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Pituitary and adrenal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
In the non-pregnant, diagnosis is conventionally with a fluid-deprivation test, when the patient is not allowed to drink for 15–22 hours, during which time serial weights, paired urine and plasma osmolalities are measured. Following dehydration and a loss of 3%–5% of body weight, ADH is stimulated and urine concentration occurs in those without DI and in those with psychogenic DI.
Investigation of Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Thozhukat Sathyapalan, Stephen L. Atkin
Except in the rare patient who is clearly dehydrated under basal conditions of ad libitum fluid intake, the evaluation should begin with a fluid deprivation test. The test should be started in the morning and water balance should be monitored closely, with hourly measurements of body weight, plasma osmolarity and/or sodium concentration, and urine volume and osmolarity.
The kidneys
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
The ability to form concentrated urine in response to fluid deprivation depends on normal tubular function (countercurrent multiplication) and on the presence of ADH. Failure of this ability is usually due to renal disease, or cranial diabetes insipidus (see Chapter 2 for discussion of the fluid deprivation test). The investigation of renal tubular acidosis is covered in Chapter 4.
Psychogenic polydipsia associated with sertraline treatment: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2019
Esra Okyar, Leyla Bozatlı, Işık Görker, Serap Okyar
A 12-year-old girl presented to our outpatient clinic with complaints of uncertainty, repetition, checking, symmetry, changing the appearance of hair and clothes more frequently, restlessness, and irritability. It was learned that the complaints of the patient began two years ago and her academic success has decreased and her relationships with family and friends broke down in recent years. Developmental milestones were reached on time. She had no history of seizure, surgery, or systemic disease. There was no known disease in her family history. The patient was diagnosed with OCD according to DSM-5 diagnostic criteria. Sertraline was started at a dose of 25 mg/day and then was gradually increased up to 50 mg/day within a week. The second day of sertraline treatment, the patient started to drink a lot of water. The water intake was 2 liters per day in the past periods, but now it was 19 liters per day. For this reason, she was consulted to the pediatric endocrinology. The patient’s routine examinations showed that only urine specific gravity was slightly decreased, it was 1003. Diabetes insipidus was excluded by the fluid deprivation test. The cranial MRI of the patient was evaluated as normal. After the tests were performed for the organic etiology, she was again directed to us because of PP. Sertraline treatment was discontinued and fluid restriction was recommended. Thus, the patient’s daily water consumption declined to 7–8 liters in two weeks period and to 3.5 liters at the end of the first month. In this period, the outpatient clinic follow-up continued, and medical treatment was not recommended. When the daily water consumption declined to 7 liters, fluoxetine was started at a dose of 10 mg/day and then was gradually increased up to 20 mg/day within a week due to OCD symptoms on admission. It was seen that OCD symptoms improved with this medication, there were no adverse drug effects, the complaint of drinking a lot of water did not maintain, and the daily water consumption was around 2–3 liters. Our case was considered as sertraline associated PP because the complaint of drinking a lot of water developed with the use of sertraline, the organic etiology was excluded by the pediatric endocrinology, and the complaint disappeared with the discontinuation of sertraline treatment.