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Title: Polyuria-polydipsia syndrome: a diagnostic challenge.
Austin Authors: Nigro, Nicole;Grossmann, Mathis ;Chiang, Cherie;Inder, Warrick J
Affiliation: Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Medicine (University of Melbourne)
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
Issue Date: Mar-2018
Publication information: Internal Medicine Journal 2018; 48(3): 244-253
Abstract: The main determinants for the maintenance of water homeostasis are the hormone arginine vasopressin (AVP) and thirst. Disturbances in these regulatory mechanisms can lead to polyuria-polydipsia syndrome, which comprises of three different conditions: central diabetes insipidus (DI) due to insufficient secretion of AVP, nephrogenic DI caused by renal insensitivity to AVP action and primary polydipsia due to excessive fluid intake and consequent physiological suppression of AVP. It is crucial to determine the exact diagnosis because treatment strategies vary substantially. To differentiate between the causes of the polyuria-polydipsia syndrome, a water deprivation test combined with desmopressin administration is the diagnostic 'gold standard'. Thereby, AVP activity is indirectly evaluated through the measurement of urine osmolality after prolonged dehydration. However, this test has several limitations and may fail to distinguish precisely between patients with primary polydipsia and mild forms of central and nephrogenic DI. The direct measurement of AVP during the water deprivation test, which was reported in the 1980s, has not been widely adopted due to availability, assay issues and diagnostic performance. Recently, copeptin, the c-terminal portion of the larger precursor peptide of AVP, has been evaluated in the setting of polyuria-polydipsia syndrome and appears to be a useful candidate biomarker for the differential diagnosis. A standardised method for the water deprivation test is presented as part of a joint initiative of the Endocrine Society of Australia, the Australasian Association of Clinical Biochemists and the Royal College of Pathologists of Australasia to harmonise dynamic endocrine tests across Australia.
DOI: 10.1111/imj.13627
ORCID: 0000-0003-3251-4121
Journal: Internal Medicine Journal
PubMed URL: 28967192
Type: Journal Article
Subjects: copeptin
diabetes insipidus
polyuria-polydipsia syndrome
primary polydipsia
Appears in Collections:Journal articles

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