title: CENTRAL DIABETES INSIPIDUS: CLINICAL CHARACTERISTICS AND LONG-TERM COURSE IN A LARGE COHORT OF ADULTS.
abstract: OBJECTIVE
  Central diabetes insipidus (CDI) is a rare heterogeneous condition with various underlying causes. This study sought to increase the still-limited data on the clinical characteristics and long-term course in adults diagnosed with CDI.
  
  
  METHODS
  Data on demographics, presentation, imaging findings, affected pituitary axes, treatment, and complications were collected retrospectively from the files of 70 adult patients with CDI followed at a referral endocrine clinic.
  
  
  RESULTS
  Forty women and 30 men were included. Mean age was 46.8 ± 15 years at the time of this study and 29.3 ± 20 years at CDI diagnosis. Twenty-eight patients were diagnosed in childhood. Forty patients (57%) acquired CDI following surgery. Main sellar pathologies were: craniopharyngioma, 17 patients (11 diagnosed in childhood); Langerhans histiocytosis, 10 patients (5 diagnosed in childhood); 7 patients (all diagnosed as adults) had a growth hormone-secreting adenoma; 12 patients (17%; 6 diagnosed in childhood) had idiopathic CDI. At least one anterior pituitary axis was affected in 73% of the cohort: 59% had growth hormone deficiency, 56% hypogonadism, 55% central hypothyroidism, 44% adrenocorticotropic hormone-cortisol deficiency. Patients with postoperative/trauma CDI (n = 44) tended to have multiple anterior pituitary axes deficits compared to the nonsurgical group of patients. All patients were treated with vasopressin preparations, mostly nasal spray. Hyponatremia developed in 32 patients, more in women, and was severe (<125 mEq/L) in 10 patients. Hypernatremia (>150 mEq/L) was noticed in 5 patients. Overall, the calculated complication rate was 22 in 1,250 treatment-years.
  
  
  CONCLUSIONS
  Most adult patients with CDI have anterior pituitary dysfunction. Stability is usually achieved with long-term treatment. Women were more susceptible to desmopressin complications, albeit with an overall relatively low complication rate.
  
  
  BACKGROUND
  ACTH = adrenocorticotropic hormone CDI = central diabetes insipidus GH = growth hormone MRI = magnetic resonance imaging.
authors.forename: Hiba
authors.initials: H
authors.lastname: Masri-Iraqi
authors.forename: Dania
authors.initials: D
authors.lastname: Hirsch
authors.forename: Dana
authors.initials: D
authors.lastname: Herzberg
authors.forename: Avner
authors.initials: A
authors.lastname: Lifshitz
authors.forename: Gloria
authors.initials: G
authors.lastname: Tsvetov
authors.forename: Carlos
authors.initials: C
authors.lastname: Benbassat
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020790:Diabetes Insipidus, Neurogenic / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult