Persistent hypernatremia secondary to adipsic central diabetes insipidus in a patient with herpes-induced meningoencephalitis and COVID-19 infection: a case report

被引:1
|
作者
Cherchir, Faten [1 ]
Oueslati, Ibtissem [1 ,2 ]
Salhi, Salma [1 ]
Ben Hamida, Asma [1 ]
Yazidi, Meriem [1 ]
Chihaoui, Melika [1 ]
机构
[1] Univ Tunis El Manar, La Rabta Univ Hosp, Fac Med Tunis, Dept Endocrinol, Tunis, Tunisia
[2] Univ Tunis El Manar, La Rabta Univ Hosp, Fac Med Tunis, Dept Endocrinol, Rue Jbal Lakhdhar,Rabta Jabbari, Tunis 1007, Tunisia
关键词
Central diabetes insipidus; adipsia; hypernatremia; desmopressin; hyperosmolarity; COVID-19; infection; herpesvirus-induced meningoencephalitis;
D O I
10.1177/03000605241235747
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Central diabetes insipidus (CDI) typically manifests as a polyuria-polydipsia syndrome, in which normonatremia is generally maintained through the polydipsia. A 53-year-old woman presented with diabetic ketosis and hyperosmolar hyperglycemic syndrome. Her medical history included herpes meningoencephalitis, which was associated with confusion and amnesia. On physical examination, she was apyretic, confused, and had signs of extracellular dehydration. Her capillary glucose concentration was high and her urine was positive for ketones. Laboratory investigations revealed severe hyperglycemia, hypernatremia (plasma hyperosmolarity of 393.6 mOsm/L), and mild acute renal failure. In addition, she had a paucisymptomatic COVID-19 infection. Intravenous rehydration with isotonic saline solution and insulin therapy were effective at controlling the ketosis and ameliorating the hyperglycemia, but failed to normalize the hypernatremia and hyperosmolarity. She was not thirsty and had a urine output of 1 L/day, with urinary hypotonicity. Desmopressin administration reduced the hypernatremia and hyperosmolarity to within their normal ranges, and the patient's urinary osmolarity increased to 743 mOsm/L. Therefore, adipsic CDI was diagnosed. Endocrine investigations revealed isolated central hypothyroidism. The results of pituitary magnetic resonance imaging were normal. Thus, patients with impaired thirst may have an atypical presentation of CDI. In addition, the diagnosis of adipsic CDI is particularly challenging.
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页数:6
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