Diabetes insipidus in Thai children.

ABSTRACT

The medical record of 43 patients who presented with diabetes insipidus (DI) at Endocrine Unit, Department of Pediatric, Siriraj Hospital during 1986-1995 were retrospectively reviewed in order to determine the causes of diabetes insipidus in Thai children. The results demonstrated male to female ratio of 1.91, mean age of 6.1 (4 years. Patients had central diabetes insipidus of 90.7% and remaining 9.3% had nephrogenic diabetes insipidus (P<0.05). The causes of central DI were hematology and oncology disease (28.2%), brain tumor (25.6%), post CNS infection (10.25%) and indiopathic cause (35.8%). Hematology and oncology disease included Langerhan cell histiocytosis (23%), non-Hodgkin lymphoma (2.5%), ALL (2.5%). Brain tumor included germinoma (15%), craniopharygioma (7.5%), astrocytoma (2.5). The results of morning urine and serum osmolarity ratio showed less than 2 in 88% of cases. The remaining 12% had the ratio more than 2 and all patients of this group had organic causes of central DI. A water deprivation test did not demonstrate a difference between organic and non organic causes of central DI. The most common hormone insuffiencies after stimulation test were growth hormone and ACTH. In summary, children who present with central DI need investigations including complete physical examination and investigations for hemato-oncology disease. If there is no hematologic causes, a CT or MRI brain is a further investigation. An anterior pituitary function evaluation is also necessary foe further management.