patients with postoperative central diabetes insipidus were more likely to have multiple anterior pituitary axis deficits than those with nonsurgery-related central diabetes insipidus.
Thirty-two patients developed hyponatremia, most of whom were women (n = 23), and 10 of whom had severe hyponatremia. Five patients developed hypernatremia. The overall annual incidence rate for serious complications was 1.8%, Masri-Iraqi and colleagues reported.
Researchers acknowledged that the study was limited by its retrospective design.
“To conclude, the etiology of central diabetes differs between adults and children,” the researchers wrote. “Most adult patients with central diabetes insipidus have a concurrent anterior pituitary hormone deficiency. Patients usually remain stable on long-term treatment, and the rate of serious complications is relatively low.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.