Approach to the Patient With Suspected Hypotonic Polyuria

Investigation and management of hypotonic polyuria is a common challenge in clinical endocrinology. The 3 main causes, recently renamed to arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus), arginine vasopressin resistance (AVP-R, formerly nephrogenic diabetes insipidus), and primary polydipsia (PP) require accurate diagnosis, as management differs for each. This new nomenclature more accurately reflects pathophysiology and has now been adopted by the Systemized Nomenclature of Medicine (SNOMED). Advances in diagnosis over the last few years have centered around the use of copeptin measurement. Here, we use 3 patient case histories to highlight the use of this approach, and to demonstrate how it can succeed where other approaches, such as the water deprivation test, sometimes fail. We discuss the overall approach to each type of patient and the strengths and limitations of diagnostic strategies, illustrating the use of the new nomenclature.

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Publication Details

Journal
The Journal of Clinical Endocrinology & Metabolism
Published
2024-08-16
DOI
https://doi.org/10.1210/clinem/dgae565
Citations
15
Primary Topic
Electrolyte and hormonal disorders
Type
article
Field-Weighted Citation Impact
6.28
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article

Approach to the Patient With Suspected Hypotonic Polyuria

John Newell‐Price, Juliana Drummond, John Wass, Miles Levy et al.
15 citations
The Journal of Clinical Endocrinology & Metabolism
Electrolyte and hormonal disorders
6.28
article

Approach to the Patient With Suspected Hypotonic Polyuria

John Newell‐Price, Juliana Drummond, John Wass, Miles Levy, Joseph G. Verbalis, Mark Gurnell, Mirjam Christ‐Crain, Deborah Cooper, Ann McCormack
article en
15 citations

Abstract

Investigation and management of hypotonic polyuria is a common challenge in clinical endocrinology. The 3 main causes, recently renamed to arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus), arginine vasopressin resistance (AVP-R, formerly nephrogenic diabetes insipidus), and primary polydipsia (PP) require accurate diagnosis, as management differs for each. This new nomenclature more accurately reflects pathophysiology and has now been adopted by the Systemized Nomenclature of Medicine (SNOMED). Advances in diagnosis over the last few years have centered around the use of copeptin measurement. Here, we use 3 patient case histories to highlight the use of this approach, and to demonstrate how it can succeed where other approaches, such as the water deprivation test, sometimes fail. We discuss the overall approach to each type of patient and the strengths and limitations of diagnostic strategies, illustrating the use of the new nomenclature.

The Journal of Clinical Endocrinology & MetabolismVol. 110(2)
Universidade Federal de Minas Gerais (BR), Garvan Institute of Medical Research (AU), Georgetown University (US), University of Basel (CH), University of Cambridge (GB), University Hospitals Bristol NHS Foundation Trust (GB), Churchill Hospital (GB), University Hospitals of Leicester NHS Trust (GB), University Hospital of Basel (CH), UNSW Sydney (AU), University of Oxford (GB), St Vincent's Hospital Sydney (AU), Hospital Base (CL), Georgetown-Howard Universities Center for Clinical and Translational Science (US), St Vincent's Clinic (AU), Addenbrooke's Hospital (GB), University of Sheffield (GB)
Clean water and sanitation
Openalex Percentile: Top 3%
Electrolyte and hormonal disorders
6.28
DOIOpen Access PDFOpenAlex
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